Many of us have become more than a bit frustrated by Congress’ inaction on APMA’s Title XIX legislation. I think that APMA’s Associate Director of Legislative Advocacy Ben Wallner helps to put this situation into perspective.
“There are 330 million people in the United States,” Ben says. “There are approximately 15,000 licensed podiatrists, and 75–80 percent of those podiatrists are members of APMA. This means that APMA members make up about 0.004 percent of the US population. All US podiatrists barely make up 0.005 percent.”
On an average annual basis, only 30–35 percent of APMA members participate in political action (and that might be a high estimate), whether through contributions to APMAPAC, or local political campaigns, or contacts made with members of Congress. That is about 4,000 voices out of 330 million, or 0.001 percent!
Is it really that much of a surprise that it is taking a while to get Title XIX passed?
We can and will get this legislation passed, but we need your help. We need every APMA member to get active and get involved, and we need you to get your patients, families, friends, and colleagues involved. You can do that by visiting the APMA Federal Resource Center today.
Glenn,
..thank you for the “View From the Top” and the diverse topics chosen so far…
..all of our podiatric colleagues effort together can help make Title XIX happen, the inertia is on our side!
Sylvia Virbulis, DPM
I understand this point of view regarding getting this legislation passed, but I have a real problem with how APMA has communicated with members on this issue over the years. Every year, a new strategy is unveiled, and members are assured that this year we have hundreds of co-sponsors and no opposition and the chairman of the committee is supportive, ect, and if we just give more money and send out more e-advocacy and phone calls, then passage of our bill is practically assured.
And when year after year, it doesn’t pass, then we get explanations and excuses, such as Ben Waller’s comments, on why it is so hard to get this kind of legislation enacted.
I just want honesty. If our bill faces obstacles to passage, say so. If the numbers Ben cites above really play a role, then tell us.
I am very active in my local and state associations and a regular contributor to PPAC. I expect and deserve a more honest and realistic assessment of the status of our bill each year.
Dr. Chisholm, thank you for your response. APMA tries to balance an honest assessment of the legislative environment with the need to encourage our members’ involvement—because without active, involved, committed members like you, our cause would be lost. We will continue to provide our members with as realistic an assessment as possible of our chances, and we thank you for your honest opinions, as well.
Our Title XIX bills in both the House and Senate have been bipartisan. We have garnered the legislative support that we have reported to the membership. This has been extraordinarily frustrating to all of us. Members of Congress have received letters of support for our bills from national medical societies as well as large labor unions and public-health organizations. Our issue has little financial impact. Many on the Hill describe the expense as budget dust. So we too ask why. Why can’t this simply get done? The only thing we can do to help maintain our sanity and continue our steadfast efforts to enact Title XIX reform is to look at the impotent way that Congress has been dealing with even bigger health-care issues like the Medicare Fee Schedule and SGR and medical-liability reform, just to name two issues. We will not give up our efforts on behalf of our profession and members.
Glenn:
To let you know I am following your activities. It would be great to build interest in our legislation if there was some bill that demanded action prior to the elections to which we could attach it. I think health care may be done as a subject for legislation this session, however. Now, if Faye identifies a likely piece of health legislation, I will do my best to invigorate the troops in Wisconsin!
Mike
This has been more than awhile. How long did it take us to get admitted to Medicare? 20 or 30 years? Do we have any staff that can think out of the box ? Maybe we need a new approach.
Tom Zoldowski DPM
Thanks for your input, Dr. Zoldowski. I share your frustration; this has been a long road. We hope that the APMA-sponsored Thomson Reuters study data will reinvigorate our message to Congress. The data demonstrate in no uncertain terms the cost-effectiveness of foot and ankle care provided by podiatrists, and we believe they send a no-nonsense message that Congress simply can’t afford to ignore.
As Podiatry has spent so many years working on the same task and the results have been suboptimal. Today it might be best to refocus on a loftier quest. We could always have the XIX as our fall back position. Remember, “Practice does not make perfect, Practice makes permanent”.
As a small profession, we will never have enough members (votes) or money (contributions) to impact legislation. What we do have as a profession, is the proven ability to provide the highest quality foot care in the world for the American people. We also have the ability to prevent many needless amputations in diabetics. We should be stressing our education, knowledge, experience, outcomes, and most importantly cost effectiveness. Our frustration remains that this legislation has not been effectively conveyed to Congess as good cost effective policy. Obviously, we need a new approach, not just a few more dollars, calls and letters as done in the past.
Absolutely! Podiatrists provide high-quality, cost-effective care, and we save the American health-care system millions of dollars in hospitalizations and amputations. The APMA-sponsored Thomson Reuters study demonstrates that when podiatrists provide care to people with diabetes, we prevent amputations and all-cause hospitalization, resulting in millions of dollars in savings. These data are scheduled for publication in two peer-reviewed journals (including JAPMA) later this year, and once they are published, they will become an integral element of our legislative advocacy strategy.
It must be noted that when the Congressional Budget Office scores bills, it does not factor in the savings, but the expenses. It is not rational, but that is the way it has been done by the federal government. The bottom line is that the feds see our Title XIX legislation as a $20-million annual expense. We will continue to emphasize the cost savings especially now that we have the results of the Thomson Reuters Study. It is critical that grassroots support be increased. Legislators respond to constituents. Without grassroots support even the best arguments fall on deaf ears. Thanks for your feedback, Dr. Holfinger.
The statistics compiled by Ben are brutally honest. The fact that our Title XIX bill has reached as far attests to the tenacity and resourcefulness of the 30-35% of members who have been active in this cause. Imagine what we can achieve in the future if that participating percentage could be doubled.
Steve
Hello,
I am curious how were our earlier pioneers in Podiatry able to become recognized as “physicians” under the Medicare Federal Program back in the 1960′s with less voices than our current 15,000 DPM’s?
Why does it appear to be so much more difficult in these times with Medicaid and other upcoming Federal programs? I would think this would be a lateral move with Podiatrists already recognized as physicians in the Medicare Program without my understanding of the complexity of the politics of our time.
Thank you for your leadership at APMA,
Douglas F. Klepfer D.P.M.
Member 25 years
Thank you, Dr. Klepfer, for your long-term support, and thank you for raising an interesting point. You hit the nail on the head with the word “complexity.” The health-care system and health-care spending have grown exponentially since the 1960s, and we are competing with a great many more special interests.
It seems logical that if we as podiatrists are recognized as physicians under Medicare, we should also be recognized under Medicaid. But who ever said CMS was logical? In all seriousness, our success in gaining recognition under Medicaid hinges on our ability to capture Congress’ attention and make the case for cost savings. If every member of APMA gets involved in the Today’s Podiatrist campaign, makes donations to APMAPAC, and is active in contacting his or her legislators, we will gain their attention. The APMA-sponsored Thomson Reuters study data will help us build our case that podiatrists save limbs, save lives, and save dollars for the health-care system.
Of course, it should be noted that during the 1960s our profession was very lucky to be led by President Charles Turchin, DPM. Dr. Turchin was a pretty remarkable man, but his relationship with the sitting president of the United States (he was Lyndon Johnson’s personal podiatrist and confidant) was one of the major reasons for our inclusion in the Medicare program as physicians.
Here is some outstanding information I received via e-mail from Irv Kanat, DPM, APMA past president. I wanted to share this with my readers:
“I could not let the moment pass without providing a more detailed and accurate account of the facts surrounding our profession’s inclusion in Medicare.
“Charley Turchin’s relationship with LBJ is well-known and accurate. He was even close enough to the ‘prez’ to have been able to have our colleague Dr. Earl Kaplan accompany him to the White House for the wedding of one of his daughters.
“But, although Charley claimed credit for the profession’s inclusion in Medicare, the real story is not so simple.
“The relationship between Wilbur Mills of Arkansas (Speaker of the US House of Representatives) and APMA President Ed Baron, of Little Rock, is where we really had the opportunity to explain how the inclusion of podiatrists in the Medicare program would be vitally important to meeting the health-care needs of older people. Additional grassroots efforts on the part of many APMA members sealed the deal for podiatry.
“Another note, just to be complete: It didn’t take 20 or 30 years for podiatry to be included in Medicare, as referenced in your column. It was about a year from the time of adoption of the Medicare Act to the inclusion of podiatry, and at the behest of Speaker Mills.”
Thank you, Dr. Kanat, for setting the record straight!
This should be in Websters as the definition of insanity. Continuing to do the same thing over and over and expecting a different result. There has to be different a different approach or several different approaches tried until this is done. Excuses are not acceptable and are dangerous. Our window in time is very small before we become a footnote in medical history. Effective leadership finds a way or gets out of the way.
Angelo Petrolla DPM
Angelo, you are absolutely right; however, we still must rely on the people who vote for the legislators to create awareness and understanding of our issues. APMA has been modifying its approach to Congress throughout this frustrating ordeal. Over the past few years, APMA’s legislative strategy has been fluid and dynamic. We have retained several different legislative consultants, lobbyists, and political strategists to supplement our staff and leadership efforts. We have engaged the support of various labor groups, public-health associations, diabetes interest groups, and medical societies. It still boils down to the same thing … constituents, voters, have the only real political clout in our government. Lobbyists alone cannot get this job done. APMA is not making any excuses because we DO expect to win. We are confident in the efforts that we have made on behalf of our membership. This battle is not over.