September 2013. It was my first time at the ACC Legislative Conference in Washington, DC. There were nearly 400 ACC members in attendance. I remember being amazed at the number of physicians, fellows-in-training (FITs) and cardiovascular team members who had traveled there for an advocacy meeting.

For the first two days, we listened to a series of talks that included a review of ACC's Strategic Plan, an overview of current cardiovascular health care policies, the relevance of clinical data registries, the In-Office Ancillary Services Exemption, and the need to permanently repeal and replace the sustainable growth rate formula for Medicare physician payments.

It was fun. I networked with other FITs, volunteered as a reporter for the FITs-on-the-Go blog interviews, and listened to Bob Woodward at the ACC-organized dinner benefitting the ACC's Political Action Committee (now HeartPAC). On the third day, as we traveled from our Georgetown hotel to Capitol Hill, it suddenly dawned on me that I was truly going to meet with U.S. lawmakers and speak out on cardiovascular health care policies and legislation.

What if I said the wrong thing? Or jumbled up the names of the Senate bills or the House of Representative bills?

I wondered if it might be best to let the "seasoned" advocates among our group make the speeches, while I watched and learned. However, Christopher J. Cooper, MD, FACC, my ACC Ohio Chapter Governor, was of a different persuasion. He believed in active learning via participation by all and rotating roles. All of us on the ACC-Ohio team were delegated talking points and roles for our visits with our lawmakers.

Our ACC-Ohio Legislative Conference team comprised FITs, early career physicians, advanced practice providers, and mid-to-late career cardiologists. Our governor stressed the importance of utilizing the strengths and diversity of our health care team in making our presentations to our national lawmakers.

A couple hours later, I found myself talking to a congressional staffer about the impact of health care policies on my postgraduate medical education clinical experience. It wasn't perfect, it was nerve-racking, but I'd done it – my first presentation to a congressional staffer, and I was pleased. I was a team player who had contributed her voice and physical presence to advocate for cardiovascular health on Capitol Hill.

What is the ACC Legislative Conference?

The ACC Legislative Conference is an annual three-day meeting hosted by the College in Washington, DC. The primary goal of the conference is to educate ACC members on health care policies that affect cardiovascular care and provide attendees with an opportunity to discuss cardiovascular health care policies with congressional leaders on Capitol Hill.

The schedule of activities during this conference usually includes two days of lectures and break-out sessions, advocacy reports from state chapters, networking sessions with ACC leadership, and an evening guest lecture focused on providing participants with an insider's perspective on the political landscape. The final day of the conference is dedicated to a series of face-to-face meetings with U.S. lawmakers on Capitol Hill.

This year, the structure and the content will be the same. But the delivery will be virtual, because of the COVID-19 pandemic. Even still, from October 4 to 6, all attendees of ACC's Legislative Conference will hear from health care policy experts and have an opportunity to virtually interact with congressional leaders and/or their staff.

How Does the College Support CV Advocacy?

Advocacy on behalf of patients with cardiovascular disease and of cardiovascular professionals is an integral part of ACC's strategic goals. Support for advocacy is provided by the ACC at all levels of the College – local, state and national. Several committees and task forces focus on this advocacy mission. The Health Affairs Committee (HAC) helps to establish ACC's advocacy priorities, develop ACC's policy positions and construct frameworks for policy execution.

There are five ACC staff advocacy teams that work with the HAC to implement the ACC's advocacy strategic goals. These staff teams are Congressional Affairs, Medicare Payment and Coverage, State Government Relations, Payer and Care Delivery Policy, and Research and Innovation policy.

ACC's HeartPAC is a nonpartisan, member driven unit that helps to amplify the voices of U.S. ACC members and staff on Capitol Hill, for the purpose of protecting, promoting and transforming cardiovascular health care delivery. Funding for HeartPAC is voluntary and separate from ACC membership dues.

All funds donated to the HeartPAC are used to support federal political candidates who serve on committees or have relationships with members who impact cardiovascular care. Other ACC committees which work closely with the HAC include the Coding Task Force, Partners in Quality Subcommittee and the Population Health Management Task Force.

There is a lot to celebrate regarding the advocacy activities of the College during COVID-19. In the area of telemedicine/telehealth, the ACC partnered with the American College of Physicians (ACP) to publish a joint statement regarding the need for increased access to telehealth to combat community spread of SARS-CoV-2. The ACC worked with U.S. lawmakers to ensure increased access to telehealth was secured in the initial COVID-19 emergency funding package passed by Congress.

The ACC and the ACP also requested flexibility and a waiver of telemedicine rules. These advocacy requests led to expanded flexibility and waivers by the Centers for Medicare and Medicaid Services (CMS) and increased reimbursement for telephone clinic visits. ACC's advocacy team worked with CMS and other stakeholders regarding the waiver of prior authorizations during the COVID-19 emergency.

CMS listened, and subsequently issued guidance for the waiver/relaxation of prior authorization requirements for Medicare Advantage plans during the COVID-19 emergency.

The Washington expression "if you are not at the table, you're on the menu" is an important factor to remember when weighing the importance of ACC's participation in health care advocacy.

Attendance at the annual ACC Legislative Conference has steadily increased over the past six years. Last year, 505 attendees, including 94 FITs, made the 2019 Legislative Conference attendance the largest ever for this meeting. This trend reflects the relevance ACC members have placed on collaborating with our lawmakers to improve cardiovascular health.

Start at your local institution and community, and ask, "how can I advocate for improved cardiovascular care?" Cardiovascular advocacy can range from providing recommendations to relevant cardiovascular/quality committees at your health care institution, providing community talks/lectures geared toward improving population health or participating in advocacy in your ACC state chapter.

Another way to get involved is to host a legislator at your practice. This is a great opportunity to develop relationships with your local legislators, providing them with an opportunity to visit your health care practice and a first-hand experience with the daily routine of cardiovascular health care.

My experience at the 2013 ACC Legislative Conference left an indelible mark. I have attended five Legislative Conferences since then, hosted three local U.S. legislator visits, and I plan to attend the ACC 2020 Virtual Legislative Conference. As we individually and collectively advocate for the cardiovascular patient and cardiovascular health care, we will ultimately make a difference.

I look forward to seeing you (virtually) at the 2020 ACC Legislative Conference.

Clinical Topics: COVID-19 Hub

Keywords: ACC Publications, Cardiology Magazine, Medicare, Problem-Based Learning, Physicians, Government, Persuasive Communication, Health Policy, Patient Care Team, Registries, COVID-19, severe acute respiratory syndrome coronavirus 2, Coronavirus, Pandemics, Medicaid, Delivery of Health Care, Leadership, Consultants, Cardiovascular Diseases, Prior Authorization, Centers for Medicare and Medicaid Services, U.S., Education, Medical, State Government, Goals, Legislative Conference, ACC Advocacy

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