The American Society of Hematology (ASH) selected Jerome Seid, MD, as its 2020-2021 ASH Congressional Fellow. The Congressional Fellow program aims to connect hematologists to the policy-making process and educate congressional members and staff about issues that are important to hematologists and their patients. In his first column, Dr. Seid gives an inside look at his role in the office of Nevada Senator Jacky Rosen.
I never expected to serve as the 2020-2021 ASH Congressional Fellow. Having practiced hematology/oncology for 27 years, with expertise in hospice/palliative care, my plan was to continue on that path until retirement. But my strong belief in the importance of advocacy efforts to mitigate the effect of flawed health policies on so many of my own patients compelled me to apply.
I had been involved in efforts to pass oral chemotherapy coverage parity and prior authorization reform legislation in Michigan and had also participated in advocacy efforts through medical associations on Capitol Hill. The ASH Congressional Fellowship was "my shot" to take my game to another level, to try to leverage my years of experience and insight, and to provide a more informed, rational perspective that could impact development of health care policy.
As a mid- to later-career physician, I thought that I would be considered a non-traditional candidate for the fellowship. One memorable and valuable question raised during my interview in March 2020 from a disembodied voice (the process was virtual) was, "How would you react to being the low man on the totem pole, after being the person in charge for so many years?"
Reflecting on the fellowship after nearly five months in the position, my perspectives are evolving, though not so differently from what I expected. I am embedded in the office of Senator Jacky Rosen (D-NV), who is a co-chair of the bipartisan Comprehensive Care Caucus. Sen. Rosen has a strong interest in palliative care and sits on the Senate Committee on Health, Education, Labor, and Pensions (HELP), the Senate Special Committee on Aging, and four others.
My interests and Sen. Rosen's aligned and a relationship was quickly forged. Due to COVID restrictions that necessitate a virtual work environment, my comprehension of the office landscape continues to evolve. Having a seasoned mentor has been crucial in keeping me focused and challenged, but not hindered. I've learned that willingness to tackle unfamiliar issues is important to a successful fellowship, as such exposures can – and do – trigger unexpected engagement, expand collaborative networks, and create opportunities for personal and professional growth.
An early opportunity arose as the Centers for Medicare and Medicaid Services (CMS) was rolling out the Radiation Oncology Model for payment reform. I sat in on a meeting between Sen. Rosen and a Nevada-based radiation technology business to ask questions and provide context that would help frame our office's response. As of mid-February, CMS has deferred implementation.
When looking for other opportunities to shape health care policy, I identified, helped research, and proposed legislation to reintroduce a resolution recognizing November 2020 as Hospice and Palliative Care Month, an initiative that seemed to have languished for a number of years. This was an opportunity to help improve public awareness of these services and emphasize Sen. Rosen's interest in the topic, which is an important distinction of serving as a fellow in a personal Congressional office, versus serving with a committee. What seemed to me a relatively simple "slam-dunk" piece of legislation required several steps that I did not foresee, including garnering buy-in on bill language from various stakeholders and obtaining signoff from the other caucus co-chairs. It was introduced in the Senate and passed unanimously – a small victory perhaps, but an early incentive builder for me.
Now, I have directed my attention to the need for payment reform for transfusion support within the hospice benefit – an important goal for hematologists and hospice/palliative care physicians. Under the current payment structure, hospice organizations receive a daily payment for each patient enrolled and are required to cover all items, services, and medications for the palliation and management of the terminal illness and related conditions, including blood transfusions. While blood transfusions can be offered during hospice care, they often are not because of the high cost. Transfusion support within the hospice benefit could improve the use of life-extending hospice care, especially for hematologic patients who are dependent on transfusions.
Unaware that one year prior to my arrival, ASH staff and Sen. Rosen's office had met to discuss this topic, I independently proposed hospice benefit payment reform as a reasonable initiative to be explored. Having done my research and pending Sen. Rosen's approval, I hope to help draft a bill in the 117th Congress that will direct CMS and the CMS Innovation Center to develop a model addressing the transfusion payment formula. If transfusion services are included in Medicare hospice reimbursement, I believe we will see cost savings from reduced Medicare spending on emergency department visits, hospital admissions, and other health care visits, along with better end-of-life care. I am still working my idea up the office chain of command and hope to help promote a tangible CMS policy shift.
These are just a fraction of the diverse opportunities I am presented with, and the issues are informed by current health care policy, the breadth of the Senator's interests, constituents' concerns, and the rapidly changing circumstances that define Congressional service. I have been welcomed as a member of Sen. Rosen's health policy team and, while hematology/oncology issues remain my primary interest, societal, governmental, and constituent needs have introduced new areas of interest that I had not anticipated.
Coupled with the American Association for the Advancement of Science's opportunities for formal education, the fellowship experience is extraordinary. Being the low man on the totem pole is a valuable lesson in professional reorientation, and one I recommend. It's not about me, as I remind myself and my patients; it's about advocacy.
Disclaimer: The content of Notes From the Hill is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.