After a week out of town on vacation, I was home for a night then off to Washington, DC for ACP Leadership Day. As always, it was a wonderful experience.

First, I am always so impressed by the ACP advocacy efforts. Bob Doherty in particular is such an impressive speaker, and is always in command of the facts. It is reassuring to know we have such people looking out for us as physicians and for our patients.

A couple thoughts and impressions from the past 2 days:

-It was interesting to be there lobbying for the 5 year SGR patch only to watch it crumble apart on the very morning we headed to Capital Hill. The AMA effectively killed whatever chance it may have had of passing. I understand the AMA’s point that we need a permanent fix and not a temporary patch, but come June 1st we are back to, at best, a year-to-year situation. Since we got home, another possible fix is on the table–and one that preserves the “two bucket” approach championed by the ACP, which would allow for selectively higher payments to primary care.

-The Independent Payment Advisory Board (IPAB, or as it is known in Cupertino, iPab) can make recommendations regarding Medicare payments. Now, however, certain of these recommendations (notably, those affecting physician payments) take effect automatically unless Congress intervenes to stop them. This is not actually a bad idea in my opinion, but the law requires a super-majority in Congress to overturn the IPAB recommendations. This part is a very bad idea. I think the Senate has shown us nicely what happens when a super-majority is required.

-The 10% bonus to Medicare payments to primary care is a very good idea. However, there are some definitions problems. Specifically, to qualify a practice must earn at least 60% of income from primary care visits. It is not too hard to imagine how a practice that sees a lot of inpatients and maybe has a lab and an xray machine might earn 41% of income from non-office visits. And yet these are exactly the internists that we need more of–the ones still doing it all.

-Lastly, I was a little bit disheartened by the Congressional staffer panel this year. Always my favorite part, you usually get the idea that even if the rest of Washington has gone crazy, at least these 24 year-olds will still go out and get a beer together. But this year there did seem to be a little less congeniality than last year. The tone from all the politicians and staffers was a little more sharp this year.

Once again, it was a great meeting, and kudos to the ACP. To those interested in getting involved, go to the ACP website and follow the “advocacy” links. The easiest and yet very useful step is to sign up to be a Key Contact. You’ll get info about breaking issues and advice on how to lobby your representatives.