In December, SIR members flew to Washington, DC, to meet with congressional representatives to advocate for IR patients and providers.
The SIR annual congressional fly-in, which took place over 2 days, was an opportunity for volunteers to not only learn more about legislative advocacy, but also to educate lawmakers on the crucial issues facing access to care and to urge support of proposed legislation that will positively impact patients.
“In 2023, only 11 percent of counties in the United States have an interventional radiologist,” said fly-in participant Ammar Sarwar, MD, FSIR. “To quote Matt Hawkins, without IR you can’t do cancer, trauma, or transplant. So, in 89 percent of U.S. counties, cancer, trauma and transplant patients are being routed to large cities, which is not sustainable for most communities.”
This challenge is partially due to the size of the specialty, according to Allan I. Hoffman, MD, FSIR.
“I believe there are only 10,00 practicing IRs in the U.S., and when healthcare dollars are scarce, you need to be an effective advocate to assure your specialty’s needs are being served,” Dr. Hoffman said. “Getting in front of the decision makers and convincing them to support us is necessary to assure the continued growth and success of the specialty, but more importantly, to extend access to our services to those in underserved and rural areas. It is unacceptable that in the wealthiest country on earth that so many don’t have access to our services.”
While there are multiple social and economic factors impacting access to care, it is also exacerbated by continual reimbursement cuts, which hit all physicians, but especially IRs.
“IRs do a lot of bread-and-butter work on common diseases within the hospital system, but we also are an innovative specialty. We’re doing cutting edge therapies and creating data to prove their efficacy, like geniculate artery embolization and prostate artery embolization. And with that comes the challenges of reimbursements,” said Alok Bhatt, MD.
There’s an unfortunate financial balance that comes with providing high-quality care, Bhatt says. For example, if it takes 4 or 5 hours to do a complex lower extremity revascularization, and the reimbursement for that procedure gets cut every year, some IRs may have to make the difficult decision to stop offering that procedure.
“That hurts our patients. The number of limb-saving procedures goes down, and amputation rates go up,” Bhatt says.
Legislative advocacy can be key for increasing access to these minimally invasive therapies, said Ammar Sarwar, MD, FSIR, who has participated in fly-in events in the past with other societies.
“We’ve seen success with legislative advocacy, such as Rhode Island passing a bill that forced private insurers to reimburse UAE for fibroids, and payment for yttrium-90 microspheres was actually approved through legislative action,” Dr. Sarwar said. “When y-90 could not be pushed through regulatory agencies and CMS, we were able to take it to legislators who supported reimbursement I think the same thing will come true when it comes to peripheral arterial disease therapies, or HCC therapies.”
The day after the Dec. 5 kickoff dinner with special guest Rep. John Joyce, MD, R-Pa., the physicians took their concerns to individual meetings with their members of Congress, before hosting a luncheon for Reps. Mike Burgess, MD, R-Texas, and Brent Wenstrup, DPM, R-Ohio.
“Legislative advocacy is never about going to the Hill with a bill in hand and looking for it to be signed same day,” said Dr. Sarwar. “Legislative advocacy is about building a relationship and making face-to-face connections, so that when there is a bill coming that will either help or hinder IRs and their patient communities, you have allies you can reach out to who understand the impact.”
These conversations were also opportunities to prove the value of IR—a specialty that has substantial value proposition, but often works in anonymity within the hospital system.
Dr. Bhatt agreed. “The only way we make our value known is by evangelizing IR or spreading the word. That’s what we did in Washington—we got involved and put a face to the specialty,” he said.
As Dr. Sarwar pointed out, almost everyone has been touched by cancer in some way, and many patients have benefited from IR procedures, even if they don’t realize it. Dr. Sarwar met with one staffer whose mother had a port placed by an interventional radiologist.
Once there is a personal connection and an understanding of value, then it’s easier to advocate for the challenges—and rather than discussing the difficulty of turf wars or practice barriers, participants focused on how these challenges are ubiquitous in healthcare.
“There were so many moments where you could see the lightbulb go off,” said Venkatesh P. Krishnasamy, MD. “The representatives and their staff were really engaged, and they wanted to better understand how things may be impacting patients.”
The participants, who were just a handful of the medical providers who visited Congress in 2023, said they felt the representatives and their staffers were invested and agreed on the importance of topics like adjusting physician payment for inflation.
“For the most part these issues discussed have bipartisan support, which helps set the stage for a fruitful discussion,” said Alexandra Fairchild, MD, “but the devil is in the details.”
Dr. Fairchild met with her elected representatives, Sens. Bill Cassidy, R-LA, and John Neely Kennedy, R-LA, as well as Speaker of the House Mike Johnson, R-LA, and Rep. Steve Scalise, R-LA, who has been a friend to the specialty since being treated by an IR after being shot at the Congressional Baseball game in 2017.
As a medical student, Dr. Fairchild said she was told by William Rilling, MD, FSIR, about the importance of being present and having a voice where decisions are made—something that stuck with her and has become part of her mission to advocate for her patients.
Participants noted that part of being at the table also involves understanding the challenges faced by lawmakers in driving forward change.
“Our medical piece is just one part of the giant puzzle of U.S. policy,” said Dr. Bhatt. “We’re thinking about our practices and patients, and not always realizing the way that medical issues are tied in with national security or energy. It was eye-opening to see how the sausage gets made.”
Dr. Sarwar agreed and stressed that this puzzle is why Fly-In events are so important.
“It opened the eyes of many of us—participants and representatives combined—to how big the problem really is and how much dedicated effort is really required to change the problem,” said Dr. Sarwar. “It’s important that SIR members understand that while we’re all frustrated by what’s going on, meaningful change requires consistent effort over multiple years.”
This takes time and energy, Dr. Krisnasamy said, and acknowledged that many members may not realize how much effort goes into keeping IR and patient issues front and center in legislators’ minds. He encouraged any members interested in working for change to reach out and volunteer.
“The participants gave up two days away from their practices and families to come here, and that’s not viable for everyone,” Dr. Bhatt said. “But if you’re interested in this kind of work, if you reach out to even your local representative, it makes an impact, and they’ll take the time to listen to you.”
Even a short conversation can make a big difference, participants said.
“IR is a specialty built for this challenging healthcare environment,” said Dr. Hoffman. “We need to tell our story to the decision-makers on policy and reimbursement, and this fly-in provided the opportunity to share how even though IR is a relatively small specialty, it can be impactful.”
Want to reach out to your local representative? Feel free to share these talking points from the Fly-In.
Issue: Need for delay in Medicare cuts, allow for COLA and inflationary increases, overall Medicare reform
- The instability of the Medicare Physician Fee Schedule (PFS), along with insufficient implantation of the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP), has resulted in many practices seeing their payments decrease yearly, despite increasing costs and growing inflation. Once again, the bulk of reimbursement decreases continue to impact specialized care such as IR.
Solution: Strengthening Medicare for Patients and Providers Act, H.R. 2474 (Reps. Ruiz, Bucshon, MD), which would modify the PFS to provide an annual update tied to the MEI.
Prevent the 3.4% cut in Medicare physician payment that the Centers for Medicare & Medicaid Services recently finalized in the CY 2024 PFS final rule.
Issue: Increased demand for interventional radiologists
- Demand for IRs has increased because hospitals experience improved patient outcomes, shorter inpatient length of stay, improved efficiency and increased patient satisfaction when using IR services.
- SIR has proposed graduate medical education (GME) redistribution as an approach to ensure that all residency training slots are filled each year—including many to the specialties and programs most in need, such as IR. SIR also supports increasing Medicare residency training slots.
Solution: Resident Physician Shortage Reduction Act of 2023. H.R. 2389 (Reps. Sewell, Fitzpatrick)/S. 1302 (Sens. Schumer, Boozman) would provide 2,000 new Medicare-supported GME positions per year over 7 years, for a total of 14,000 new GME positions, with priority given to address certain needs such as new medical schools, rural areas and other medically underserved locations.
Issue: Physician shortages, especially in IR
- The Association of American Medical Colleges projects a shortage of 124,000 physicians by 2034. Demand for specialty physicians continues to outpace the supply, especially in rural America.
- Student loan debt carried by medical school graduates is increasing. Over 71 percent of medical students have some amount of student loan debt, and 53% have $200,000 or more.
Solution: Specialty Physicians Advancing Rural Care (SPARC) Act S. 705 (Sens. Rosen, Wicker)/H.R. 2761 (Reps. Joyce, Ross) provide qualified specialty medicine physicians the opportunity to have a portion of their eligible student loans repaid by the federal government in exchange for practicing in a rural community experiencing a shortage of specialty medicine physicians.
