Physician advocacy

Thursday, March 01, 2018 12:10 PM
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CMS CPMG Section, Medical Student Component and COPIC sponsor successful public policy training on Feb. 3

by Kate Alfano, CMS Communications Coordinator

The CMS Colorado Permanente Medical Group (CPMG) Section and CMS Medical Student Component joined COPIC to sponsor the 2018 Public Policy Leadership Forum, which brought together an all-star lineup of speakers – including two members of Congress, two state legislators and many physicians and students– to give attendees real-world tips and tricks for successfully advocating for patients and physicians within the public policy and regulatory spaces.

“This concept for this session has been more than a year in the making,” said CPMG Section Chair Kim Warner, MD, in her opening address to the audience. “What are we ultimately talking about in terms of health care advocacy? Quality improvement, and improving safety and availability for our patients. At the end of the day I want you to believe that you can make a difference in health care public policy on behalf of our profession and our patients, that there are a number of ways for you to step forward, be involved and have your voice heard, and to lead others in this endeavor. Right now you already have the skills available, if you’re willing to invest your time and follow your passions; we’re going to be even stronger for our patients and the physicians we serve.”

Sofiya Diurba, a medical student and student representative on the CMS Board of Directors, addressed her peers. “To the students in the room: public policy will affect us as doctors. It will affect our patients and we’ll be expected to step up in the future for our patients beyond the exam room. I hope what you’ll learn today will give you a greater understanding of how your white coat can bring greater value to society through public policy.”

“What you should emerge from this session with is how to put the pieces together between public policy and how you practice,” said Ted Clarke, MD, COPIC chairman and CEO. “They are intimately connected and you have to be able to connect those dots.”

A bill’s journey

Joe Hanel, associate director of strategic communications of the Colorado Health Institute, explained the journey of a bill in theory and practice before and during a state legislative session and why lobbyists exist. Fortunately, he said, Colorado has several “good-government laws” to make the legislative process more accessible to the public and less subject to political gaming. The GAVEL amendment ensures that each bill that is introduced gets at least one vote, most often in committee. This prohibits committee chairs from killing a bill by not scheduling a vote on it. The Single Subject Rule ensures that amendments to a bill fit under the title of the bill to avoid it being hijacked to pass policy on a completely different issue. Sunshine Laws ensure that meetings of two or more legislators are publicized 24 hours in advance and open to the public. The Colorado Open Records Act (CORA) requires most public documents to be produced within three days to anyone who asks.

Lobbyists are hired by organizations to represent them throughout the 120-day legislative session. They provide expert information on bills that legislators don’t have, particularly on the state level where it is common to have little or no staff support to research each issue. “Lobbyists build relationships and have reputations,” Hanel said. “The best way to burn yourself as a lobbyist is to lie and get caught.”

His final point was about what happens if and when a bill makes it through committee, passes both chambers and is signed by the governor into law. Once a bill passes, one of hundreds of citizen boards will be directed to do rulemaking. All notices of rulemaking are published in the Colorado Register, available online on the secretary of state’s website. These hearings are also open to the public and public testimony is solicited. “This is where expert advice really helps: In the real world, how will this work? How will agencies enforce this? Check the register to see where rulemaking hearings will be held and when. This is a crucial part of lawmaking that is overlooked by the media and most citizens in general,” he said.

Tell a story

Moderator Joe Gagen, JD, focused on how to be an effective advocate on the federal level. His first message was that an individual meeting with his or her member of Congress can make a difference. This conclusion is reinforced by a survey of senior congressional staff of which 60 percent reported that of all the advocacy strategies directed at the Washington office, in-person visits had the most influence on a legislator who hadn’t arrived at a final decision on an issue. “That one-on-one conversation with your legislator, talking with them about your issue, is more likely to influence that legislator than letters, lobbyists or phone calls. Telling your story makes a big difference,” he said.

“The key to being effective is understanding your legislative audience,” he added. “Just like sales, when you talk with a legislator, you’re selling your issue, and you have to understand what’s important to the buyer. The better you understand the buyer, the more effective you will be at that sale.”

With the audience’s help, he listed various factors that influence legislative decision-making, which included: their constituents, the facts, personal experiences, philosophical beliefs on the role of government, proximity to an election and party leadership, among others.

Gagen explained that lack of time and expertise to fully research each issue necessitates a cadre of trusted experts on which the legislator can call for perspective. “If you don’t remember anything else from today, remember this: The key to being successful is establishing relationships, because relationships yield trust and the legislator lacks time to determine what is true. They look to people they trust to keep from making mistakes and the ones they trust are those with whom they have relationships.”

Finally, he gave his advice for effective legislative visits: Introduce those involved in the visit, directly state the reason for the visit, tell a story to illustrate the position, explain the legislation briefly if in support of the legislation, leave a one-page handout for more information, end on time and thank the legislator or staff member for the meeting, and take a photo of the group with the legislator or staff member to share on social media or the local newspaper to remind the legislator of the visit and reinforce the advocacy relationship.

Attendees then practiced their new skills in mock legislative visits. Read further in this issue for more coverage of the Public Policy Leadership Forum.

Posted in: Colorado Medicine | Initiatives | Advocacy


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