I do my best to learn from others who exist beyond my physical (personal, institutional, national, global) boarders to help better understand and appreciate how others approach issues. An example is what I have learned from our Canadian neighbors (~30+ of SGIM members are from Canada) and their adoption of the CanMEDS framework that defines the various abilities of the physicians, including the identities of Scholar, Professional, Communicator, Collaborator, Leader, Health Advocate, and the integrating function of Medical Expert. This framework optimally articulates the varying roles of the physician, including that of serving as a Health Advocate. The framework states that physicians, as Health Advocates, “work with those they serve to determine and understand needs, speak on behalf of others when required and support the mobilization of resources to effect change.1 In many ways, the SGIM advocacy aim to envision a “just system of care” embodies the CanMEDS role of Health Advocate.
In the 24 months since the beginning of the pandemic, SGIM has provided more than 90 advocacy statements and/or legislative endorsements. Most of those endorsements have been advocacy items related to COVID-19. Our decisions to engage in other areas are guided by SGIM Council approved Health Policy Committee (HPC) Agenda and White Papers.2,3 It is important to highlight that advocacy issues related to the pandemic continue to be situated within the HPC Goals of “1) Fair and equitable Medicare reimbursement policies, 2) Adequate funding for health professions training and 3) Support for health services research.”4 During this same timeframe, our advocacy work has focused on improving the health and health care of our patients—a summary of those actions are discussed below.5 As we continue to fortify ourselves against the ongoing assault of COVID-19, it is critical for us to see the impact of our small yet mighty society of ~3,000 members.
We continue to advocate for access to care for our patients inclusive of COVID-19 testing and contact tracing. Other issues where we have contributed include Part B coverage of blood pressure cuffs as well as the loosening of federal prescription of buprenorphine regulations to treat opioid use disorder. In the mist of the pandemic, we continue to be active in the call to protect reproductive rights. We continue to demand affordable healthcare services and access for our patients during the pandemic and beyond.
We joined our partners to demand strategies on issues such as public support of scientific integrity, address the scarcity of PPE, whistleblower protections, vaccine mandates for healthcare workers, leave policies enhancement, as well as temporary economic assistance to non-profits, primary care providers, and small businesses impacted by COVID-19.
Equitable and Fair Reimbursement
We continue to seek the full range of care and equitable reimbursement for remote care (telemedicine) over the course of COVID-19. Our legislative activities in the United States include work to avoid the planned Medicare Physician Fee Schedule (MPFS) payment adjustment as well as alleviate the impact of budget neutrality requirements for any adjustments to the fee schedule. We continue to support financial solutions that provide stability to safety net providers, while ongoing research and long-term policy changes are considered. This is inclusive of recommending peer grouping based on social complexity to ensure providers and practices caring for the most socially vulnerable patients are not unfairly penalized. In addition, we sought out a more harmonized portfolio of alternative payment models that would advance health equity while reducing cost.
SGIM recommends further review of clinical quality and health equity measures that evaluate the care needed to address the SDOH for at-risk populations. The pandemic provided the opening as well for us to join with others and support the National Academy of Sciences, Engineering, and Medicine, report on “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care which calls for fundamental reforms on how primary care is funded.”6
Research and Healthcare Infrastructure
We support the ongoing expansion of licensure flexibilities for the duration of COVID-19. We spent many of our coalition activities focused on the support of CMS reimbursement for telehealth services inclusive of audio only options.
We support healthcare infrastructure by lobbying for increased appropriations for agencies such as HRSA, CDC, NIH, CMS, AHRQ, and VA to address cross-disciplinary research exploration, emergency supplemental funding for ongoing and innovative research, improved pandemic preparation and response, care delivery, and workforce development, especially related to diversity. Continued support for enhancements to our “public health infrastructure to pay for such essential activities as disease surveillance, epidemiology, laboratory capacity, all-hazards preparedness and response; policy development and support; communications; community partnership development; and organizational competencies” is needed.7
We continue to focus on funding that supports cross-disciplinary and primary care research, often exemplified by the health services and translational research of many of our members. We use our advocacy platform to support further research on health-related societal issues, such as the implementation and outcomes of telemedicine and the social and basic science research needed to solve issues of structural racism and inequality. We also use our expertise to call attention to the need for the United States, as well as other countries, to track COVID-19 data that is stratified by race, ethnicity, and census/geographic location to fully understand the impact of the pandemic and identify solutions. In addition, we continue to advocate for research on the prevention of violence as well as the need to address research workforce diversity, equity, and inclusion.
SGIM supports the provision of additional funding to restart research projects and training programs disrupted by COVID-19.
We continue to advocate for loan forgiveness and hazard pay to provide financial relief for COVID-19 front line workers. We also support the continued expansion of all levels of office/outpatient E/M services (CPT codes 99202-99205 and 99211-99215) provided by resident physicians using the primary care exception. We also support the ongoing reauthorization of the Community Health Center Fund (CHCF), Special Diabetes Program and Special Diabetes Program for Indians (SDP/SDPI), Teaching Health Centers Graduate Medical Education (THCGME), National Health Service Corps (NHSC), and Personal Responsibility Education Program (PREP).
SGIM continues to advocate for immigration solutions that retain the current policy of “Deferred Action for Childhood Arrivals” as well as ensure accessible visa services for international medical graduates.
The CanMEDS framework provides a comprehensive tool to review the various roles of physicians within society. In our work both within and outside of SGIM, we should all use our role as a Health Advocate during the ongoing pandemic and always to “lead the way to better health for everyone.”8
- Royal College of Physicians & Surgeons of Canada, CanMEDS. Health advocate. https://www.royalcollege.ca/rcsite/canmeds/framework/canmeds-role-health-advocate-e. Accessed February 15, 2022.
- Society of General Internal Medicine Health Policy Agenda: 2021-2022. https://www.sgim.org/File%20Library/SGIM/Communities/Advocacy/2021-22-HPC-Annual-Agenda-CRD-final.pdf. Accessed February 15, 2022.
- Society of General Internal Medicine Policy White Papers. https://www.sgim.org/communities/advocacy/policy-white-papers. Accessed February 15, 2022.
- Society of General Internal Medicine Health Policy Committee, Goals. https://www.sgim.org/communities/advocacy/committee. Accessed February 15, 2022.
- Society of General Internal Medicine Legislative Agendas. https://www.sgim.org/communities/advocacy/legislative-endorsements. Accessed February 15, 2022.
- National Academy of Sciences, Engineering, and Medicine. Implementing high-quality primary care: Rebuilding the foundation of health care which calls for fundamental reforms on how primary care is funded. https://www.nationalacademies.org/our-work/implementing-high-quality-primary-care. Accessed February 15, 2022.
- Letter to Leadership for Public Health Infrastructure Long-Term Funding. https://www.sgim.org/File%20Library/SGIM/Communities/Advocacy/Legislative%20Endorsements/PH-Infrastructure-sign-on-FINAL-4-3-2020.pdf. Accessed February 15, 2022.
- SGIM. Vision and Values. https://www.sgim.org/about-us/vision—values. Accessed February 15, 2022.
Advocacy, COVID-19, Health Policy & Advocacy, Medical Education, Research, SGIM
“In the 24 months since the beginning of the pandemic, SGIM has provided more than 90 advocacy statements and/or legislative endorsements. Most of those endorsements have been advocacy items related to COVID-19. As we continue to fortify ourselves against the ongoing assault of COVID-19, it is critical for us to see the impact of our small yet mighty society of ~3,000 members.”
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