Category Archives: STFM News

Fiscal Cliff, Grand Bargain, and Kick the Can Down the Road

Hope Wittenberg

Hope Wittenberg, MA
Director, Government Relations

What do these have in common? They are the new post-election lexicon of legislators and lobbyists, pundits and commentators. What do the election results mean for the lame duck session of Congress that begins this week?

I attended a post-election program the morning after the election, put on by the National Journal, which had various experts providing their views of the election’s impact on key economic issues and the political fallout from the election. There are three major economic realities coming in the next 2–4 months. First, we have the Bush era tax cuts expiring on December 31. If not attended to, tax rates for individuals and businesses will rise dramatically. Our second fiscal obstacle is the Congressionally mandated sequestration, due on January 1, cutting a swath through defense and non-defense spending alike, with some cuts to entitlement programs, such as Medicare. The third hurdle we face is the climb toward the debt ceiling; we’re expected to approach that peak in February or March.

What can we expect? There are basically two options for Congress. They can deal with these limits by passing debt reduction legislation during the lame duck session, achieving a “Grand Bargain” that will resolve our fiscal crisis before these events take place. This, of course, has proven impossible to date with the current makeup of Congress.

What would a Grand Bargain consist of? Would it include tax hikes, entitlement reform? What would be on the table? Were the election results influential enough to cause the current makeup of Congress to work with the president? Does the president have additional leverage? Some say he has a bit, but others say the tone and climate of the relationships between the president and the Congress must change for that to happen. There seems to be a consensus that deals can’t be crafted between the president and the four leaders of the House and Senate. The president needs to involve members of each party and both bodies, not just the leadership, to arrive at a consensus to move forward.

The second option for addressing the looming economic hurdles, and one seemingly expected by the pundits, is a short-term delay, from 3 to 6 months, to allow the new Congress time to deal with the debt problems. This “Mini Deal” would suspend a certain amount of sequestration on both defense and discretionary programs. There are several reasons that this is a distinct possibility. With about 50 calendar days left of this Congress, and only 16 legislative days, this might be the only viable option. Moreover, if the tax cuts are allowed to expire on January 1, and sequestration is postponed for a few months, Congress would have more funds to deal with. Once the tax cuts expire, Congress can put back many, but not all, of them, and both Republicans and Democrats would be able to claim that they have not increased the tax burden; in fact, they’ve provided new relief to large portions of the electorate. In addition, should the tax cuts expire, Republicans from this Congress would be off the hook regarding their signing of the Grover Nordquist “no new taxes” pledge. Members of the new Congress could choose not to sign such a pledge.

One key physician issue that is caught up in this high-stakes game of chicken is the January 1 scheduled large drop in the Sustained Growth Rate (SGR), cutting physician payment by almost 30%. Since Congress can make any legislation to resolve the debt crisis or sequestration retroactive, the largest concern is what the markets would do during the period of harsh fiscal cuts. For physicians, the additional concern over how this might affect claims and reimbursement looms large.

Interestingly, both Senate Majority Leader Harry Reid (D-NV) and House Speaker John Boehner (R-OH) have stated that they are ready to resolve the issues during the lame duck session, rather than kicking the can down the road. Speaker Boehner even went so far as to say that House Republicans are “willing to be led” on taxes, meaning they could accept new revenues under the right conditions. As part of tax reform, they could consider new revenues, but only if entitlement program reforms, such as Medicare, are also on the table. In the days since the election, comments from both sides of the aisle raise a great deal of uncertainty over how willing Congress and the president will be to compromise.

There are a few nuances of leaving these decisions for the new Congress. The new Congress will have more House members who have been in office less than two terms than they’ve had since 1992. The Senate will have a larger democratic majority and includes the highest number of women (20) ever.

The resounding cry from Americans with respect to this election was, “Why can’t Congress get the job done?” A clear answer to that question was given by former Representative Richard Gephardt, who stated, “A member of Congress in either party doesn’t want to vote for any of this stuff; it’s all toxic. There’s no benefit to them personally. It takes a high act of patriotism on the part of both Democrats and Republicans because they’ll have to cut spending, cut programs, and raise taxes—causing lots of political pain. Some will have to give up their political career to vote for a bargain.”

What else has the election put back on the top of Congress’s list of issues to address? There is increasing sentiment that immigration reform may take center stage. On the one hand, President Obama will still be looking for a legacy he can leave the country (in addition to health care reform). Republicans, on the other hand, need to do something to widen their base of support into the Latino community. Equal Pay for Equal Work legislation might also move forward with Republicans taking note of the declining support for their candidates among women voters. One other factor to consider as the new Congress takes over is the issues the new chairmen of the Committees in both the House and Senate put on their plates.

On the good news front, this election has solidified the survival of health care reform. There will not be an opportunity to repeal the Affordable Care Act during the next session of Congress. Instead, much of the work at the state and federal levels will begin regarding development of insurance exchanges and implementing other pieces of the law. Many states, such as Virginia, that have waited to see the results of the election, will now have to move forward rapidly.

Governance, What If…

Stacy Brungardt, CAE STFM Executive Director

Imagine an organization where an individual who works in academic family medicine knows where to turn to get his/her problems solved.

Imagine that this disciplined organization aligns products with its mission, uses data-driven strategies, and focuses on members’ needs. This organization is highly functioning and nurtures an inclusive culture that engages in dialogue between members and leaders.

Imagine an organization with sufficient resources to do its work. This organization is agile, proactively addresses issues, assesses and takes action quickly, and makes course corrections as necessary.

Imagine an organization that pursues alliances that relate to existing strategies or that form a tight fit with its mission and purpose. It is selective about determining with whom they should partner to be as effective as possible.

Imagine what we could accomplish if STFM operated like this all the time.

I do imagine this and believe there are literally hundreds of members and staff who are helping us move toward this vision.

I also believe that a strong governance structure either moves you in this direction or provides barriers that staff and members sidestep or hurdle, slowing down progress toward our vision.

Yes, good governance matters. Simply put, governance is the way decisions are made, who makes them, and under what parameters.1

Good governance can make the difference between the Society moving forward or not. It can demonstrate inclusiveness and be accountable for actions, or it can waste time and resources of the organization. By the way, we spend a lot on governance when you consider member time and STFM dollars to support Board, committee, and task force meetings and the staff time to manage these groups.

The STFM Board recently reflected on series of events related to our governance structure that have caused us to consider the best way to approach these issues.

The Board saw a convergence of activities and agreed that we would benefit from taking a more systematic approach to our governance assessment rather than trying to address each of these issues separately. We recognized the risk of each of these groups making separate recommendations that weren’t coordinated or in alignment. In fact, experts in association governance would tell you that groups who approach governance assessment elements in a piecemeal fashion generally struggle and are less happy with their outcomes than groups that approach this assessment in a way that starts globally with how the model assists their organization in meeting its desired ends.

Thus, the Board approved bringing in an outside consultant to facilitate this process of reviewing our governance structure. We will be working with governance consultant Michael Gallery, PhD, a well-respected association management professional who chaired the task force that created 7 Measures of Success: What Remarkable Associations Do That Others Don’t. This landmark research in association management applied the work of Jim Collin’s Good to Great to association management. Dr Gallery understands medical associations and association governance. (He also comes highly recommended and is affordably priced!)

What I like about his process is that he starts with the end in mind and includes operational elements such as obtaining member input, creating a communications plan for stakeholders, and evaluating any new structure we would create.

I don’t think we’re doing a bad job at governing the Society, but we haven’t taken an in-depth look at our governance structure since we created STFM in 1967. Until you spend some time thinking about what outstanding governance performance looks like, how our current structure compares, and how to address the gaps, we are likely not reaching our potential as an organization.

What if…

Reference
  1. Gallery M. Governance: a new approach to an old problem. Session presented at the American Society of Association Executives Annual Meeting, Dallas, TX, August, 2012.

Office Stories

I find office spaces interesting. The piles (or lack of piles), photos, and mementos share a glimpse of the personality of the people, work styles, and things individuals value.

Stacy Brungardt, CAE STFM Executive Director

A little more than a year ago, STFM revamped our headquarters office. In our 4,000 square-foot corner of the 5th floor of the AAFP building, STFM staff publishes the journal, plans our conferences, and runs the more than 40 initiatives of the Society. We wanted the space to be both inspiring, practical, and reflect the core values of STFM. We squeezed a lot from our lean redecorating budget and started by getting rid of stuff—old office furniture and unused items you collect over time that clutter the mind. That felt good.

Now when you walk in our offices, the first thing you’ll likely notice are five 8-foot color images of a stethoscope and lab coat, tree-lined arched path, a journal/smart phone, a circle of hands, and a capital building. These images depict the Society’s core priorities of workforce development, professional and leadership development, scholarship and innovation, professional relationships, and policy advocacy. They’ve added a splash of color and meaning to our space. This wall used to display all our past presidents’ photos. We took those down and put them in a nice scrapbook. Admittedly, they were interesting to see and are missed by some of our staff. At the same time, staff agreed that the message we want to communicate to one another and visitors is that we are here to serve and celebrate all our members, not just those who move to STFM’s highest ranks.

As part of the revamp, we took a storage area and interior office and created a conference room as a space to come together for meetings or just to build relationships by eating together at lunch or special occasions.

We painted several walls nutmeg (think nice burnt orange), which added warmth to our sterile walls. A little table and lamp provide an extra homey touch. Around the top of all our walls we have black and white framed and matted pictures. These are pictures staff provided of images that inspire them. The pictures show children and grandchildren, landscapes and beaches, and people and places that matter to each of us.

Staff selected a quote for the top of one wall that says, “You can’t discover new oceans unless you have the courage to lose sight of the shore.” This reminds us that taking risks is a necessary part of our business, and the success of the Society depends on it.

On two walls we created a montage of members, photos and conference locations. Highlighting another wall are images that spell out the letters STFM in photos, a thoughtful gift to staff from past President Terry Steyer.

My favorite part of our space is my office wall with member photos of individuals who have had an impact on my career with STFM. My favorite shot is a photo of Lucy Candib and Peter Coggan dancing on stage when Lucy accepted the 2010 F. Marian Bishop Award. That moment captured so much of what I love about STFM – the joy and celebration of our members who make a difference in the world every day.

That’s our story. Does your space reflect the values you want to communicate? Let us know; we’d like to share your story.