Owais Durrani, OMS-IV
February 2018 OHPI

March 13, 2018


elcome back! It has been only a few short weeks since I last updated y’all, yet I have experienced so much in that time. I have truly enjoyed the process of learning something new every day. One thing that has taken some getting used to is the number of acronyms that are used in DC. It reminds me of anatomy from the first week of medical school! The two themes that stand out since my last update are the release of the President’s fiscal year (FY) 2019 budget and the continued emphasis on finding solutions to the opioid crisis.

FY19 Budget Release

Each year, the President of the United States submits a budget request to Congress for the following fiscal year as required by the Budget and Accounting Act of 1921. The law’s goal was to consolidate spending across agencies in both the executive and legislative branches of government. The act also created the Office of Management and Budget (OMB), which reviews funding requests from government departments and assists the President in formulating the budget. Once the budget is submitted, it is referred to the House and Senate Budget Committees. There have been many years when Congress was unable to pass a budget resolution by the end of the fiscal year. In these instances, Congress can pass a continuing resolution, under which the previously passed budget remains in effect until legislators enact a new budget deal. One final note about the process is that the President’s budget serves as a guide for Congress and indicates where the President’s priorities lie. The recommendations for spending and tax policy signify to Congress the President’s preferred agenda, but ultimately, Congress decides how federal money is allocated and divided.

In mid-February, the President submitted his budget for FY19. To say our office was busy that morning would be an understatement! The osteopathic medical education issues under AACOM’s purview fall under various government agencies. My assignment was to look at the proposed budget for the U.S. Department of Health and Human Services (HHS). HHS manages many crucial programs, including the Teaching Health Center Graduate Medical Education Program, the National Health Service Corps, and health professions opportunity grants, to name a few. I helped analyze how the proposed budgets for these programs changed from their current levels. Once we studied the budget proposals, we had a better idea of how the President’s proposals meshed with AACOM’s policy agenda. Read AACOM’s statement on the President’s FY19 budget proposal.

The FY19 budget fun doesn’t stop there!

The next step in the process is for members from the Administration to attend hearings on the budget called by Committees of Jurisdiction. I had the opportunity to attend the U.S. Senate Committee on Budget and the U.S. House Ways and Means Committee hearings with OMB Director Mick Mulvaney and HHS Secretary Alex Azar as witnesses, respectively. During the hearings, legislators had the opportunity to ask Administration officials about various components of the budget, how it would affect their constituencies, and ways Congress and the Administration could work together to achieve mutual goals. The in-depth conversations taught me how every nut and bolt of the budgeting process has a purpose and deep meaning to constituents across our country.  

More On The Opioid Crisis

Funding for the opioid epidemic was included in the President’s FY19 budget as well as in the Bipartisan Budget Act of 2018, which passed in February.

Educating providers on how to manage pain is a topic that has come up in many committee hearings. In addition to the use of non-opiate medications, committee hearings I have attended have emphasized treating pain with a long-term mindset, rather than only acutely. Any treatments ring a bell? Yes, Osteopathic Manipulative Treatment (OMT)! As osteopathic medical students and future osteopathic physicians, OMT is an important non-pharmacologic treatment that can complement, or even replace, drugs. Our training allows us to bring an important dimension to standard medical care.

Thanks For Coming Back

If you have not already, I encourage you to sign up for the ED to MED campaign! Medical school can be overwhelming at times with the course work, rotations, boards, and the thousand other things in our lives—the ED to MED campaign makes it easy to keep on top of important issues affecting us and provides clear steps on how to get our voices heard. Thanks for joining me again and even more so for your advocacy! We have many state and national level advocacy days coming up, so if I can be of any help, please let me know. I am always happy to share any resources or talk more about my experiences.

Owais Durrani, OMS-IV
February 2018 OHPI

February 22, 2018

Introduction to Your Policy and Advocacy Nerd!

Hello everyone! My name is Owais Durrani and I am a fourth-year medical student at Oklahoma State University Center for Health Sciences College of Osteopathic Medicine. During the months of February and March, I have the opportunity of interning with the AACOM Government Relations (GR) team in Washington, DC. I am truly looking forward to learning about the complex world of health and higher education policies and how they affect our learning and practice environments. I will be blogging about my adventures every two weeks and look forward to bringing y’all along for the ride.

If you ask my friends what my interests are, the first answer will almost universally be policy/politics. Thinking back, ever since I was in the 5th grade I would watch the evening news with my parents and be intrigued by domestic and international events. As I became older, that curiosity continued to grow and eventually led me to major in political science. It was then that I realized the power of advocacy: a simple concept—organizing citizens around an issue they are passionate about and engaging with our democratic institutions to influence public policy. Throughout medical school, I have advocated for policies supporting students and the osteopathic profession—many of those efforts were organized by AACOM GR. I hope to learn about how the passion we all have as medial students can be manifested into a movement that creates better outcomes for students, physicians, and our patients.

What is Negotiated Rulemaking?

My first encounter into the world of policymaking was at a negotiated rulemaking session convened by the U.S. Department of Education (USDE). I had never heard of federal negotiated rulemaking before, and upon further inquiry and my firsthand experience, learned that it is a process used by federal agencies that involves the convening of relevant interest groups and government representatives, with the goal of achieving consensus in the development of a proposed federal regulation.  

The process includes:

  • The government agency, in this case the USDE, determines the issues to review and publishes a notice announcing its intention to establish a negotiated rulemaking committee in the Federal Register.
  • The Federal Register notice includes a public call for nominations of negotiators with expertise on the issues identified by the USDE to serve on the committee.
  • The USDE selects the negotiators, and a series of negotiated rulemaking sessions are held.
  • During these sessions, the committee often takes “temperature checks” on various issues. This is done via thumbs up, down, or sideways from negotiators.
  • This process gives the USDE a sense of how the negotiators feel on an issue and can take that into account when drafting regulatory proposals.
  • If the committee reaches consensus, the USDE uses the agreed-upon language in their draft regulations. However, if a consensus is not reached, then the USDE moves forward in the regulatory process and discretion regarding whether it will take into account discussions from the committee.

I had the opportunity to attend session two of the gainful employment (GE) negotiated rulemaking. The stakeholders in this series of negotiations included financial aid administrators, organizations representing veterans and student interests, representatives from large public institutions, and other relevant parties. There was a lot of energy on all sides of the negotiating table on this issue.

At one side of the auditorium was the USDE, at the other were members of the public, and in the middle the negotiators. I would describe the scene as what democracy was envisioned to be like so many years ago. Every negotiator spoke with passion and conviction in their view point. It was exciting to see negotiators debating issues, while government officials took direction and offered input from their perspectives as well. The public nature of this stage truly stood out to me.

The Opioid Crisis

As a student that plans to go into emergency medicine, I had the chance to rotate in numerous emergency departments across the country during my fourth-year of medical school. A common theme in all of them was seeing drug overdoses in patients of all ages, genders, and ethnicities. A good number of these overdoses were due to opioids.

I was excited to attend hearings regarding the opioid crisis by the Senate Health, Education, Labor, and Pensions Committee and the House Ways and Means Committee. I learned about prevention strategies, how we can better treat pregnant mothers addicted to opiates, and how to ensure that Medicare meets the needs of those affected by the epidemic. Two very important things stood out to me from these hearings—the bipartisan nature of the hearings and the personal stories from witnesses. It was refreshing to see that members from all sides of the political spectrum were genuinely interested in understanding and solving this issue. The solution-oriented conversations demonstrated how important it is for health care professionals to engage with our legislators and help them understand how we move forward.

See You Next Time!

One of the primary themes that drew me to medicine, like many of you, is the ability to help our communities. Programs like the Teaching Health Center Graduate Medical Education Program, National Health Service Corps, and Community Health Centers allow physicians to do just that—help the most vulnerable of our neighbors. AACOM has advocated for these vital programs tirelessly for the past few years, and last week those efforts paid off! Congress passed the Bipartisan Budget Act of 2018, which funded these programs through fiscal year 2019. Being able to see firsthand those advocacy efforts come to fruition is an amazing feeling. We have so much more work to be done and I look forward to writing about some of the topics that will need our energy and advocacy in upcoming blog posts. Thanks for joining me on this journey, please send me a message if you want to chat about anything policy related, and I look forward to updating you soon!

Katie Kaeppler
Katie Kaeppler, OMS-IV
October 2017 OHPI

November 16, 2017

Welcome back, readers! It’s been another exciting few weeks in Congress, and I’m excited to share the news from some of the events I attended recently. This week, I’ll give you brief updates on the opioid crisis and veterans’ health. Since we have a lot to talk about, let’s dive right in!

Update on the Opioid Crisis

On November 1st, the President’s Commission on Combating Drug Abuse and the Opioid Crisis released their final recommendations. The report expands upon the interim recommendations released by the Commission this past July, on which AACOM submitted comments. In these comments, AACOM highlighted efforts by the nation’s osteopathic medical schools and osteopathic medical education community to combat the opioid epidemic and the issue of substance abuse across the country.

The final report starts with an in-depth look at the historical factors contributing to the development of the crisis. Did you know there was a smaller-scale opioid crisis about 100 years ago? I didn’t before reading this report. After reviewing the root causes of the current epidemic, the Commission offered 56 specific recommendations to the Administration, Congress, and relevant federal agencies regarding programs to expand, research to invest in, and legislative priorities to support. Some interesting points to note are:

  1. The Commission placed significant emphasis on improving patient education about painkillers. This was discussed from multiple angles. On one front, the Commission highlighted the need for patients receiving pain treatment to have a better understanding of their options, including alternatives to medication and awareness of the addictive potential of opioids. The Commission also expressed strong support for educational advertising campaigns to increase awareness of the dangers of addiction and diversion (when patients move from licit to illicit opioids), similar to the tobacco intervention not too long ago. Their concern centered largely around teens and young adults, but the Commission still recommended that marketing strategies be targeted to broad audiences.
  2. Expanding access to treatment was identified as a critical component for reversing the opioid epidemic. The Commission noted that changes in access could come in all different forms. Some examples they listed include increased telemedicine capabilities to reach rural populations, improved treatment strategies for inmates during and after incarceration to protect them from relapse and overdose when they are most vulnerable, and expanded mental health treatment opportunities for patients with both a substance use disorder and other mental health disease.
  3. The Commission repeatedly emphasized the need to view opioid and other substance use disorders as a disease rather than a crime. They stressed that patients with substance use disorders should not be treated through the law, and advocated expansion of drug courts to keep people struggling with addiction out of criminal courts. In this light, the report was highly focused on expanding mental health treatment and reducing the stigma of addiction.

The report is very comprehensive and offers much more than I’ve covered above, including appendices detailing the current programs in place to combat the opioid epidemic. I’m excited to see how this report shapes the future response to the opioid crisis, and I hope that someday we can look back to this point as a milestone in turning the tide on the opioid epidemic!

Veterans’ Health

Last week, I had the opportunity to attend a two-day meeting of the Veterans’ Rural Health Advisory Council (VRHAC). As a future physician, I was interested in their strategies for recruiting new health care providers to the U.S. Department of Veterans Affairs’ (VA) Veterans Health Administration hospitals; as the sister of a Marine and significant other of an Airman, I was interested in their mission to expand access to care to all veterans, regardless of location.

The Council’s meeting was specifically focused on workforce issues, as many veterans living in rural areas suffer from lack of access to care. The VRHAC spent most of the two-day meeting brainstorming ways to improve rural veterans’ health care access by expanding their health care workforce in both numbers and geographic location. The chairman of the Council announced on the first day of the meeting that the Secretary of the VA specifically asked for bold ideas for improvement from this advisory council, and encouraged committee members to dream big when making their recommendations. The Council members—most of whom were veterans themselves—passionately rose to this challenge. It was inspiring to witness and encouraging to note that this Council was ready to fight for the care of their rural veterans.

From a workforce perspective, the Council faced a two-pronged problem: how to recruit health care professionals to the VA in general, and how to recruit them to VA medical facilities in rural locations in particular. The Council acknowledged that salaries were generally lower through the VA than private hospital systems, so they worked to find ways to highlight the other benefits of the VA instead. Some of the unique aspects of VA employment to which they hoped to call attention included the excellent benefits given to workers and their families, the ability to use a widely integrated electronic records system that followed veterans over a lifetime to any VA facility, and the chance to work with cutting edge technologies in areas such as telemedicine. They also wanted to find a way to share the intangible benefits that VA service could provide—namely, the chance to work with a wonderful patient population and provide service to those who have served the country. They felt that these benefits would be better appreciated with actual experience in a VA during medical school, and sought to increase student and resident exposure to VA systems during their medical education. They also thought it would be helpful to create a database of information about medical students who did a rotation at the VA so that they could more easily follow up with them after graduation, once they were looking for employment.

Recruiting professionals to a rural location posed some unique challenges. Representatives from VA health professions recruitment programs noted that providers who leave rural sites often cite social isolation and lack of opportunities for their spouse and/or children as major reasons for moving to a more urban site. Rather than try to change these fundamental characteristics of rural living, the Council discussed at length how to better recruit health professionals from small or rural towns, with the thought that these future providers would then return to an area similar to their hometown to provide service. The Council worked to incorporate this idea of early rural recruitment into their final recommendations to provide to the Secretary of the VA.

I rotated through the VA in Leavenworth, Kansas, while completing my internal medicine rotation in my third year, so it was interesting to hear the Council’s discussions while picturing that small hospital in my mind’s eye. From my own personal experiences, I thought that they were right to highlight intangible benefits such as the great patient population, and were spot-on when identifying challenges specific to rural locations. Attracting medical professionals to rural areas is not a goal unique to the VA, so I’m sure that their recommendations and the successes that result from them will be of great interest to other health care organizations in the future!

That’s All, Folks

That wraps up another OHPI blog! As always, thank you for your readership. You can always reach out to me if you’re interested in the events I attended or reports I discussed, because there are way more details to these issues than what I have time to include here! I’ll be back in two weeks for my fourth (and final!) OHPI blog, so stay tuned for one more edition.

October 27, 2017

Wow! Somehow my time as an Osteopathic Health Policy Intern (OHPI) is already halfway over. I guess time flies when you’re having fun! These past two weeks continued to be packed with interesting meetings and daily excitement from the Hill as the battle to reform health care continues. Let me give you the important updates.

The Opioid Crisis

Yesterday, President Trump officially declared the opioid crisis a national public health emergency. This designation is important because it opens new avenues for funding and legislation that will hopefully expedite efforts to combat the substance use disorder epidemic. The full impact of this announcement is not yet apparent, so for this post I’m going to focus instead on what has evolved over the last few weeks.

First and foremost: You can play a role in helping curb the opioid epidemic. October 28th (this Saturday!) is National Take Back Day, where any and all unused medications can be returned to a pharmacy, no questions asked, and will be disposed of properly there. Find a participating pharmacy or learn more about National Take Back Day.

national Prescription Drug Take Back Day. Turn in your unused or expired medication for safe disposal Oct. 28, 2017

Many of you probably watched the recent 60 Minutes episode that focused on the far-reaching effects the opioid crisis has had across America. Early last week, I had the opportunity to attend a meeting hosted by the Washington Post (who co-produced the episode and did much of the investigative journalism behind the scenes), which focused on how people across private organizations, government bodies, and local initiatives have collaborated to address the opioid crisis. Representatives from health care and government organizations shared their thoughts on what progress has been made and what needs to be done in the future.

The meeting was specifically influenced by the recent 60 Minutes episode, and much of the questioning focused on the fallout caused by a bill enacted in April 2016 called the Ensuring Patient Access and Effective Drug Enforcement Act. This bill, reporters argued, makes it much harder for the Drug Enforcement Administration to effectively prevent opioid trafficking. After learning more about its impact, all three Senators present at the meeting expressed support for the repeal of the legislation.

The meeting also featured testimonials from a family that was affected by the crisis and an interview with the CEO of Leidos that centered around how large companies can play a role in helping their employees deal with this epidemic. Both the CEO and the family agreed that, from a private sector perspective, it seemed like the main reason this epidemic was still raging across the country was because everyone thought of it as “someone else’s problem.” One mother who spoke about her son’s battle with addiction said her family never knew how to handle what he was going through because problems like addiction “just didn’t affect families like ours.”

Leidos’ CEO pointed out that management tends to take the same view regarding their workers, which was true in his case until a few of his company’s employees were forthcoming enough to ask for help. Many more employees then came forward and discussed how they or a close friend or relative were affected by the epidemic, and sought help through their workplace. He said that employees spend the majority of their lives at work, so by extension, workplaces could be considered a viable place for employees to find health care resources. He called on CEOs of all companies to help de-stigmatize this epidemic by making prevention and addiction treatment resources easily available to their employees.

I also had the privilege of observing the fourth meeting of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by Governor Chris Christie. The meeting focused on insurance companies and their role in combating the opioid epidemic. Each company gave testimony about what they were doing to mitigate opioid use and abuse and offered their recommendations about legislative and regulatory changes that would make it easier for them to partner with providers and patients. One challenge that all insurers highlighted was the difficulty they had in obtaining information about prescribing or use habits that would help them identify patients at increased risk for addiction earlier on. Many also noted the difficulty in transferring prescription drug monitoring program information across state lines.

Governor Christie acknowledged the work each company had done so far, but stated that the Commission’s report was going to call on each of them to do much more in the future. The Commission members were particularly interested in insurer coverage of mental health services and alternative treatments for pain, and they implored the insurers to play a bigger role in creating access to preventive and treatment services for patients struggling with addiction.

The Commission is set to release its final report on November 1st, so I’ll give you many more updates in the next blog!

Loan Repayment Programs

Each AACOM OHPI has the opportunity to work on a policy project during our time in DC. My interest centers around why medical students choose to enter primary care (or, more importantly, why they don’t) and, on a related theme, how to reduce health care disparities by improving specialty and geographic distribution of providers. While there are a whole host of factors that play into these decisions, one major reason that young doctors eschew primary care in favor of specialty medicine is money.

This may sound greedy or self-serving, but the reality is that the average osteopathic medical student graduates with nearly $250,000 in debt, and many have debt loads that are even higher. To put it in perspective, that’s a decent-sized house in the suburban Midwest, or about seven brand new Jeep Wranglers (my favorite car). Those in primary care specialties have a lower average earning potential, therefore asking someone shouldering a small house’s worth of debt to forego half a million dollars per year in salary can be challenging.

I want to pause here and offer the caveat that, in my opinion, most medical students don’t enter medicine for the money. Most students choose their specialty based solely on interest and love of the patient population. However, there is a significant segment of the student population that is torn between equal love for multiple specialties and, when it comes down to it, end up choosing the field that will provide best for them and their family. The question I’m working to answer is: how do we get these “swing voters” to decide on a primary care field?

One answer is loan repayment programs that help reduce debt burdens on young doctors. There are many federal programs available that offer loan relief in exchange for service in a particular region, often a medically underserved area. The programs are generally available only to students who plan to practice in a primary care field. Medical students can take advantage of loan repayment programs available through the National Health Service Corps, Indian Health Service, and National Institutes of Health, to name a few.

Last week, I had the chance to participate in a webinar put on by AACOM Government Relations staff around its grassroots campaign, ED to MED, which works to highlight graduate and medical student debt issues and advocates for policies that support these students. One program we discussed, in particular, was the Public Service Loan Forgiveness Program, or PSLF. The PSLF Program allows young professionals to make income-based payments on their loan balance for 10 years if they work for a non-profit or a government entity, after which the remainder of their loan balance is forgiven. The program is not only for doctors--it’s open to students from many service-oriented fields including teachers, social workers, nurses, and more.

Many federal agencies, such as the U.S. Department of Health and Human Services and the Health Resources and Services Administration, have stated their vested interest in programs that develop the primary care workforce. However, as you might imagine, programs like these are prone to being cut from the budget because of their associated costs and the nebulous, long-term nature of their benefits. Grassroots campaigns like ED to MED are crucial for protecting programs like the PSLF so that future students can make decisions about their career based on personal interests and workforce needs, rather than being directed by their loan burden. If you’re interested in ED to MED, you should read more about the campaign here:

We’ll Wrap It Up Here

I could talk much, much more about the primary care workforce, loan forgiveness, and the opioid crisis, but I’ll save some topics for next time! I’ve enjoyed sharing my DC experience with all of you readers so far, and I hope you’re finding this information helpful.

Thanks for reading, and as always, stay healthy my friends!

October 20, 2017

A Little Introduction

Hi readers! My name is Katie Kaeppler and I’m a 4th year medical student from Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM). Most importantly, I have the awesome privilege of being the new Osteopathic Health Policy Intern (OHPI) here at AACOM for the next two months! My medical passion lies in pediatrics (which you probably could tell by the excessive use of exclamation points), a field that lends itself well to policy work because the health of children is so heavily dependent on their environment.

My advocacy interests originated while doing volunteer work in Kenya, when I met a little girl who came to the clinic to receive surgery for correction of club feet. Her parents told me they knew of another family with a little boy who suffered from the same condition, but he would never receive treatment because his family couldn’t afford the journey to the clinic. I was frustrated to know that the little boy’s bright future was going to be ruined by a simple lack of access. That experience made me realize that medical care was about so much more than medicine itself, and marked the beginning of my interest in effecting change at a higher level.

My interest continued to develop through my work in management for an Electronic Medical Records company before starting medical school, where I realized it was important for physicians to know how to stand up not only for their patients, but also for themselves.  Once I reached medical school, l learned a lot about policy and management through KCU’s DO/MBA dual-degree program, but I knew that an on-the-ground experience would be the best way to turn my background learning into real-life lessons I could use in my future career.

Katie Kaeppler in front of the U.S. Capitol

I’m excited to arrive in D.C. at a time when there are so many important health care issues being discussed, and I can’t wait to share some of my experiences as an OHPI through this blog! But that’s enough about me. Let me tell you about what I’ve seen so far.

The Opioid Crisis

On the third day of my internship, I attended the Senate Health, Education, Labor, and Pensions Committee’s hearing on the federal response to the ongoing opioid crisis. This hearing was the first in a series of hearings designed to give the Senate greater insight into what has been done to combat the opioid crisis so far, what has been working, and what still needs improvement.

Expert witnesses gave testimonies and answered individual Senators’ questions about their field of expertise. The expert panel consisted of representatives from the U.S. Food and Drug Administration, U.S. Health and Human Services, the National Institutes of Health, and the Centers for Disease Control and Prevention. These agencies have played major roles in the fight against the growing number of opioid addictions and overdose deaths, and highlighted some major points, including: 

  • The need to develop better non-opioid alternatives to treat pain, either through novel drugs that are non-addictive or work on non-opioid pain relief pathways, or non-medicinal options such as acupuncture, massage, or devices such as implantable neural stimulators.
  • The need to address that, based on witness testimony, about 20% of people newly exposed to opioids for acute pain still use opioids a year later.
  • The need to shift perception of addiction from a criminal act to an illness. Multiple Senators emphasized the need to remove the stigma of addiction and allow it to be treated as a true illness rather than a failure of character.

It was encouraging to hear the amount of passion each person expressed in combating this problem. Each of the Senators shared how the opioid crisis has affected their state, and there was a palpable sense of urgency in doing more and funneling funding towards the right places to attack this problem from all angles.

Graduate Medical Education (a.k.a. Residency!)

If any of you readers are fourth-year students like me, your brain is currently focused on one thing: residency. This past week I had the opportunity to attend a full-day conference that centered around improving graduate medical education, or GME. Attendees ranged from representatives of the American Council of Graduate Medical Education and the National Board of Medical Examiners to residents and program directors. The goal of the conference was to come up with reasonable, actionable recommendations for how to better evaluate the quality of current GME programs and, based on those recommendations, discuss future directions that programs should consider taking.

One of my main takeaways from this conference was the emphasis the entire group put on the need to measure outcomes rather than inputs. I know that sounds like typical diluted government-speak, but the translation is very important. Essentially, conference attendees realized that it was much more important to answer questions such as, “Do residents feel prepared for practice when they graduate?” or, “Do graduates of certain GME programs have better clinical outcomes than others?” than it was to use the current evaluation measures, which focus on hours spent doing certain activities or specific numbers of procedures completed.  In short, many people realized that it was more important to look at how residents were doing than what residents were doing. This has important implications for residents and programs going forward, so I’ll keep you all updated on any changes that are made based on the recommendations that resulted from the conference.

Another GME-related topic that we’ve been keeping our eye on is the reauthorization of GME programs done through teaching health centers, or THCGME. These programs were designed to fill gaps in care in rural and underserved areas, as well as increase residency positions available to new graduates. Congress recently authorized a three-month funding extension for teaching health centers to keep the hospitals afloat. Without congressional action, the program would have expired on September 30th. The House of Representatives is now considering a bill that would extend THCGME funding through September 30, 2019.

Many hospitals have been forced to undergo layoffs or reductions in services due to the uncertainty of continued funding after the start of the new year. At a webinar I attended last Friday, the National Association for Community Health Centers shared data about how this unexpected “funding cliff” has affected their member hospitals. Many hospitals have been forced to undergo layoffs or reductions in services due to the uncertainty of continued funding after the start of the new year. However, the group shared encouraging news as well. They applauded the many physicians, nurses, and other hospital staff who contacted their legislators about this issue, and talked about the important new legislation that has been drafted in response to their hard work.

Two bills that would reauthorize funding for two more years for community health centers and many of the programs they support, including THCGME, are working their way through the House and the Senate with bipartisan support. I’ll keep you posted as these bills undergo many markups and changes in the next few weeks!

Some Parting Thoughts

These first few weeks have been a whirlwind, but they have been wonderful. In the hearings I’ve attended so far, I was surprised by how much Senators were impacted by personal stories. It reinforced to me the importance of contacting your legislators and sharing your own thoughts. Because of this experience, I plan to be much more active in advocacy going forward.  I’m excited to see how future conversations on the opioid crisis and so many more issues go in the coming weeks.

Hopefully you’ve enjoyed this first post! If you have, look for another one in about two weeks. I’ll give you updates on the issues we already talked about, and the insider scoop on some new ones as well. Until then, stay healthy my friends!

Fritz Stine selfie on DO Day
Frederick (Fritz) Stine, 

March 2017 OHPI

Selfie taken with almost 1,000 osteopathic medical students in D.C.
May 17, 2017

Fritz SteinHealth Care Repeal Takes a Leap Toward the Senate

Welcome back, my friends, for the third and final installment of the blog depicting my misadventures on Capitol Hill! For those of you just tuning in, my name is Fritz Stine, OMS-IV, with the University of Pikeville Kentucky College of Osteopathic Medicine (UP-KYCOM) and I am the current AACOM Osteopathic Health Policy Intern. If you haven’t read my two previous posts, check them out below!

I know it’s hard to believe but SO much has happened since my last post and the wave of compelling news has hit the Hill hard! Below is just the tip of the news iceberg:

  • The House passed the GOP-synthesized American Health Care Act (AHCA) by a slim margin of 217 to 213, successfully sending the bill to the Senate for consideration. However, the plot thickens. Many Senate Republicans have noted that they may be crafting an entirely new bill. The Congressional Budget Office also announced that it will release its score of the revised AHCA on May 22! Keep your finger to the pulse of this story, folks, cause it’s gonna get live!
  • Insurance providers continue to drop out of state exchanges or publicly claim that they will not be offering Affordable Care Act-specific insurance plans in 2018. Aetna recently announced that it will not be offering plans in 2018, leaving Delaware and Nebraska with just one insurer apiece to provide such plans.[1]

There are also multiple efforts springing forth to make the world a more charitable place. Let’s talk about a few of them!

Week 6 – “Exploring Solutions to Violence and Abuse” and the “13th Annual AAMC Workforce Conference”

Week 6 hit the ground running! I started out by attending a briefing sponsored by the non-profit organization Futures Without Violence with the theme, “Public Health Crisis: Solutions to Violence and Abuse.” This briefing was one of the more powerful experiences I’ve had in a Hill briefing, as those in attendance were shown video footage of individuals affected by intimate-partner violence and drug abuse. These individuals shared compelling testimony about how these destabilizing social determinants of health caused their lives to spin out of control. Afterward, they shared how Futures Without Violence and similar non-profit organizations helped them get back on their feet.  

Session at the 13th Annual AAMC's Workforce ConferenceIf you remember, week 5 was almost entirely devoted to the Joint AACOM & AODME 2017 Annual Conference. Following this, I attended the 13th Annual Association of American Medical Colleges’ Workforce Conference! This year’s conference had the theme, Working Together for Health: Aligning the Health Workforce with Population Needs,” and focused not just on the physician workforce shortage but also on the critical nursing shortage our country now faces, and so much more. The presentations I found most compelling regarded the Department of Veterans Affairs (VA) health system and health workforce realignment strategies. The VA health system talk focused primarily on fellowships the VA offers (i.e., VA Quality Scholars Program), panel management, and curriculum creation for attracting health care students to the VA as a learning hub. The health workforce realignment talk was fascinating as well, because it spoke to the different technologies and management systems being pioneered that can aid health systems in analyzing workforce needs in real time and filling the employment and need-based gaps to create more functional workforce systems. With so many great minds together in the same room, it certainly made me confident that there are practical solutions to the critical workforce shortages that the medical profession faces.

Week 7 – “House Appropriations Subcommittee Hearing on Veterans Affairs Oversight” and “A Rising Tide Lifts All Boats!”

House Appropriations Subcommittee hearingWith week 7 being my last full week on the Hill, I was very excited to learn that I would have the opportunity to attend the House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies hearing on veteran’s affairs oversight. The key witness during this hearing was none other than Secretary of the VA, the Honorable David J. Shulkin, MD. With this being the committee’s first opportunity to publicly interview Secretary Shulkin, many members of the committee wished to inquire about proposed solutions to some of the VA’s most challenging current issues. Among those discussed, most pertinent were the budget increase, the Veterans Choice Program and “Choice 2.0,” opioid abuse among veterans and alternatives to narcotic pain relievers, the appeals and benefits backlog, and the Secretary’s perceived notions on privatizing portions of the VA health system. In response to what was arguably the most pressing issue, the potential privatization of the VA health system, Secretary Shulkin noted that while he has no intent of privatizing the entire VA, there are some aspects of the VA that he recommends outsourcing, such as the electronic medical records system and care sought by veterans outside of the VA system (which is seen in the “Choice 2.0” initiative). There are many interesting developments ahead in this debate!

Lastly, this week saw the culmination of my independent study project for my internship, which was focused on researching grassroots movements. With the title, A Rising Tide Lifts All Boats, I sought to answer three primary questions about grassroots movements: (1) How is the concept of the grassroots movement defined in the literature? (2) How are these movements formed and what causes people to join? and (3) How do organizations measure the effectiveness of the movement? Organizational Research Services (ORS) outline six key categories of measurement:

  1. Shifts in social norms: Advocacy and policy work focuses closely on this value, as grassroots movements typically seek to align themselves with core and enduring social values and norms.
  2. Strengthened organizational capacity: This includes improving staffing and leadership, organizational structure and systems, finances, and strategic planning of nonprofits and formal coalitions that perform advocacy and policy work.
  3. Strengthened alliances: This allows for an organization to band together with others to create larger, denser power structures.
  4. Strengthened base of support: “The breadth, depth, and influence of support among the general public, interest groups, and opinion leaders for particular issues are a major structural condition for supporting policy changes.”[2]
  5. Improved policies: Most organizers and non-profits will use this measurement as their gold standard of measuring success. However, it should be noted that this category cannot occur in a vacuum and typically occurs as a result of achieving success in the other categories.
  6. Changes in impact: This encompasses the long-term changes achieved through advocacy (i.e., the effect felt within the community and amongst individuals) (Reisman, Gienapp, & Stachowiak, 2007).

These six core guidelines can be used effectively by any organization to #MeasureTheMovement to ensure that a grassroots endeavor is striving for its goals productively and is headed in the right direction. In my opinion, these metrics of success were one of the more important findings of my research, with far-reaching implications in both the worlds of organizing and community medicine, and I will certainly come back to these guidelines later in my political life.  

Alas, All Good Things Must Come to an End…

Well, my friends and dutiful readers, I am afraid that we have come to the end of the line, as the end of my internship is imminent. Firstly, I wish to thank you, reader, for taking the time to follow my adventures! It has been a true pleasure! Secondly, a HUGE shout out to the AACOM Government Relations team, without whom I would not have had this excellent experience. It has been an absolute honor! Lastly, I wish to give one more shout to the #EDtoMED campaign, which seeks to educate medical students about legislation that affects their graduate-level higher education and student loan debt burden, and what they can do about it. You can visit the ED to MED website at, follow the campaign on Twitter at @ed2med, and connect on Facebook at Ed to Med. Again, thank you so much for reading and, as always, take care, be well, and don’t forget to connect with #EDtoMED!

[2] Reisman, J., Gienapp, A., & Stachowiak, S. (2007). A guide to measuring advocacy and policy. Baltimore: Organisational Research Services ( pdf).

May 2, 2017

Congressional Spring Recess Is Over and It’s Time to Get Back to Work!

Greetings again, friends! In case you forgot or are just tuning in, my name is Fritz Stine, OMS-IV, and I am currently the AACOM Osteopathic Health Policy Intern (OHPI)! As I dive head first into week five of this eight-week internship, Congress is just returning from their two-week recess and their current schedule is chock-full of activity, to say the least! A few of the topics that have dominated the headlines recently include:

  • The GOP effort to repeal and replace the Affordable Care Act (ACA) in time for President Trump’s 100th day in office
  • The timeline for stabilizing insurance markets to maintain current ACA coverage
  • Congress’s spending budget to keep the federal government running

This is certainly a dramatic time here on Capitol Hill! Humor me a moment and let me show you some of the deeper policy waters I have been wading in these last couple of weeks.

Week 3 – “The Future of Rural Medicine” and “Health Care Goes from Volume to Value!”

Roundtable presentation: The Future of Rural MedicineAt the outset of my third week, I had the opportunity to observe the proceedings of the National Advisory Committee on Rural Health and Human Services, which is a panel of 21 experts in rural health issues which convenes to advise the U.S. Secretary of Health and Human Services, Dr. Tom Price, on ways to meet the health care needs of rural America (photo at left). For me, this meeting was so valuable to attend because the committee discussed the rural “upstream social determinants of care,” which are the social issues that either prevent individuals from seeking care (i.e., lack of transportation, living more than 35 miles from a critical access hospital, lack of insurance) or that directly impact the care they receive (i.e., living in an economically depressed community and being unemployed, being an IV drug abuser and contracting hepatitis). The panel spoke about the current lack of availability of health services in rural America and how this has destabilized insurance markets, pushed ACA exchanges to the brink of failure, and been exacerbated by Medicare debt loads on regional hospitals. Having gone to school in a rural community, this hearing was positively eye-opening to the struggles of providing rural medicine.

Session: Securing the Future of Value Based PaymentI also had the opportunity to attend a forum titled, “Securing the Future of Value-Based Payment,” which was sponsored by Health Affairs, the self-described leading peer-reviewed journal at the intersection of health, health care, and policy (photo at right). This forum focused on what some of you may know as the inevitable shift in health care delivery culture from “volume to value,” or rather, it’s not about how many patients you see but how well you deliver care. The panelists mainly discussed current efforts being taken to transition our system toward value-based payments, and even took on the thorniest question of all, “If the value of something is in the eye of the beholder, how do you standardize and measure it?”

Week 4 – “The Future of Health Care” and “How Much Does This Prescription Really Cost?”

Attendees at the Future of Health Care sessionMy 4th week on the job started with the epic task of attempting to tackle the future of health care at a forum hosted by The American Cancer Society and The Cancer Action Network (photo at left). This forum focused primarily on what patients need and can expect from a reformed health care system, some of the subtleties of the changing health care landscape, and what the practical issues are behind implementing a replacement health care package in Congress. This forum was incredibly educational because some of the brightest minds in health care today came together to talk about innovative ways to work within and fix some of the ACA’s most difficult issues. For example, not only did the forum discuss flipping the system upside-down and spending more to address the social determinants of health care, but they also talked about a total restructuring of the state-wide insurance markets to allow for states to work together in “regional markets.”

Attendees at the Future of Prescription Drugs seminarTo add another proverbial Jenga piece to the top of the delicate tower that is health care in America, I next attended a forum on the future of prescription drugs in the context of a value-based market hosted by The Atlantic magazine (photo at right). This dizzying discussion on the real price of pharmaceuticals made it easy to understand why, after a period of relative drug expenditure slowing, we are beginning to see a steep rise in the cost of prescription drugs borne by the consumer (Cox et al. 2016). Panelists spoke about the lifecycle of a drug and how, when you pay for a prescription, you are paying for that drug, the research and development that went into it, and for all the failed drugs that never made it to market. In this way, the pharmaceutical companies can recoup their lost investments and continue to operate. In closing, one of the panelists noted that value may not necessarily mean that drugs will be cheaper, but it should mean that patients get more bang for their buck.

Week 5 – #EducatingLeaders17 at the Joint AACOM & AODME Annual Conference

Selfie at Ed to Med BoothThis week was, by far, the most jam packed and “flyin’-by-the-seat-of-my-pants” week that I have had in Washington. Week five saw the beginning of the five-day Joint AACOM & AODME Annual Conference titled, “Educating Leaders: Integrated Health Systems, a Paradigm for the Future.” The conference addressed current and emerging issues in osteopathic medical education (OME) for individuals across the medical education spectrum, from deans of medical colleges to students. Each day was full of splendid workshops and lectures dedicated to the furtherance of OME. I also had the opportunity to meet some strong student and faculty advocates at the ED to MED booth and even managed to take a few selfies!

Screen displaying 'What is Ed to Med'One particularly enlightening talk was the Thursday morning plenary session with Matthew Kelleher, MD, and Benjamin Kinnear, MD, titled, “From Bedside to Milestones: Successes and Stumbles While Building an Assessment System.” These two physicians from the University of Cincinnati created a new learning assessment tool over the course of the last seven years that focuses on maximizing resident training potential and supporting individual strengths while identifying and correcting deficiencies. Another innovative workshop that I attended was entitled, “Addressing Health Disparities in Osteopathic Medical Education.” This talk focused primarily on how we can structure our curriculum to address social determinants of health, such as homelessness or food insecurity. The talk was led by J. Aaron Allgood, DO, FACP, a faculty member of A.T. Still University School of Osteopathic Medicine in Arizona and full-time physician with Circle the City Medical Respite Center, which is a non-profit community health organization dedicated to providing high quality, holistic health care to people experiencing homelessness in Phoenix, AZ.

Ed to Med Town Hall speaker, Pamela Murphy, MSWOn the second-to-last day of the conference, AACOM’s Office of Government Relations hosted an ED to MED Town Hall to raise awareness about the campaign, provide an update on its first-year accomplishments, and inspire others to become advocates in support of the future physician workforce. The town hall was moderated by AACOM’s Senior Vice President of Government Relations, Pamela Murphy, (photo at left), who led a panel comprised of professionals and a medical student, including AACOM’s President and CEO, Stephen C. Shannon, DO, MPH, through a discussion about their advocacy efforts and what their visions were for moving forward. It was also at this town hall that the ED to MED campaign announced its exciting strategic alignment with multiple organizations throughout the medical spectrum, such as the American Medical Student Association, Student Osteopathic Medical Association, and many others who have signed on to endorse the ED to MED campaign principles. This town hall was an exciting opportunity to rally students, physicians, and deans alike to the cause of crafting responsible, common sense solutions to soaring student debt in osteopathic graduate medical education.

See you again next time…

Well folks, this signals the end of another installment of my health policy intern blog spot. It has been an exciting five weeks so far and I so look forward to continuing to share this experience with you further. We will continue to see how things on the Hill unfold and will continue to advocate on behalf of osteopathic medical students, osteopathic physicians, and most importantly the patients whom we serve. Remember, you can visit the ED to MED website at, follow the campaign on Twitter at @ed2med, and connect on Facebook at ED to MED. Until next time, take care, be well, and don’t forget to connect with #EDtoMED!

Works Cited: Cox, C., Kamal, R., Jankiewicz, A., & Rousseau, D. (2016). Recent Trends in Prescription Drug Costs. Jama, 315(13), 1326-1326.

Apr 14, 2017

A little bit about your new author …


reetings, reader!! My name is Fritz Stine and I am a 4th year osteopathic medical student from the Kentucky College of Osteopathic Medicine in Pikeville, Kentucky! I am so grateful to share that I will be your health policy intern with AACOM’s Government Relations (GR) office from March 27th to May 17th! I will be posting on this blog throughout the course of my internship about my policy misadventures in our nation’s capital, so make sure you don’t miss out!

A little bit about my policy interests …

Being in Washington, DC for two months sampling the entire health care policy landscape can be overwhelming, particularly at a time when the American health care system is such a hot topic. While I will be attending all kinds of meetings on behalf of AACOM GR, I will try to blog only about the particularly juicy stories that may interest you, reader. I want to make sure that you get the VIP, inside scoop of what is going down in the health care policy scene on the Hill.

Topics that I will likely be exploring in the coming weeks:

  • Medical student advocacy on the Hill and on the grassroots scene
  • Affordable Care Act (ACA) repeal efforts
  • Higher education and student loan repayment efforts (e.g., AACOM’s ED to MED grassroots advocacy campaign … more on this later)
  • Health care finance (aka “How does all this health care stuff get paid for?!?”)
  • Health care workforce issues in rural America (e.g., the physician shortage)

Secretary Tom Price testifying on proposed budget cutsSo, how did my first week go … ?

The Osteopathic Health Policy Internship (OHPI) has already been an experience like no other, and there is never a dull moment! The AACOM GR staff are tireless advocates for osteopathic medical students and the profession, and they certainly expect the same from their interns! In my first week on the Hill, I was fortunate enough to have had the opportunity to sit in on a Health and Human Services (HHS) budget hearing with Secretary Tom Price testifying (pictured above) in defense of proposed budget cuts to the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) for Fiscal Year (FY) 2017, and of the President’s “skinny budget” proposal for FY18. 

While Secretary Price came to the meeting with the intention of laying out his public health policy priorities for the next four years, he was also inquired about the HHS plan for the ACA, the proposed cuts to the CDC and NIH, and how the HHS would deal with the current opioid epidemic. However, the Secretary largely exempted himself from providing logistic details of the budget, which he stated would be further expounded upon in May. Secretary Price noted that his public health policy agenda items would be to focus primarily on the opioid crisis, substance abuse, the childhood obesity epidemic, mental health, and emergency preparedness and responsiveness. As a medical student, it was particularly thrilling to be present at this hearing because I know that the legislation being debated has the power and authority to alter the way physicians practice medicine.

National Public Health Week seminarAlso in my first week, which just so happened to be National Public Health Week (#NPHW), I had the opportunity to attend a day-long seminar entitled The Affordable Care Act: What’s Next? at the George Washington University Milken Institute of Public Health. (at right) This seminar brought together some of the most influential and brilliant minds in public health to discuss three sets of issues: 

  1. ACA—Achievements, Challenges, and What Comes Next
  2. Health Insurance, Hospitals, and Economic Considerations
  3. Population and Public Health Issues

I know what you’re thinking: this sounds like a total nap-factory. And I get where you’re coming from, but once you realize how vitally integral these factors are to the health of our communities and our families—once you bridge the understanding gap—you begin to see just how mysterious and intriguing this subject matter really is!

Week 2 – Advocating for Change: Going Live on Capitol Hill

KYCOM students with Kentucky Representative Brett Guthrie.My second week as an OHPI was dominated by advocacy. This spring, I took part in two events on Capitol Hill—AACOM’s COM Day on Capitol Hill and the American Osteopathic Association’s (AOA’s) DO Day on the Hill—that brought together osteopathic medical students, deans, and physicians in practice to advocate on behalf of our patients, communities, and profession. (Photo: KYCOM students from the Bowling Green area in Western Kentucky met with their Representative, Mr. Brett Guthrie.)

KYCOM delegation with Sen Paul Rand on DO Day 2017(Photo: The KYCOM delegation had a meeting with Sen. Rand Paul to discuss GOP healthcare efforts and his thoughts as a physician-legislator.) During these advocacy days, we shared our stories with policymakers about primary issues that affect the health care profession. AOA’s DO Day emphasized advocacy on behalf of Teaching Health Centers Graduate Medical Education, while AACOM’s COM Day urged students to share their stories on graduate student loans, the reauthorization of the Higher Education Act, and federal public service scholarship and loan repayment programs. Graduate student loans are a very important piece of the puzzle because in 2017, osteopathic medical students will routinely graduate from their four-year program with over $240,000 in student loan debt. AACOM sparked a revolutionary new campaign, ED to MED, which seeks to educate medical students about legislation that affects their graduate-level higher education and student loan debt burden, and what they can do about it. You can visit the ED to MED website at, follow the campaign on Twitter at @ed2med, and connect on Facebook at Ed to Med.

Ed to Med logoCiao, au revoir, aloha, auf wiedersehen, see ya’ next time …

Well, reader, that’s it for our first post! I hope that you enjoyed hearing about my first two weeks on the Hill! Stay tuned for my next post, wherein I will share more advocacy mysteries, more intense conference photos, and who knows … maybe even some DC foodie pics! Thank you so much for reading and, as always, take care, be well, and don’t forget to connect with #EDtoMED! 

Harika Kantamneni

Harika Kantamneni,

February 2017 OHPI
Mar 17, 2017

Hi everyone! I hope you’ve been enjoying reading my blog posts as much as I’ve enjoyed writing about my experiences as an OHPI. Sadly, my time in DC is coming to an end and this will be my final posting. I want to take this chance to talk about AACOM’s COM Day, which took place on March 8. COM Day is the only lobbying day that focuses exclusively on issues pertaining to osteopathic medical schools and students. The primary issues we focused on this year were graduate student debt, the reauthorization of the Higher Education Act, and the sustainment of graduate medical education (GME)—issues in which I’m sure you all have a vested interest.

Each school’s delegation consisted of the Dean or another school lead, along with a few osteopathic medical students. The University of Pikeville - Kentucky College of Osteopathic Medicine’s (UP-KYCOM’s) team contained Dana Shaffer, DO, Associate Dean for Osteopathic Graduate Medical Education, along with myself and three other students. This manageable team size allowed for all voices to be heard, and helped advocates be strategic about framing their message efficiently as a group.

Each delegation met with the offices of the Senators and Representatives of their respective schools. Most of these meetings were with the elected officials’ staff members and occasionally, some delegations met directly with their lawmaker. The UP-KYCOM team met with staff members from the Kentucky delegation: Senate Majority Leader Mitch McConnell (R), Senator Rand Paul (R), and Representative Harold Rogers (R-5th). We also visited the offices of Representatives Brett Guthrie (R-2nd) and Thomas Massie (R-4th), both from Kentucky and with whom UP-KYCOM has long-held relationships.

One thing to focus on during congressional meetings is letting students share their personal stories. Most congressional offices are familiar with the issues that are important to osteopathic medical students, thanks to AACOM’s Government Relations team and other organizations. And even if policymakers and their staff are not familiar with the issues, it’s easy for them to acquire information. Students’ stories were a unique contribution. Personal experiences are a direct testimony about the effects of the policies being contemplated and/or enacted on Capitol Hill. Congressional staff holds personal student stories in high regard and genuinely want to hear from you.

On our team, Dr. Shaffer would begin each visit by discussing the Teaching Health Center Graduate Medical Education (THCGME) Program and Medicare-funded GME, along with brief mentions of the legislation we support. But we soon transitioned to our student personal stories. During this time, I shared my perspective as a fourth-year student who went through the process of applying and matching into residency, and I emphasized the importance of continued funding for GME. I explained how I had applied to residency programs at Teaching Health Centers, and while there is strong interest from osteopathic medical students in this program, the lack of certainty about funding prevents the THCGME program from reaching maximum effectiveness. I explained in detail how medical students are cautious about attending a residency program that might not have funding during all years of their training.

My story highlighted for several staffers how residency training at these programs would be adversely affected if the funding for THCs is not reauthorized. A fellow fourth-year also shared his personal story of applying to residency programs. He focused on the importance of continuing or potentially increasing funding for Medicare GME. Listening to students who’ve experienced the impact of GME legislation seemed to have a significant effect on the congressional staffers. Similarly, the other students in our group talked about the necessary reauthorization of the Higher Education Act and then shared their own personal stories. At the end of each meeting, we all shared how much total student debt we have accumulated, and how much interest we are accruing every single day—years before we have the chance to start working. Many of the congressional staffers could relate, and even shared with us their own stories about student loans that they are still paying off.

Overall, the day was a huge success. Our group delivered our message with an effective combination of technical legislative details we support and personal student stories. The congressional staffers in every office were very receptive to us and loved hearing directly from osteopathic medical students. And while COM Day might be over for this year, that does not mean my advocacy efforts stop. I will continue to advocate for osteopathic medical students throughout my career, and I hope you’ll do the same.

If you have any questions about how to become involved in advocacy or about this internship, or if you just want to chat about medical school, please don’t hesitate to reach out to me.

Thanks to the fabulous GR team at AACOM for making my internship so memorable, and I’m glad I could share it with you all!


Harika Kantamneni, OMS-IV
AACOM Osteopathic Health Policy Intern

Feb 10, 2017

Hello everyone, welcome back to AACOM’s Osteopathic Health Policy Intern (OHPI) Program blog. I am Harika Kantamneni, a fourth-year student at the University of Pikeville – Kentucky College of Osteopathic Medicine (UP-KYCOM). I recently matched into an American Osteopathic Association (AOA) obstetrics & gynecology program and will be starting my residency in the fall of 2017. I am very excited to be spending these two months with the AACOM Government Relations team in my favorite city: Washington, DC. 

Upon arrival at the office, everyone kept telling me that I am in DC at a very opportune time. I quickly understood what they meant, as my schedule immediately started filling up with congressional hearings, policy conferences and briefings, and numerous other meetings related to health care and higher education policy.

One particularly important and educational event I attended was the annual National Health Policy Conference, hosted by AcademyHealth. This year’s theme was “A First Look at the Evidence, Politics and Priorities Shaping Health Policy in 2017,” an area of discussion which I’m sure is of great interest to many of you. The various plenaries and concurrent sessions called upon the nation’s health policy experts to provide clarity and insight on the trajectory of health care policy. The conference opened with AcademyHealth’s President Lisa Simpson introducing the acronym VUCA (Volatility, Uncertainty, Complexity, and Ambiguity), a term she believes offers a general feel of the current state of health care policy in DC. The term was referenced throughout the conference, and I’ve heard it mentioned at other events I’ve attended.  

During the two-day conference, I heard speeches from various elected officials, including Senator Bill Cassidy (R-LA), House Minority Leader Nancy Pelosi (D-CA), and Senator Tim Kaine (D-VA). Senator Cassidy detailed the various plans he and other Republicans have put forth as possible replacements for the Affordable Care Act (ACA). He emphasized the need to restore the states’ authority to make decisions regarding health care. Both Rep. Pelosi and Senator Kaine acknowledged that the ACA has problems that need to be fixed but that complete repeal is not a viable option. Additionally, Senator Kaine stressed the importance of including health professionals and other stakeholders in the conversation during this process. It was encouraging to hear from lawmakers who are willing to work together to improve the law for the benefit of the public.

I also attended multiple panel discussions on a variety of topics. My favorite was “The Journey from Health Care to Population Health,” which focused on the intersection and synergy of patient care and population health. The panelists examined how the changing payment and measurement systems are transforming health care. They examined some of the newer care-related models and discussed lessons learned. Additionally, they discussed the overlap of health care delivery systems and public health, and how both are moving toward a stronger population health focus. Some of the other panel discussions I attended focused on the politics of universal health care from the perspective of states, the future of reproductive health care, and developing evidence-based policy to address the opioid epidemic. There were also plenary sessions by former congressional staff and members of the media providing perspectives on the future of health care.

Beyond the nitty-gritty details of health policy, a few overarching ideas took prominence that I would like to share with you. First is the importance of advocacy at the individual level. While there is strength in numbers with organizations like AACOM and the AcademyHealth, politicians ultimately listen to their constituents, which is you! I encourage you to reach out to your senators, your representative, your governor, and make your voice heard! This point was made several times by Senator Kaine and other speakers. And this leads to the second point: put a face to the numbers! As health professionals we are very data-oriented people, but when it comes to advocacy, personal stories make a difference. So write a letter to your elected officials and share your story, or tweet to them about medical student debt. As Dr. Simpson said during the conference, “data makes you credible, stories make you memorable.”

If anyone wants to learn more about the issues I discussed or the events I have attended, or if you have questions about what it means to be an OHPI, feel free to reach out to me. I look forward to sharing many more of my DC adventures with you all!

Until next time,

Harika Kantamneni, OMS-IV

Lanren Delana
Lauren Delana, OMS-IV
September 2016 OHPI

Nov 18, 2016

Student loan interest rates. Federal funding for graduate medical education.  Health insurance for our future patients.  These are just a few issues currently being debated at the national level, and each of you have a vested interest in these issues.  That being said, I know firsthand how busy and stressful medical school can become.  Hopefully, this post will highlight some ways that you can be an effective advocate while still handling the rigors of medical school and just life itself.

Sadly, this is my last post for the blog as my time in Washington, DC as one of AACOM’s Osteopathic Health Policy Intern has come to an end.  I really want to take this opportunity to emphasize how important it is for medical students to be advocates both in their communities and on the national stage.  Levels of involvement can vary greatly and there are ways for everyone to be involved.  It is important that we let OUR voices be heard so that those making such critical decisions on Capitol Hill have a clear understanding of how their actions will affect not only our futures, but the future health care of this nation.

For those who would like to create more of an advocacy presence on your campuses and need a point of reference, I’d like to share what I did at Pacific Northwest University several years ago.  I organized a health policy week on my campus where we had the following speakers address ways medical students could become more politically active in various ways: faculty at my school who completed a health policy fellowship, a local elected official, and AACOM Government Relations.  It took a significant amount of work and time to organize and pump up my classmates, but help from other classmates and assistance from my school administration really worked to make that week a success. 

In one particular instance during the health policy week, I recall a student who presented the local elected official who came to speak with a letter he had recently received regarding his medical student loans.  The representative was surprised at the amount of debt accrued and spoke with the student about what he could possibly do to help address this issue.  This was a prime example of how students could be an advocate for themselves and their classmates.  

Obviously, organizing an event this isn’t the only way you can be an advocate.  You can write a letter to your elected representative and attend local and national advocacy events (e.g. AACOM’s COM Day on Capitol Hill, etc.) - the options are limitless.  The important message of here is that lawmakers want to hear YOUR story.  A personal story carries much more weight in the political and policy world than pages of data and research; so NOW is time for us to share our stories.

Also, I cannot emphasize how important social media is when it comes to politics.  Many elected officials monitor these platforms to evaluate the position of their constituents.  Following @AACOMGR on Twitter or joining ED to MED on Facebook and simply retweeting or sharing the message can make a significant impact.  Strong social media presence has shown to greatly influence a legislator’s decision.  So when you have a study break, take a couple of minutes to click the “share” or “like” button; the strength of our message can spread and carry more weight.  

I’d like to close this post out by thanking all the work that osteopathic medical students have already done to promote our profession and advocate for students.  The road to becoming a physician is challenging, but it is crucial we stay up-to-date on health care policy because it will affect us not only as students and physicians but will greatly impact our future patients as well.  

If you have any questions about how to become involved, either on social media or with event planning, please feel free to reach out to me.  I would love to help get as many students involved as possible and will do whatever work it takes to assist you in the process.

Keep up the great work as advocates and as students!  I’m honored to call you future colleagues and I look forward to working with you as physicians and as advocates for our profession and patients!

Lauren Delana, OMS IV
AACOM Osteopathic Health Policy Intern 2016

Hello Fellow Osteopathic Medical Students!

Nov 7, 2016  

I hope that you enjoyed the first blog post that talked about the Osteopathic Health Policy Internship (OHPI) Program with AACOM’s Office of Government Relations, and my experience during the first month of my term. I’m hoping this blog will serve as a resource for students who want to learn more about health care policy and also show that medical students can have a significant impact when it comes to national politics.

Since my last post, there have been two key events I attended that I want to share more about. One was a discussion on the national opioid epidemic and how public policy can help address that issue, and the other focused on the current state of and next steps on health care for military veterans. Both issues are hot topics in Washington DC right now, and are receiving much attention from national organizations and the media.

The first event, “The Opiate Crisis: How Can Public Policy Promote Recovery?” was hosted by the American Enterprise Institute (AEI). Three featured panelists were former Speaker of the U.S. House of Representatives Newt Gingrich, former White House Advisor and political analyst Van Jones, and former U.S. Representative Patrick Kennedy. The discussion, moderated by Sally Satel, MD, Resident Scholar at AEI, highlighted an organization called Advocates for Opioid Recovery, which was founded by the three panelists. When asked why they created the group, the panelists responded that they all have interests varying from addressing the misuse of opioids to mental health awareness to criminal justice reform to research on brain function, and so they decided to join together for this cause. Since many of the issues are interrelated, they realized that focusing on the opioid crisis would also have an impact on the other aspects of society that they are passionate about.

There were two main themes from the discussion: the need to look at substance abuse as a disease, and not just as an addiction, and access to long-term and behavioral treatment. If we do not address the biochemical processes associated with addiction, then we will not be able to make strides in treating this problem. The panelists highlighted the importance of advocating for increased access to long-term treatment and stated that insurance companies need to assist with the cost of such therapy. The speakers remarked that addiction cannot be cured with a two-week inpatient treatment and that it is a lifelong process that requires significant dedication and motivation by the patient. Thus, in order to truly make an impact, we need to provide evidence-based methods for long-term therapy, the same way in which we provide treatments for all other diseases. They also discussed that taking on the opioid crisis could decrease rates of incarceration and could also help provide patients with the appropriate mental health resources. One of the barriers identified by the panelists to making these advancements is the federal budget, as it will cost money for these ideas to come to fruition, and even with bipartisan support for the actual issue, obtaining appropriate, and reliable funding, is another issue.

Overall, it was reassuring to see leaders of our country, from various backgrounds and political parties, come together to address an issue that affects nearly 2.5 million people. We need to change the stigma of addiction so that those who need help aren’t afraid to seek it and are willing to share their stories and the importance of treatment and follow-up care.

The second event I attended was “Health Care for Veterans: Where Things Stand and Next Steps” hosted by the Alliance for Health Reform. In August 2014, the Veterans Access, Choice and Accountability Act of 2014 (VACA) was enacted with the goal of improving access and quality of care to veterans. It set forth a way for veterans to seek care outside of the U.S. Department of Veterans Affairs (VA) if they met certain requirements. The panelists for the event discussed the progress that has been made, areas that still need to be improved, and other topics. They talked about how veterans now have better access to care, but stressed the importance of improving communication between electronic health records and physicians in order to provide more consistent and comprehensive care. It was also noted that the system needs to be simplified so that veterans can better understand qualification requirements and payment structures. One major issue that the panelists agreed on was that private care should supplement the work of the VA, but should not be a replacement. Funding for VACA expires in August 2017, so work needs to be done now to determine if the program is effective enough to continue, and if so, how more sustainable funding can be provided.

During my time as an OHPI, I was able to work on the ED to MED campaign, which is AACOM’s national grassroots campaign, which advocates on behalf of medical students regarding student loan debt and other important issues. The success of this campaign relies heavily on student involvement, so I encourage you to visit and join. Lastly, I summarized a recently-published research article on the effectiveness of competency-based education programs. Medical education is branching out into a new teaching model of mastering competencies versus required time for a program. For more information, you can read the full article at 

As always, please feel free to reach out to me if you have questions about any of the topics above or if you want to learn more about the OHPI Program!  I’d love to chat and share my experience!

Lauren Delana, OMS-IV

Hello Fellow Osteopathic Medical Students!

Oct 27, 2016

Lauren Delana poses in front of the nation's CapitalMy name is Lauren Delana and I am an OMS-IV from the Pacific Northwest University of Health Sciences College of Osteopathic Medicine.  This fall I have had the opportunity to work as an intern in the American Association of Colleges of Osteopathic Medicine’s (AACOM) Office of Government Relations in the heart of Washington, DC.  One of my goals during the internship was to increase awareness among medical students across the country about current federal health policy issues and how students can take a more active role with health care legislation.  I also wanted to share my experience in hopes of encouraging others to think about applying for this wonderful opportunity.  This first post will be about the Osteopathic Health Policy Internship (OHPI) Program and what I have been up to during my first month in DC.  From here on I will have weekly posts about meetings I have attended, projects I am working on, and how you can get involved.  The plan is that each OHPI will continue the blog during their time.  There are three interns throughout the year, each working for two months, so we will make sure to announce when the blog will be active. 

AACOM’s Office of Government Relations selects three osteopathic medical students each year to be OHPIs.  Any student can apply, but an interest in health policy and experience with political advocacy are recommended.  Each intern spends two consecutive months in Washington, DC, helping with projects in the office and covering meetings on and off of Capitol Hill.  Interns are expected to take notes for the office at hearings and briefings and also stay up to date with the news by providing summaries of important articles.  It is a wonderful opportunity and I am more than willing to chat with anyone interested in the program. 

Needless to say, there has been a lot to learn during my first month in DC.  There is so much going on and I have had the privilege of hearing presentations about the direction of health care and medical education.  Thus far, I have had the opportunity to attend briefings on the hill on topics including: the use of technology to increase access to health care, Vice President Joe Biden’s Cancer Moonshot Initiative, future directions for mental health research, and the future of health care in America.  I also attended the National Academy of Medicine’s presentation on “Vital Directions in Health and Health Care,” organizational panel discussions on graduate student debt, and attended the Medicare Payment Advisory Commission’s (MedPAC) most recent meeting.

Aside from attending meetings, I have been working with the office to review articles regarding graduate medical student debt and helping to monitor and summarize proposed legislation regarding medical education and debt.  This includes attending a webinar for the National Advisory Council on the National Health Service Corps and working to help develop new content for the ED to MED campaign, which is AACOM’s national grassroots effort to advocate for lower loan interest rates and more stable loan repayment programs for medical students.  This campaign focuses on the reauthorization of the Higher Education Act (HEA), which addresses topics such as debt interest caps and public service loan forgiveness.  This legislation will be discussed in the upcoming Congress, and it is crucial that we convey the importance and impact of medical student debt while legislators are drafting policies to address these issues.  There is much more information available on this topic, and you can join the campaign, and make your voice heard by signing up at

Most importantly, I have learned that students can make their voices heard, and it is easy to make an impact.  Even if you share a Facebook post, or retweet an ED to MED post on Twitter, you are helping to spread the word, and Congress will notice the volume of students who engage.  I highly recommend following AACOM’s Office of Government Relations on Facebook and Twitter to not only stay up to date on issues, but also to help spread the word and share your story.

I look forward to keeping you all updated on my experience and developments in DC!  I would love to talk to anyone interested in learning more about the issues or events I have attended, and if you are interested in becoming an OHPI, please reach out to me, because I am more than willing to answer any questions! 

Lauren Delana, OMS-IV