By Amanda Kelley, NSH Legislative Committee Chair
January 26, 2018 was an unusually warm day in St. Louis. We were amid our January thaw, when I received an email from NSH Executive Director, Sharon Kneebone. Sharon and our NSH President, Diane Sterchi, were attending the ASCLS Legislative Symposium in Washington DC on Monday March 19 through March 20, 2018. Since I am the Legislative Committee Chair they asked would I like to come along, of course I said yes! By Valentine’s day we had coordinated our flights and itineraries. NSH was on its way to Washington. This was the first time NSH attended a medical technology based legislative symposium. The list of medical laboratory agencies was a who’s who of laboratory medicine. Attendees were from every segment of the industry.
· ASCLS American Society for Clinical Laboratory Science
· CLMA Clinical Laboratory Management Association
· ASCP American Society for Clinical Pathology
· AMT American Medical Technologies
· AGT Association of Genetic Technologists
· NSH National Society for Histotechnology
It was exciting to be included with other laboratory professionals (chemists, hematologists, microbiologists, blood bankers, physicians, and histotechnologists) discussing the impact of regulatory agencies like CMS on our medical and business practices. The agenda held the logos of every group, to recognize each attendee. This was the first time NSH attended a legislative symposium and we were warmly received by the organizers and the attendees. After all, we are laboratory professionals working toward the same goals, treating the same patients, and facing the same issues.
Monday March 19, 2018
After a hearty continental breakfast, we began learning about politics in Washington. I know most folks thinks it’s divisive and partisan. Nothing can be further from the truth. Honestly, without a scorecard you don’t know a Republican from a Democrat. The environment outside the Hill is totally different than on the Hill. Sensationalism is for the activists and the newspapers, not the offices on Capitol Hill. We were there for one reason and one reason only, to talk to our Congressional Leaders about Laboratory Medicine. Our first goal was to develop our strategy and talking points. What was our agenda, which legislative issues were affecting Laboratory Medicine the most? It didn’t take long to figure out which issues were the most important.
The PAMA Act – Protecting Access to Medicare Act https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/PAMA-Regulations.html
CMS Personnel Regulation Request for Action Briefing https://www.federalregister.gov/documents/2018/01/09/2017-27887/request-for-information-revisions-to-personnel-regulations-proficiency-testing-referral
Our mission for Monday was to sharpen our message, learn what we needed to learn to speak effectively with our Congressional Leaders on Tuesday. Here are the links to the two position statements we shared with our legislators on the Hill.
CMS Personnel Regulation Request for Action Briefing –
NSH signed on to the ASCP Board of Certification letter as part of the clinical laboratory science coalition. In addition, NSH worked on a separate response to this to CMS. NSH organized a CLIA Task Force to address the issue regarding Laboratory Personnel Qualifications for Histotechnicians and Histotechnologists.
After our seminar, we met with people from our state, I met Kristen and Natasha, both Medical Technologists from Kansas City and Diane met with Leah.
Tuesday March 20, 2018
It was a very cold rainy day when Diane, Sharon, Leah and myself stepped out of the hotel to board the Metro into Washington. The train was full of morning passengers on their way to work. We also had work to do. We were on our way to convince our representatives in Washington that our policy positions are worth supporting. Although there isn’t currently a bill involving medical laboratory medicine on the floor, it is a hot button topic due to the restructuring of the Affordable Care Act (ACA). PAMA came out of the ACA to reduce Medicare and Medicaid costs for the government. It was originally supposed to go into effect in 2016, but the AMA lobbied and delayed the implementation until January 1, 2018. That gave them time to renegotiate the physician fee schedule. Meanwhile large laboratories, like ARUP, LabCorp and Quest, were surveyed for the fee schedule determinations for clinical laboratories. CMS was charged by Congress to survey a representative sample to determine the new fee schedule and fell short of its charge. Large laboratories have enough work volume to break even with their costs. Smaller and rural labs however are struggling and were not part of the survey sample. Currently, CMS has no plans to rectify its flawed research.
Before you know it, the Metro dropped us off at the Capitol Hill South station. When we emerged from the subway it was a cold drizzly rain mixed occasionally with ice pellets and snow. There were protesters shouting via megaphones in front of the Supreme Court, so we just crossed the street and made our way to the Senate side of Capitol Hill. We went to the Hart building first, each building had its separate TSA style screening, so we had to get scanned to go in. Once we located room numbers, I went to visit Senator Claire McCaskill from Missouri and Diane went to visit Senator Joe Donnelly from Indiana. My plan was to go with Kristen and Natasha because they had appointments at noon and 3:30pm. However due to the Nor’easter blowing in from the west, and flights being cancelled. I thought it was best just to go ahead and show up. Note to self for 2019, make your appointments at least a month before you arrive in Washington. McCaskill’s office was very busy, and I asked for two staff members who were too busy to see me. The gentleman at the desk was kind and took down my information. We had flyers with our position statements, so I dropped them off with the young man at the desk. Now it’s time to go see my other Senator, Roy Blunt, located in the Russell Senate building. Diane was also going to this building to see her Senator, Todd Young. Lucky for us the building was next door. When I arrived I almost got to speak with Senator Blunt’s healthcare policy adviser, but his next appointment arrived before I could make it into the office. So, I dropped off a copy of our position statement, took the business card of the healthcare adviser and off I went to meet up with Diane and Sharon.
Now it was time to pass the protesters outside the Supreme Court, to go to the buildings which house the members of the House of Representatives. We went to the Rayburn building, which was much busier, the halls were narrower, and people were everywhere. They had a cafeteria in this building with a Baskin Robbins and it was busy. I went to see my 3rd Congressional District Representative Blaine Luetkemeyer, and I got lucky as he was in his office. I apologized for not having an appointment and spoke to the young man at the desk. The Healthcare Policy adviser for his office, Mitch Erdel, was there and we sat down and talked for over 20 minutes about histology, healthcare, the PAMA act, workforce shortages etc. I asked Representative Lutkemeyer for a photograph, and he posed with me for an official photo, which of course will find a hallowed place on my wall. I spent so much time at his office that Sharon and Diane had lost me. I told them where I was, and I was just finishing up when they came down the hall. I was very happy that my representative took so much time to speak with me about histology, my lab, and healthcare. We made one more stop to see one of Diane’s representatives, but he was not available, so we dropped off literature and made our way off Capitol Hill. It was raining harder, colder with bigger Ice pellets as we made our way back to the hotel. We were satisfied that we had made real progress. Sharon made it home just as her street became icy, and although our flights didn’t leave before 7:00pm, we both made it home before the Nor’easter hit.
When I returned to work the next day, I sent a thank you email to all the business cards I picked up on Capitol Hill. Again, Representative Luetkemeyer’s staffer Mitch sent me a very nice response. I believe he was paying attention, besides the Representative signed “Great job” on my autographed photo, my keepsake from my trip when “NSH went to Washington”.