Washington Scene: An Interview with Rep. Larry Bucshon

STS News, Summer 2016 -- Cardiothoracic surgeon Larry Bucshon, MD is both an STS member and a member of the United States House of Representatives. Rep. Bucshon (R-IN), who is running for reelection this year in Indiana’s 8th District, shares his thoughts on pressing issues facing the specialty, the value of connecting with legislators at all levels of government, and the change of pace between the operating room and Capitol Hill.

What are the most important legislative issues in the health care arena right now?
I think the most important thing is what CMS is doing as it relates to MACRA, the SGR replacement legislation. We need to make sure that as members of Congress, we have appropriate oversight. It does sound like for the most part, CMS has been listening to societies like STS during this process, but that’s what we’re working on. 

The other thing, which is applicable to all of medicine, is the opioid situation. I have legislation, as do many others in the House and Senate, to address the opioid crisis that we have in our country.

I also think that Meaningful Use [requirements related to the mandatory use of electronic health records] is an important issue, in terms of how it affects the ability of people out in the communities to practice medicine and how it’s going to be involved in assessing quality and helping to determine payment.

What are some of your biggest achievements in health care?
Obviously, one of the biggest achievements has been replacing the SGR with MACRA. It’s pretty hard to top that. It’s been a priority of mine since I’ve been in Congress, since the SGR was putting a lot of uncertainty into the health care system every year for seniors and providers.

Also, Dr. Ami Bera from California and I worked in a bipartisan way to essentially stop CMS from eliminating global surgical payments. For cardiovascular and thoracic surgeons, this is a big deal. I feel really good about the fact that we were able to get leadership on both sides to recognize that this would be a failed policy.

What can cardiothoracic surgeons do to help you resolve these issues?
It’s very important to be engaged, not only at the federal level, but also at the state and local levels. As cardiothoracic surgeons, we carry a lot of credibility. When STS members talk to legislators, their voices are really heard.

Here in Washington, I can tell you that it’s important for me—even though I understand cardiothoracic surgery—to continue hearing what’s actually happening in the field day to day and what challenges there are. I performed my last surgery almost 6 years ago, so things have already changed dramatically. There’s no replacement for personal contact and one-on-one conversations with your legislators. That doesn’t mean things are always going to go our way, but I can tell you that they won’t go favorably to our specialty if legislators don’t have input from people who are in the field practicing every day.

That’s one of the reasons I ran for Congress in the first place. I felt like we, as physicians, needed to have more of a voice in government.

Rep. Bucshon (center, holding plaque) received the Society’s Legislator of the Year Award in recognition of his extraordinary efforts promoting issues of importance to cardiothoracic surgeons.

How has the Society in particular contributed to your achievements in Congress?
I think STS has been an important player in moving SGR replacement forward and continues to be very important as CMS develops its rules related to MACRA. The Society also has been very involved in talking with CMS and giving advice to legislators like myself on reimbursement issues, as CMS has not necessarily been following the RUC recommendations for reimbursement decisions.

I think STS and other specialty societies and primary care organizations have had a tremendous impact on the legislative direction of Congress. Without the input of these organizations, I don’t think the SGR would have been repealed and replaced with MACRA.

Also, just helping members of Congress understand what our specialty does, how we help patients, and how important that is to the overall makeup of the health care system has also been very important.

Is there anything else you want to say to STS members?
I just want to reiterate the importance of being engaged politically at the local, state, and federal levels. The voices of surgeons in practice do matter, and people are listening. Even though the wheels of change seem to be moving slowly, without that engagement, our voices would just not be heard. Trying to advance the goals of our specialty and ensure our continued ability to treat patients would be hampered without that engagement.

"The voices of surgeons in practice do matter, and people are listening."

Rep. Larry Bucshon, MD

Extended Version: Online-Only Questions

How has your training and career as a cardiothoracic surgeon prepared you to serve in Congress?
I think physicians are very well-prepared to be in government. Throughout our training, we learn to look at a problem, develop a solution, and then act. Legislating is very similar. First, you identify legislative issues, you work together as a team to find solutions, and then you act on those solutions to get to the end goal.

Are there any differences between being a Congressman and being a cardiothoracic surgeon?
I think the big difference, and something that I miss and that you can’t really get anywhere other than health care, is the personal interaction on a daily basis with patients and family members. You do that in politics, but it’s not as personal and as day-to-day.

The other thing that can frustrate me is the pace. The pace of change, solving problems, and coming up with solutions is much more tedious and slow in government than it is in day-to-day cardiothoracic surgery practice. You have to be more patient and persistent as a legislator sometimes than you have to be as a cardiothoracic surgeon.

Why is it important for STS members to contribute to the PAC?
The STS-PAC is extremely important because STS needs the resources to interact with legislators in Washington. Without the financial resources given to the PAC from STS members, that interaction would not be possible.