| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Commentary |
1 Department of Radiology, Bridgeport Hospital, Yale New Haven Health, 267 Grant Street, Bridgeport, CT 06610.
Address correspondence to A. Kaye
(pakaye{at}bpthosp.org).
Keywords: advocacy • lobbyist • American College of Radiology • ACR • State Government Relations Committee • state politics
Thomas "Tip" O'Neill—former Speaker of the House in the U.S. Congress—once declared, "All politics is local." He was explaining how the problems and concerns of towns and cities around the country affect the actions of their Representatives and Senators in Washington, DC. His assertion, however, has been applied more broadly to remind us that each region has its own ways of dealing with issues. While most attention in the radiology and general medical literature and professional society newsletters and bulletins focuses on national issues, much of what affects our practices, departments, and hospitals is determined in our state capitals. This article deals with state governmental advocacy by radiologists, and will make the case for activism and discuss the infrastructure needed for effectiveness.
The specialty of radiology has become more complex from scientific, technological, and socioeconomic aspects. These aspects engender legislative and regulatory challenges and opportunities, which are necessary to marshal the responsible application of these complexities to the care of our patients. National legislative and regulatory initiatives related to our specialty are ongoing under the general direction of the American College of Radiology (ACR), overseen by its Government Relations Commission. This is a difficult task, as federal legislation is frequently more difficult to pass than are state laws. Some potential reasons for this include, among others, intricacies of the political process, difficulty in reaching consensus, and high visibility.
Indeed, however, state politics may actually have more impact on radiologists' practices than federal politics. State laws exist that influence almost every aspect of radiologic care. In aggregate, state legislatures introduce more than 100,000 bills each legislative session, an increasing proportion of which are related to health care. Some apply to medicine in general, such as medical liability, managed care and contracting, reimbursement, universal health coverage, and licensure. These bills apply to radiology may because it is a specialty of medicine or because they have specific language that relates to radiology, possibly even excluding it from the laws' provisions. Other bills are intended to apply specifically to radiology, such as those dealing with radiologic technologist and assistant licensure, mammography coverage, handling of nuclear materials, etc. Many are general in their application, but with high relevance to radiologic practice. These can be the most important of all, but can be the most difficult to pass. Self-referral, certificate of need, and telemedicine are just such issues. At the same time as the number of bills grows and practice becomes more complex, radiology is also under more scrutiny from payers, legislators, regulators, and other physicians. With the future of imaging in question, the stakes become higher.
The ACR also has a State Government Relations Committee and staff dedicated to state matters. Each year, state bills are screened by ACR staff, who then report to the state chapter leaders on the 250 to 500 bills considered relevant to the radiology profession. As the initial Chairman of the ACR's State Government Relations Committee, I can attest to the impossibility of the notion that monitoring from ACR headquarters in Reston, Virginia can effectively substitute for activities in the states. Assistance to states is largely on an "as needed" basis, and thereby delivered in the crisis mode—never the optimal situation.
Thus, it behooves radiologists to become knowledgeable about and active in state politics. Submission and passage of legislation are highly visible denouements to an intense, complex sequence of events sown from a carefully cultivated field of preparation and experience. Submission is an unusual occurrence, and actual passage of new legislation is rare. Unfortunately, many radiologists first become active in governmental relations with proposal of a new law in mind. They are handicapped in that they have not developed the infrastructure and internal processes or established relationships with legislators who know them and their issues.
Each state has a chapter of the ACR to which all ACR members must also belong. The chapters collect dues separate from those of the ACR. By dint of an existing membership base for radiologist-volunteer activism and the existing or potential supplemental financial resources, the chapters are most appropriate venues for state political activism. Chapters vary considerably in terms of how they approach state government relations and the resources they bring to bear. Several states have robust governmental relations involvement. Others have nearly none and are, therefore, dependent upon a computerized surveillance of state legislative activity provided by the ACR or on the state medical societies' staff. The former, typical of computerized searches, is sometimes incomplete and nonspecific. In the latter, medical society staff are not focused on radiology issues and, in fact, may have perspectives on the issues that are discordant from that of radiologists. Thus, it behooves state chapters to take responsibility in these endeavors.
Most chapters report on state legislative or government relations issues at the chapter annual meeting but few discuss legislative priorities or direction. Even fewer have regular strategy sessions before, during, and after legislative sessions. Chapter representatives also should be involved in regulatory matters. Chapters may provide representatives to sit on regulatory advisory committees and medical boards. They also typically are called on to testify at legislative and regulatory hearings or submit comments on proposed rules and bills. To this end, most of the chapters have a government relations, legislative committee, or at least a designated member who is responsible for legislative and regulatory issues. These committees meet periodically to review issues. They serve various functions ranging from proposing legislation to developing legislative priorities and a legislative agenda. It may be difficult for a chapter and its government relations committee to monitor legislative activity quickly or accurately enough to affect an issue's outcome. In addition, once a chapter has embarked upon the process, it may not have the needed expertise to guide the legislation through the political process.
Accurate, timely, and proactive monitoring, assessment, and action are integral to an effective legislative program. So, too, is knowledge of the political process and of the players in state government. I strongly recommend that chapters hire a legislative consultant (lobbyist) to supplement the activities of the volunteer members of the committees. About half of the chapters have lobbyists. Lobbyists, professionals who are well versed in legislative and regulatory strategy, are experts in the process. They can direct the chapter to the appropriate venue for its goals, e.g., the regulatory rather than legislative process. They know who the key figures are on the key committees or agencies for each issue, have access to them, and know what their "pet" issues are. Should submission of a bill be advisable, they can assist in drafting persuasive legislative language. Should there be legislation introduced by the chapter (or others) that affects radiology, the needs for surveillance and action intensify. Lobbyists have expertise in legislative strategy and technique to facilitate legislation through the process. They can quickly respond to issues and can assist chapters in providing appropriate communication to key legislators and regulators. They can identify where leverage needs to be applied and can point out pitfalls, because they understand the political climate in the state.
Sometimes the lobbyist's firm also provides the full spectrum of the chapter's general administrative needs. Some chapters have a legislative consultant on retainer who is paid a flat fee to represent the chapter's interests in the capital. Services are available to track and monitor legislation, to provide lobbying services on a case-by-case basis, or both.
Some chapters also contract with a legal firm that provides legislative consultation. Most of the time, however, these firms have registered (with a state agency) representatives who specialize in their field.
Some chapters contract with the state medical societies to provide lobbying services. This is a mistake. First, state medical societies may not have sufficient knowledge about the breadth of radiology issues to recognize the relevance in proposed legislation or regulations. Thus, their screening may be incomplete. Second, there are issues where the interests of radiologists and our patients may be discordant with the perspective of the general medical community. These situations are certainly not conducive to the success of radiologists. Since the lobbyists have either primary responsibility to the medical society or they are paid by both entities, there is an inherent conflict to the detriment of one or both parties.
Success in government relations is all about familiarity, credibility, and continuity. With familiarity comes credibility. This takes time, and the more the officials know and trust you and your lobbyist, the more effective you can be. Thus, the chapter's relationship with a lobbyist is best if it is long-term. This allows the lobbyist to learn not only to become familiar with the field of radiology, but also to learn about the chapter and its issues. Encourage the lobbyist to visit local hospitals and radiology centers, give the lobbyist background information about your chapter, and be sure to include the lobbyist in meetings with the government relations committee. Also, the lobbyist should regularly attend chapter meetings to provide a report on his or her activities. Furthermore, members should be given access to the lobbyist through e-mail or phone.
I used to be surprised that many of my state's legislators do not know what a radiologist is. That is no longer the case. As the tenure of the lobbyist lengthens, he or she will become a familiar face to the legislators and regulators, such as state commissioners, as well as the members of the chapter and will be recognized as a spokesperson for the chapter. Legislators will become familiar with the role of radiologists in the health care milieu. Of course, the same applies to the tenure of the radiologists in their legislative committee roles. It takes time to achieve these absolute prerequisites for having a voice in the political process.
State laws and regulations govern most of what radiologists do. Health care issues, including imaging, are increasingly under scrutiny. Quality, safety, reimbursement, and competitive issues affect the practice of radiology and require diligent surveillance and effective advocacy that are beyond the capability of the resources of the ACR, which is the entity most radiologists rely upon for representation and guidance. State chapters and their legislative committees with the able assistance of a legislative consultant are the vehicles for the most effective advocacy for radiology.
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
