The Society of Critical Care Medicine's (SCCM) Advocacy Caucus in Washington, D.C. proved a great success, as several governmental leaders helped spread the Right Care, Right NowTM message while highlighting important issues facing critical care. Rep. Patrick Kennedy, D-R.I., co-chair of the 21st Century Health Care Caucus and the person responsible for uniting Sen. Hillary Clinton, D- N.Y., and former House Speaker Newt Gingrich on healthcare reform, was among those to voice support for SCCM and its movement to improve critical care.
The congressman enthusiastically endorsed what he called “the right care for the right people at the right time” as he addressed an audience of Advocacy Caucus attendees and participants of the third annual Critical Care Summit: Quality and Cost. He explained how SCCM's efforts fit with his legislative agenda for the 21st Century Health Information Act. Kennedy, joined by SCCM member Peter Pronovost, MD, FCCM, argued that quality and technology were crucial for reaching the level of care expected by patients today.
Before the congressman's presentation, caucus participants put forth a great effort to develop a united message on behalf of the critically ill and injured patient and to deliver that message to Kennedy's fellow colleagues on Capitol Hill.
A Unified Voice on Capitol Hill
Caucus participants came with a clear purpose: to educate legislators about the continuing need for improved critical care. Critically ill or injured patients in the United States often do not have access to the best possible care - the Right Care, Right Now.TM Attendees conveyed this message by highlighting obstacles that must be addressed in order to meet the challenging needs of critical care patients and healthcare professionals while offering solutions for overcoming these obstacles. Key points included:
- The inconsistent availability of the multiprofessional team, which has been demonstrated to improve outcomes, decrease ICU length-of-stay and decrease the cost and use of resources.
- The shortages of team members, which is a problem projected to worsen as baby boomers age and demand for critical care services increases.
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- The lack of ICUs to meet demand in case of a surge in the need for critical care services following a mass-casualty event such as a pandemic or bioterrorism attack.
Participants spent the first day of the Advocacy Caucus reviewing these key policy issues. Presentations included “Promoting the Team Model,” led by SCCM president-elect Charles Durbin Jr., MD, FCCM; “The Effect of Workforce Shortages,” led by Advocacy Caucus vice chair Aryeh Shander, MD, FCCM; “Disaster Preparedness Efforts,” led by Margaret Parker, MD, FCCM; and “Critical Care Payments,” presented by George A. Sample, MD; Laura Loeb, JD; and Advocacy Caucus chair Todd Dorman, MD, FCCM.
Each policy issue affects the multiprofessional team's ability to care for the critically ill or injured patient. The information was presented to ensure each attendee understood the background of each issue and could engage in persuasive discussions with elected officials.
After an energizing presentation by Marcia Nielsen, PhD, MPH, from the University of Kansas Medical Center, on grassroots efforts with tips on how to influence policymakers, caucus attendees reviewed material about each key issue and discussed the best way to apply information when it came time to meet with lawmakers. Because different members of Congress have different legislative agendas, attendees tailored their messages to individual audiences. Sometimes the focus was selected based on a legislator's seat on a specific committee in the U.S. House or Senate. For instance, Clinton has a specific interest in disaster training for New York hospitals and national bioterrorism planning, so the message brought to her office focused on SCCM's Fundamentals of Disaster Management (FDM) courses and the pilot for the new Hospital Mass-Casualty Disaster Management (HDM) course. Her seat on the Special Committee on Aging also linked her to workforce issues and the increased demand for critical care services for patients age 65 and older.
The meeting with Sen. Barbara Mikulski, D-Md, proved to be another example of how prior research helped tailor a conversation to a specific member of Congress. Participants who met with the senator recognized that she was concerned about education but not as focused on healthcare or healthcare personnel. Knowing this, team members addressed the workforce shortage by framing it in terms of the need for nursing faculty. They pointed out that nursing school applicants are turned away every year despite the ongoing nurse shortage because of the lack of faculty to teach these potential students.
Participants also emphasized the positive learning environment created by an integrated team of dedicated experts in the ICU. The team was able to spark her interest and make her more receptive to the concerns of critically ill patients.
While participants investigated the interests of legislators before going to Capitol Hill, sometimes the direction of their conversations was determined after speaking with legislators or staff members and gauging reactions. When team members learned that the senior legislative aide for Senate Majority Leader Bill Frist, R-Tenn, was a Robert Wood Johnson (RWJ) Fellow and especially interested in the model of care promoted by SCCM, they were able to steer the conversation better. The aide agreed that team expertise allows for better patient care in the ICU, and SCCM's emphasis on the team model resonated with him.
Though messages were fine-tuned to meet specific agendas and interests, it was vital that caucus participants encompassed one overall message – legislators have a role in ensuring that critically ill or injured patients receive the best care possible. This message is one unique to medical societies, as acknowledged by a senior legislative aide the next day. Rather than focus on a single profession, such as physicians or nurses, or demand services on narrow singleissue interests, participants presented a patient-centered approach to educate policymakers on the importance of critical care in today's healthcare system and offered their expertise in identifying and finding solutions for pressing issues. This approach received favorable comments from a number of congressional offices.
The day was capped with a working dinner and a keynote presentation by Atul Grover, MD, PhD, from the Lewin Group. Dr. Grover presented his findings on the history of workforce policy efforts. He pointed out that prior national efforts to shape workforce policy have vacillated, with projections of surpluses offset by projections of shortages, sometimes in the span of only 10 years. Knowing this history helped participants anticipate questions or skepticism from elected officials and answer questions about today's research.
In all, 25 members of the expert team visited 40 congressional offices and communicated stories at the day's end. Some shared disappointing experiences, illustrating the difficulty of communicating SCCM's message to policymakers unfamiliar with critical care and the challenges faced by patients needing critical care services. However, plenty of stories left attendees charged and enthusiastic for future efforts. One member met with a senior staffer who said she had never encountered such a refreshing and optimistic visit in all her years on Capitol Hill, while another attendee told of his unexpected encounter with an Ohio representative eager to learn about the ICUs in his district. The representative interrupted his schedule to discuss his concerns with members of the team. One congressman even said, “Tell me what you want in legislation, and I'll write it!” Attendees followed up their visits with thank you letters, providing another opportunity to work with officials on issues relevant to critical care patients.
Visit from the Administration
The last day of the Critical Care Summit, which was held in conjunction with the caucus, included a payor panel. Private and public payors for Medicare exchanged views on the importance of critical care and took questions from audience members on payment issues related to their critical care practices.
Panel participants included William Rogers, MD, director of the Physician Regulatory Issues Team (PRIT) and CMS affiliate; James Cross, MD, national medical director for Aetna, Inc.; Richard Whitten, MD, Noridian contract medical director for Washington and Alaska; and Laura Loeb, JD, from Hogan & Hartson, LLP, SCCM's Washington, D.C. counsel and consultant on payment issues.
Both Drs. Rogers and Cross emphasized SCCM's Right Care, Right Now™ message, noting that as the population ages, the need for critical care services will increase. Dr. Whitten, who also attended SCCM's Coding and Billing course during the Critical Care Summit, explained the differences in coverage across the nation from the perspective of regional carriers. The audience pressed panelists about the confusion that arises from these regional and national regulations.
The 2005 Healthcare Agenda
When Kennedy introduced the 21st Century Health Information Act to the House the week prior to the Critical Care Summit, he was joined by Clinton and Gingrich. Kennedy reinforced his message of bipartisan cooperation in his address, noting that his bill is the first component of a larger bill introduced last session, the Josie King Act. He said the Josie King Act represents “the policy agenda we need for healthcare.” It addresses concerns beyond the technologic issues included in the 21st Century Health Information Act by embracing patient safety concerns and stressing the importance of quality care in the ICU. Dr. Pronovost helped draft the Josie King legislation and introduced the congressman to King's family. King died at age 18 months due to a hospital error. Dr. Pronovost argued that “patients like my mother or your mother should not have to shop around for a place where they will not be harmed, for a place where they reliably receive the therapies they ought to, or for a place where they are at the center of care.”
The Society has already capitalized on its annual visit to Capital Hill. Within a week of returning from Washington, D.C., SCCM was working with one congressional office to identify issues important to the representative's constituents and regional providers of critical care. The Society will follow up to find more opportunities to engage policymakers, including advocates of critical care situated with key congressional offices and committees. With allies like Kennedy, Dr. Pronovost and the attendees of this year's Advocacy Caucus, SCCM anticipates much progress in its mission to provide quality critical care services to the patients who need them.
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