Don’t look for much to happen in Congress through the end of the year: It's an election year, and there are too many seats at stake.

In fact, it's been quiet since July, said Ted Burnes, director of RADPAC, in his “Washington Update” at the RBMA meeting in Seattle this week. Burnes pulled back the veil to reveal the inner workings of Washington, DC, and the influence that radiology’s RADPAC aims to have on Capitol Hill in 2015.

With the November elections just a few weeks away, Burnes broke down the tight races: In the House, 17 of 435 races are considered to be competitive, and more of them are seats currently held by Democrats. The real interest, however, is in the Senate. With seven Democrats and just two Republicans vulnerable, Burnes expects Republicans will regain that legislative chamber.

“The Republicans would need to net six seats in order to take over the majority,” Burnes says. “If (Sen. Mitch) McConnell (R-KY) wins, which is expected, and (Sen. Pat) Roberts (R-KS) holds on, which probably will happen, with (Sen. Mark) Pryor (D-AR) down, (Sen. Mary) Landrieu (D-LA) down, (Sen. Mark) Udall down (D-CO), (Sen. Mark) Begich (D-AK) down, that’s four. Then you have Montana, South Dakota and West Virginia that are going to go Republican—it looks like the Republicans are going to take the majority by just a couple of votes.”

What would that mean for radiology? It’s hard to say, said Burnes, but a couple of votes are not likely to make much of a difference in the balance of power: “The way they are set up with their legislative rules, in the Senate, you really need 60 votes.”

The lame duck session following the election is expected to produce action on just one front, the funding bill for the government, although Burnes does predict that our very reactionary Congress will produce some sort of bill on the Ebola threat.

Musical chairs

Depending on what happens with the elections and who moves into the prime committee seats, 2015 could also prove less than eventful. The presidential election will begin in earnest next year and could have a chilling effect on activity, as legislators defer action until candidates are chosen.

Rep. Dave Camp (R-MI), chair of the House Ways and Means committee is retiring, as is Rep. Henry Waxman (D-CA), ranking Democrat of the Energy and Commerce Committee, which also has healthcare jurisdiction.

The new chair of the House Ways and Means Committee is likely to be Rep. Paul Ryan (R-WI), which could be beneficial for several of radiology’s causes, such as funding for virtual colonoscopy and lung cancer screening.

“Paul Ryan believes in dynamic scoring, which currently does not exist in Washington,” Burnes said. Unlike the method of scoring a bill used by the Congressional Budget Office, which takes into consideration the cost of a service only, dynamic scoring takes into account downstream savings generated by the service. “That could be helpful for us, because he knows that spending a little can save us a lot down the road,” Burnes said.

Potential also exists for upheaval in the leadership of both chambers. If the Democrats lose control of the Senate, will Sen. Reid remain their leader, Burnes wonders. The possibility also exists that the Republicans could take the Senate and Sen. McConnell could lose his race.

2015 outlook

No matter what happens in Congress, the ACR is looking at a full legislative agenda in 2015, beginning with the expiration of the SGR patch in March. 

“Because of all of the turnover here, there is no way there will be a permanent fix in March, so my guess is what they will do is punt for another six-month patch,” he said.  “When you get to September, then you can look at an opportunity to have a permanent fix.”

Any day now, the ACR expects to receive data from the CMS that was used to calculate the multiple procedure payment reduction to the professional component, a transparency measure mandated by the Protecting Access to Medicare Act of 2014, better know as the SGR patch. Sketchy data could trigger a legislative response from the college.

Other issues on the ACR action agenda include:

• 21^st Century Cures. The initiative is under the radar at the moment, but Burnes expects that it will soon get a good deal of attention. A pet project of Rep. Fred Upton (R-MI), the initiative calls for increased research funding and also will include copious telemedicine language. “Keep your eye on that, on what happens when it comes to state licensure laws and how lenient they want to be about allowing folks to practice across state lines,” Burnes said, “We’re working with some stakeholders with regard to this issue.”
• Self-referral. If the Republicans take hold of the Senate, closing the Stark laws’ in-office ancillary exception is unlikely. "This is a partisan issue: Republicans do not want to add additional regulation or tell people they can't practice medicine in a certain way," Burnes said.
• Clinical decision support. The ACR will need to work with CMS on the implementation of CDS for CT, MRI, nuclear medicine and PET studies billed to Medicare beginning January 1, 2017.
• Lung cancer screening. “If CMS comes back with an answer that we may not like, there’s a good chance we are going to push pretty strong for a legislative coverage decision on that,” Burnes said. “It’s going to be hard, because we are asking Congress for Medicare reimbursement for services they don’t currently cover.”

Expanding sphere of influence

In the greater sphere of political influence, RADPAC is just one of 4,300 registered PACS in Washington, DC; and one of 145 health provider PACs. Among health provider PACs, RADPAC is typically ranked second or third in donations.

Three years running, RADPAC has exceeded 3,000 contributors; six years in a row, RADPAC has raised more than $1 million in contributions. This year, neither goal has been met, but Burnes noted that the year is not over yet.

Beginning several election cycles ago, RADPAC began leveraging independent expenditure, which enables the PAC to spend unlimited funds (beyond the $5,000 per candidate for primary elections and $5,000 per candidate for general elections) to advocate the election or defeat of a candidate.

This year, RADPAC invested more than $1 million in independent expenditures, which can result in higher visibility than straight campaign donations.  “We can have a big impact, because we are not a partisan group, we are a professional group of radiologists,” Burnes says. “Our group has supported Republicans, our group has supported Democrats, our group supports who is best for our patients. When you have that message out there, it resonates far more than just saying, ‘Obamacare is horrible, vote for the Republicans.’”

RADPAC recently contributed $100,000 to the campaign of Rep. Upton, chair of the Energy and Commerce committee, who has supported radiology’s legislative issues.  “He had $1.5 million dumped against him from a super PAC called Mayday,” Burnes said. “If he wins, he will appreciate the fact that we had his back.”

RADPAC also spent $80,000 on web and print ads advocating the reelection of Sen. McConnell, a donation noted and tweeted by watchdog David Levanthal, much to Burnes delight.

“Senator McConnell may or may not know we did it,” Burnes said. “Of course, we want him to know, but we can’t coordinate with him because that is part of the independent expenditures parameters.”

Feeling heat

Burnes felt some heat this year when RADPAC declined to support two radiologists running for office, George Flinn, who ran against Sen. Lamar Alexander (R-TN), and Milton Wolf, who challenged Sen. Roberts in the Kansas Republican primary.

“Sometimes we pick based on what is best for us globally,” Burnes said. “Some people don’t like the fact that we went against radiology, but when we knew one had no chance and the other had ethics issues, that’s not the best use of our money.

The fact that Sen. Alexander will also become chair of the Health, Education, Labor and Pensions committee was not lost on Burnes. “It’s not a bad deal to make that chairman happy,” he noted.

In closing, Burnes made a pitch for support beyond the 3,000 contributors who are funding RADPAC. “Since 2010, more than 40% of Congress members are new,” he said. “Many of them do not know how healthcare works. They need resources and people like us to be friendly and helpful to them.”

He adds: “Members of Congress do not miss fundraising events. They miss votes, they miss hearings, they miss meetings with constituents. They don’t miss fundraising events.  They need money.”