Advocacy Update

Political Climate—by Bob Siggins, Alston & Bird

With the government funding battles for FY 2024 finally wrapped up in March, the key committees in Congress finally turned their attention in the second quarter to new business and work streams, including a couple in the Senate Finance Committee where ACLM has been very active and expects to continue to engage with the committee staff and Member offices.

In early April, the Finance Committee held a hearing titled “Bolstering Chronic Care Through Medicare Physician Payment” to kick off a longer-term legislative effort in that space.  ACLM submitted a lengthy Statement for the Record following that hearing focusing on the major role lifestyle medicine must play in any approach that hopes to achieve real success in addressing the chronic care epidemic our country is facing.

The Committee followed up with a lengthy white paper on the same topic, titled “Bolstering Chronic Care Through Physician Payment: Current Challenges and Policy Options in Medicare Part B.”  ACLM filed detailed comments in response to that document as well and will be scheduling follow up meetings to discuss those comments with key committee staff and personal office staff for Committee Members active on these issues as Finance works through this legislative process.

In addition to its work stream on physician payment and chronic care, the Finance Committee also issued a Request for Information (RFI) on Graduate Medical Education (GME) seeking to address physician shortages resulting in part from a lack of residency slots, as well other issues with the Medicare-funded program.  ACLM submitted comments to that RFI focusing on the need to increase the amount and quality of the curriculum focused on nutrition and other pillars of lifestyle medicine as well as the comprehensive curriculum ACLM has developed in this space leading to partnerships with residency programs across the country.   We will be following up here as well with key committee staff and offices who are part of this GME working group.

Along with these legislative efforts ACLM has been engaged in, we have continued to work with the Department of Health and Human Services (HHS) in an effort that began in late 2023 focused on actions HHS can take to advance Food Is Medicine through increased focus on nutrition education for physicians across the spectrum of medical education.  Needless to say,  ACLM has been front and center in these discussions, with the next session scheduled for later in July.

With the number of days left on the Congressional calendar rapidly diminishing with the traditional August Congressional recess nearly upon us and only a brief return in September before they adjourn for the campaign season leading up to Election Day, all eyes in the healthcare space are on the so-called “lame duck” session expected in December and the possibility of a significant package of health care policies advancing as part of a larger package.  The headliner in all of this is the expiration of the Medicare telehealth regulatory relief that was initiated during the pandemic and has proven to be a popular innovation in care delivery.  Congress is expected to extend that relief, likely for two more years, as well as address other expiring provisions and well-developed legislative efforts in other areas of health care.  We are hopeful that some provisions from the current work streams on physician payment reform and GME may be included in such a package, as well as other provisions related to Food Is Medicine that have advanced to varying degrees through the legislative processes.

A “Seat at the Table”

• ACLM President Beth Frates, MD, FACLM, DipABLM, and ACLM Senior Director of Research Micaela Karlsen, PhD, represented ACLM at the Food is Medicine Institute’s Second Annual Food is Medicine National Summit in Boston, April 24.
• ACLM Executive Director Susan Benigas and ACLM Medical Director of Education Brenda Rea, MD, DrPH, PT, RD, DipABLM, LM Intensivist, participated in a three-hour, by-invitation Department of Health and Human Services (HHS)-hosted expert call, “Food is Medicine: Provider Education Opportunities Virtual Workshop” on May 3rd. ACLM had a strong voice there, with additional representation by ACLM partner Jennifer Trilk, PhD, FACSM, DipACLM, representing the University of South Carolina Greenville School of Medicine/ LMEd;  ACLM Board Member Melissa Bernstein, PhD, RDN, LD, FAND, DipACLM, representing Rosalind Franklin University; and member Brad Moore, MD, MPH, DipABLM, representing George Washington University.  This was the first of multiple convenings that the HHS team plans to host, with a goal to publish a formal plan of action no later than September. We urged that there are immediate action steps that can be taken, including helping to amplify ACLM’s free “Lifestyle Medicine and Food as Medicine Essentials” course to clinicians throughout our nation’s FQHCs.
  
• ACLM Deputy Director and Senior Director of Strategy and Innovation Martin Tull moderated a panel on the power of partnerships for impact in food as medicine at NeilsenIQ’s Food as Medicine Summit in Chicago May 21-22. It featured health systems, community-based organizations, and food retail and technology leaders discussing the need for more cross-sectoral partnerships.  He also produced and facilitated a workshop at the Thinc360 Healthcare Innovation Conference in Washington, DC, May 29-31, featuring three diplomate leaders and sharing case studies on the clinical use of FAM in primary care.
• ACLM was inducted into the American Medical Association (AMA) House of Delegates at its meeting on June 10. Executive Director Susan Benigas was in attendance, accompanying ACLM Immediate Past-President Cate Collings, MD, FACC, FACLM, DipABLM, who is ACLM’s inaugural delegate, and Samuel Lin, MD, PhD, MBA, MPA, MS, ACLM’s inaugural alternate delegate. Read about this and other ACLM members and ABLM diplomates in AMA leadership here.
  
• Padmaja Patel, who had been serving on the Advisory Group of the Primary Prevention Committee of the Partnership for Quality Measurement, is now part of the Recommendation Group, which makes endorsement decisions.

Responses to Requests for Information

ACLM submitted the letters during Q2 on the following:

• A statement for the record in response to the April 11^thSenate Finance Committee Hearing “Bolstering Chronic Care through Medicare Physician Payment”
• Comments to the Senate Committee on Finance’s white paper, “Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B”
• Comments to the Medicare “Graduate Medical Education Working Group Policy Proposal”

News releases

• ACLM issued a news release, “American College of Lifestyle Medicine supports proposed law requiring protections for children from ultra-processed, sugar-sweetened foods and beverages (prweb.com).”

Sign-on Letters

ACLM signed on to the following letters originated by other organizations:

• To House and Senate Appropriations leaders regarding funding for the NIH’s Office of Nutrition Research (originated by the Friedman School ofNutrition Science and Policy at Tufts University and Friends of the Office of Nutrition Research)
• To Cigna expressing concerns with its forthcoming policy that will require the submission of office notes with all claims including evaluation and management services and modifier 25 when a minor procedure is billed (originated by the AMA)
• To the sponsors of R. 2474, the Strengthening Medicare for Patients and Providers Act, supporting the adjustment of Medicare Fee Schedule payments annually for inflation (originated by the AMA)
• To a letter by Partners in Health United States (PIH-US) and the National Association for Community Health Workers (NACHW) on 3892 – the Community Health Worker Access Act.
• To a coalition letter by the International Bottled Water Association (IBWA) to Congress on support for inclusion of water on MyPlate.
• To a letter by the Coalition for Health Funding and NDD United calling on Congress to reject arbitrary and damaging funding levels for Fiscal Year 2025 and, at the very least, to fully appropriate the necessary non-defense discretionary (NDD) funds to keep pace with rising costs and demand and keep poison pill policy riders that undercut the priorities of the American people out of the package.

White House Conference on Hunger, Nutrition and Health Update

• As of the end of June, there have been 44,844 enrollments in the free “Introduction to Lifestyle Medicine and Food as Medicine Essentials” course. The course was part of our $46 million commitment in support of the strategy announced at the September 2022 White House Conference on Hunger, Nutrition and Health. Enrollment remains open until September 2025.
• ACLM announced that 112 Federally Qualified Health Centers (FQHCs)/Community Health Centers (CHCs) are represented in the inaugural cohort of its Lifestyle Medicine National Training Initiative(NTI). An effort to equip clinicians with education, tools and support needed to address lifestyle-related chronic disease health disparities, it is also part of ACLM’s $46 million commitment in support of the White House Conference on Hunger, Nutrition and Health. In partnership with national and community-based organizations and the American Board of Lifestyle Medicine (ABLM), ACLM will award $2.1 million in matching funds to train and certify one primary care provider in lifestyle medicine within each FQHC and CHC across the United States. The inaugural cohort of the NTI scholarship awardees represent 37 states and include primary care physicians, physician associates and nurse practitioners who will champion lifestyle medicine efforts at their respective facilities. The application opened in January and nearly 200 providers across the United States and globally have applied to date.

Bills We’re Watching

Two bills were marked up the last week of June and passed out of the House Ways and Means Committee, :

• R. 8816, which includes language to include a Medically Tailored Home-Delivered Meals 23 Demonstration Program.
• R. 4818, the “Treat and Reduce Obesity Act of 2023 (TROA) that would allow Medicare to cover of obesity drugs, but only for those who were already taking the medications, and direct HHS to review the national coverage determination of intensive behavioral therapy for obesity.

Congressional Physical Activity Challenge

• During ACLM partner the Physical Activity Alliance’s fourth annual bipartisan Congressional Physical Activity Challenge that took place in May, the Office of Senator Cynthia Lummis (R-WY) came out on top in both the “Total Team” category as well as the “Highest Team Average” category.

Health Equity

• ACLM Director of Health Equity Advancement StaciaJohnston joined ACLM advocacy partner organization The Root Cause Coalition (TRCC) panelists (Michellene Davis, National Medical Fellowships; Toni Jones, CareSource; Jeff Smythe, Archi Collaborative; and Stacy Wathen, Children’s Hospital Association) for a TRCC Advocacy Day on Capitol Hill May 15, speaking on our HEAL health equity efforts. She also met with staffers from Rep. Mike Turner’s office (R-OH); Rep. Hank Johnson’s office (D-GA); Rep. Mark Alford’s office (R-MO); Rep. Jill Takunda’s office (D-HI); Sen. Todd Young’s office (R-IN); and Sen. Mitt Romney’s office (R-UT).

Of Note

• A Congressional group led by Rep. Jim McGovern wrote this letter to the Accreditation Council for Graduate Medical Education (ACGME) about the inclusion of nutrition education in medical education.