An Interview with Stephen C. Crane, PhD, MPH Executive Director of the ATS

Q. What is the goal of the ATS advocacy program?
A. ATS advocacy strives to advance the legislative, legal and regulatory issues important to the Society’s diverse group of members. It’s a tall order because of the number of relevant issues and because the ATS is so diverse, not to mention international. I think that members take pride in our many successes and are pleased that the ATS has chosen to maintain an aggressive approach toward its involvement in critical health policy issues.

Q. What are some of those successes?
A. The ATS has been successful in dealing with pocketbook issues that all clinicians face. Through our work on the AMA CPT and AMA RUC committee, we have been successful in getting codes established to describe new pulmonary procedures, particularly in the area of interventional bronchoscopy. We also have been active in sleep coding and played a key role in ushering in new codes for unattended sleep testing. The ATS played a central role in preventing severe cuts in reimbursement for facility-based sleep testing. We also pushed hard for Medicare coverage of pulmonary rehabilitation—a major victory for patients and our members. For years, Medicare did not have a national coverage policy for pulmonary rehabilitation. Now patients across the nation have access to care and the providers of that care have appropriate reimbursement rates.

Q. What are some of the challenges?
A. There are three major challenges facing the ATS and its membership—federal support for research funding, healthcare reform and the Clean Air Act. Health reform remains a challenge for a number of reasons. First, the ATS took a strong position and supported Congressional efforts to reform our nation’s healthcare system. In the end, we urged Congress to pass the Patient Protection and Affordable Care Act. We felt near universal coverage is good for our patients and will ultimately be good for our members.

Of course, not all ATS members agreed with us. But we took a position on what I believe are thoughtful and principled grounds. Other healthcare organizations stayed on the sidelines, but the ATS leadership felt this was too important an issue not to have a voice in the reform debate.

The challenge for health reform, of course, doesn’t stop with Congress. Over the next several years, a whole host of regulations will be drafted by the federal government to implement health reform. The ATS will play an active role in the regulatory process so that a good, if imperfect, piece of legislation works as well as possible for our members.

Federal funding for research is also a huge challenge for the ATS. All federal domestic discretionary programs—like the National Institutes of Health, Centers for Disease Control and Prevention and VA research programs­—will be under budget pressure. The ATS goal is to remind Congress that investments in research are investments in the future health and prosperity of America. The Clean Air Act is our third major challenge. The House of Representatives has already passed legislation that would stop the Environmental Protection Agency from updating or enforcing air pollution standards under the Clean Air Act. As health professionals and scientists who are acutely aware of the adverse health effects air pollution has on patients, we need to remind Congress and the Administration of the value of clean air. The data are overwhelmingly on our side. Congress needs to understand the human and economic cost of dirty air.

Q. Just three challenges?
A. No, there are a number of other issues the ATS is committed to, including domestic and international TB control, tobacco control, physician supply—just to name a few.

Q. Any failures in the ATS advocacy program come to mind?
A. Failure is perhaps too strong a word. We certainly have had disappointments. We have not achieved what we had hoped for in advocacy around COPD, in terms of promoting awareness, and advancing techniques for prevention and treatment. While I am pleased that the National Heart, Lung, and Blood Institute has taken the lead in supporting a COPD public awareness campaign, I am disappointed that it hasn’t generated the kind of energy I had hoped for. We would like the CDC to be more engaged in the surveillance, awareness and interventions for COPD.

Q. Most of your answers have been related to U.S. policy. What does the ATS advocacy program offer to your international members?
A. A great deal. The ATS has played a leading role in drafting and seeking international support for the Framework Convention on Tobacco Control (FCTC). This international treaty is the first of its kind to tackle a public health issue like tobacco use. The ATS effort, spearheaded by Dr. Alfred Munzer, has been pivotal in bringing this treaty to fruition.

The ATS is also a leading proponent of international TB control. Due to the ATS’s efforts, U.S. support for international TB control has gone from nearly zero dollars in 1998 to about $225 million annually. What’s more, the technical assistance that the ATS and its partners are providing through USAID is having a significant impact in highly burdened countries. We have also been very effective in protecting domestic TB control from steep funding cuts.

Another international issue on the horizon is global climate change, which will, we believe, have significant human health effects. We are already seeing them, in fact, in terms of extended ragweed allergy seasons and heat wave-related deaths. As the science unfolds, the ATS will need to work closely with international professional societies to educate healthcare professionals, patients and policy makers on why climate change matters for respiratory health.