April 19, 2017 | Thad Waites, MD, FACC
Education

Aaron Kithcart, MD, PhD, and Sandeep Krishnan, MD, recently sat down with Thad Waites, MD, FACC, chair of ACC's Health Affairs Committee (HAC) and a leading voice in the ACC, to get his thoughts on advocacy and learn about his journey to becoming an advocate for the ACC.

How did you first get involved in advocacy?

TW: My first advocacy effort was through the American Legion Boys State in Mississippi just before my senior year in high school. I supported some friends running for office and myself managed to be elected to be Superintendent of Education for the state of MS for a day. My mother and father were teachers, and my father had run for superintendent of our county school district, so advocacy was a natural part of my life from a young age.

I then had a long hiatus during my medical training, military tenure, and very busy clinical practice and resumed advocacy efforts when I was elected president of the ACC Mississippi Chapter. As the governor of the Mississippi Chapter, I began to learn more about advocacy at both the state and national levels. Then, as chair of ACC's Board of Governors (BOG), my involvement and study of the political process grew exponentially. Finally, as a past-chair of the BOG, I was ex-officio on the Advocacy (now Health Affairs) Committee and found myself hooked in the exciting world of advocacy. Since that time, I have been the chair of the HAC and have worked very closely with our ACC staff. From my many years of experience with a number of associations, I must state that no organization has a better advocacy staff than the ACC.

How does advocacy affect Fellows in Training (FITs) and their future careers? Why is it important for FITs to get involved in advocacy?

TW: I'll answer by asking if the following affect FITs and their budding careers: the Affordable Care Act (ACA), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), relative value units (RVUs), electronic health records (EHRs), maintenance of certification (MOC), the appropriate use criteria (AUC) or Advanced Imaging Mandate, and several other acronyms and initialisms that are out there just waiting to encroach upon the sacred interaction between patient and physician. Since "Yes" is the answer, I encourage you to become fully involved. It is our First Amendment right and responsibility to speak out, and we must.

How can FITs get involved in the advocacy process?

TW: The easiest way to get involved is to attend the annual ACC Legislative Conference held every fall in Washington, DC. There are many opportunities through both your state chapter and the national ACC for travel grants to support your trip to Capitol Hill in the fall. Once there you can network, learn about advocacy and visit the Hill. Get involved with your state chapter and reach out to the ACC staff who focus on State Advocacy. Within the nominating process during the fall, apply for any of the numerous positions within the ACC that include advocacy needs. This would include all member sections, various work groups and task forces, and steering committees of the councils. Apply for the Emerging Advocates Program, which provides advocacy education to a small group of ACC members who do not have previous advocacy experience. Also, apply for the HAC itself; we currently have two FITs, as well as an Early Career member, amongst our ranks.

From an advocacy standpoint, what do you worry about? What keeps you up at night?

TW: We have a very complex legislative process. And, our very complex health care system was built over the years by the accretion of more and more regulation and complexity. I would like for our country to have the best health care system possible: a system that achieves the ACC's triple aim of lowering costs, improving outcomes and improving the health of the populace. That will be difficult but we will never achieve it without constant advocacy for our patients.

If you could change anything about the current health care law, what would that be and why? How do you feel that the ACA could realistically be improved in this current political climate?

TW: I would like to reach out to my "Lifeline" on this one. I can't succinctly answer these questions. However, I do want to say that the country has had an evolution over the last several years, and now no longer debates whether health care is a right. That's a healthy evolution, in my opinion. Our ACC Principles of Healthcare Reform state what we would like to achieve in the ACA or changes to the ACA, or any other legislative law that might be passed.

Do you think that this Congress will target MACRA for repeal? Is there anything that FITs should do to get ready for MACRA implementation?

MACRA and its Quality Payment Program is the law and repeal is not on the agenda. It was passed by a very strong bipartisan vote and the supporters of it are largely still in Congress. The basis of it is a transition [from volume to value] that the ACC has advocated for over several years. It's another question as to whether we got more complexity than we bargained for. There isn't a whole lot that an individual FIT or other clinician can do to implement it, as it must be a team effort. However, you do need to know, within your individual systems, whether you will be scored in the Merit-based Incentive Payment System (MIPS) or in an Alternative Payment Model (APM) and adjust your daily work accordingly. In the meantime, FITs should learn as much as possible about MACRA and what their hospitals and institutions are doing to get ready. Visit ACC.org/MACRA for more information.