Last year, the American College of Cardiology Political Action Committee (ACCPAC) celebrated its ten-year anniversary. I have been asked to comment on some of the events which motivated the ACC to form the ACCPAC.
Beginnings of the ACCPAC
I served as the first ACCPAC chair and worked with the ACC staff in the development of the governance structure and the bylaws of the ACCPAC. Dr. Senator Tom Coburn of Oklahoma met with us at the Heart House in Bethesda, MD, to give us his insight and knowledge regarding PACs and the political process. At that time, I was involved with the Florida Medical Association Political Action Committee (FMAPAC), serving on the board, and ultimately as PAC president. The FMAPAC is one of the largest Medical PACs in the country. The FMAPAC has been very successful in its efforts to elect members to the state legislature who are pro-medicine and pro-patient. Florida, in recent years, has passed several pieces of legislation to address medical malpractice and tort reform that would have never passed without the FMAPAC. Our experience in Florida demonstrated the need for the ACC to engage in the political process and led to the creation of ACCPAC.
Florida's Self-Referral Law
Florida passed a Self-Referral Law several years before the Federal Stark law was enacted. Both laws have a provision, called practice exemption, which allows for practices to perform diagnostic imaging procedures (CT scans, MRI, Nuclear and PET) on both the practice's patients and outside patients, who were referred for diagnostic imaging studies but never became formal patients of the practice. The Florida law used the word "substantial" to limit the practice exemption and thus reduce the number of tests on non-practice patients.
In Tallahassee, Florida, there was only one MRI machine owned and operated by Tallahassee Memorial Hospital (TMH). There was a wait to obtain an MRI. To meet the demand and improve patient access, the large orthopedic group led by Dr. Wingo acquired an MRI machine. The orthopedic group performed studies on their established patients as well as a substantial number of non-practice patients, including those unaffiliated with the practice and referred by other physicians. Needless to say, the hospital and the local radiologist were not pleased with this development. The orthopedic practice asked the Florida Board of Medicine to issue a Declaratory Statement regarding the legality of accepting non-practice patients for diagnostic imaging. The Board of Medicine ruled in favor of Dr. Wingo citing the practice exemption clause in the Florida self-referral law.
Wingo in Court and the Impact
TMH responded to the Board of Medicine's statement by taking Dr. Wingo to court. Ruling in favor of the hospital, the First District Appeals Court of Florida issued an opinion stating that Dr. Wingo could not perform MRIs on his patients if a "Substantial" number of those patients were referred by outside physicians. The court's interpretation of the law, the so-called "Wingo Law," applied to physicians beyond Dr. Wingo and his practice. The court's decision prohibited cardiology practices from doing diagnostic imaging on referral patients. At the time I was chair of the FLACC government relations committee, and the FLACC Board of Governors gave me the task of fixing this misinterpretation of the law. To do so, required me to advocate for changes to the law by lobbying the state legislature.
The Florida Chapter leadership met with the ACC leadership and staff. The ACC was sympathetic, but the ACC Foundation's organizational structure prevented it from pursuing the advocacy efforts that would be necessary. But as a wise old Miami surgeon told me years ago, "Politics got us into this mess, and Politics will get us out of this mess." We had to become political -- and fast. The ACC informed us that Florida was not unique. Self-referral laws were popping up in states across the country; systematically, cardiologists were being prevented from conducting diagnostic imaging tests in their offices or clinics nationwide.
Creation of a 501(c)(6) Entity
The ACC reinvented itself rather quickly; it created a 501(c)(6) entity that is able to undertake advocacy efforts -- all while maintaining the 501(c)(3) Foundation arm for the important science, education, and quality initiatives for which the College is famous.
Why Should You Give to the ACCPAC?
So why is it important that the ACC has a PAC and why should you contribute to it? The simple answer is that we must have the resources and tools that guarantee the access we need to tell our side of the story to our elected officials. Being able to deliver a PAC check to a US Senator, Congressman, or a political candidate provides Cardiology with the best opportunity to highlight the progress the College is making in Quality, Appropriate Use, and the advancement of Medical Science in front of elected politicians and candidates in state capitals and in Washington, DC. The ACCPAC opens up doors that allow us to publicize the great things that we do in terms of taking care of patients with heart disease and how our services are vital to improving communities across the country. ACCPAC also enables us to advocate for medicine-friendly public policy. We can comment on proposed legislation and how the legislation may help or hurt our practices and our patients. If cardiologists are not represented at campaign and legislative events showing our support and advancing our perspective, then who will represent us? The radiologists and the Hospital Association will be there. They get it. Cardiology needs to be there, too. Support yourself and your profession. Please make a contribution to the ACCPAC.
