Can you afford to spend time, effort, and money advocating on your own behalf with state and local lawmakers? You can’t afford not to.
Until the middle of the twentieth century - when disability insurance began to evolve into modern medical insurance - most payment transactions for medical care were conducted on a fee-for-service model. Therefore, your predecessors were able to focus almost solely on the health of their patients.
But today’s payment model has put a great burden on you to hone your business acumen and your clinical expertise. It’s all gotten so complicated, but understanding it is critical to your success. You literally cannot afford to ignore increasingly untenable insurance reimbursements or the mounting pressure to convert an ocean of doctor scrawl into efficient - but costly - medical records.
Those are just two of many issues that affect your life and your profession. They’re important but daunting, and you’re probably a tad busy. But no one knows your situation and needs better than you, so who’s the best choice to advocate for you?
But knowing this shouldn’t bring on despondent hand-wringing. Here are some ways to stand up for yourself and still have time to practice the profession you love.
The importance of being expedient
If you want to speak up on practice-related issues but don’t know how, start with your local medical society. These days, nearly all of them have Web sites. A quick look-see will show where the society stands on current issues. Likely, you’ll find a pertinent advocacy effort already underway, complete with preblazed trails for you to easily click on to add yourself to a cause.
Active medical societies do much of the dirty work for you. “We understand that physicians don’t have time to sit down and analyze a bill,” says Carol Mullinax, senior director of practice solutions for the Ohio State Medical Association.
OSMA tries to make it as easy as possible for physicians to be involved. “Legislative issues are the biggest part of our Web site,” says Mullinax. Want to help by speaking up, but don’t know which politician to contact? Just click the hard-to-miss “Who’s Your Legislator?” button on the left-hand side of OSMA’s homepage.
A well-functioning medical society is adept at bringing the confusion of legislative matters down to a level where physicians can comprehend them quickly and participate easily. Some are better equipped than others. (If yours is organizationally weak, then that’s an opportunity right there for getting involved in an important way.)
So that’s one easy inroad to self-advocacy. Here are some other worthwhile ways to affect positive change, all while running your practice:
Or, use the personal touch: Invite your public officials to your practice. Ted Okon, executive director of the advocacy organization Community Oncology Alliance, says, “Every community oncology practice should invite its members of Congress (both those in the House of Representatives and the Senate) to come into its practice, to sit in a chemo chair and understand what a patient goes through. It really opens up their eyes to the reality.”
Simply write a letter to your insurance company concerning your problem at hand and send a duplicate to the state insurance department, she says. “Insurance companies thrive on the idea that ‘nobody knows.’ They tie [clients] up with confidentiality clauses - lots of cloak and dagger. And the word never really gets out. It really gets their attention that some sort of governing body will find out.”
For example, say you submit a clean claim and the payer doesn’t pay you within 45 days. You can report that to the state insurance department. “The insurance company has to pay you interest - there’s a consequence,” says Madden. In effect, you have a framework to push the insurance company in a way that frees you up. “The insurance company is answerable to the state insurance department,” she says.
“New York physicians have gotten good with tattling on the insurance companies,” Madden continues. “Critical mass has built up.”
Mark Jarvis, senior director for practice economics for OSMA, agrees, saying, “When we hear about an issue over and over, we ask for data from our members to support the issue. We get some, but not enough. If we could supply a mountain of evidence to a legislator, we could be much more effective.”
This doesn’t take long, he says, and those letters after your name give you credentials editors crave. “If you can write, you can write a letter to the editor,” says Lessin.
Chip Hart, pediatric solutions manager at PCC, a pediatric-focused software and practice management solutions vendor, runs the pediatric-focused e-mail discussion list, and agrees that online forums, listservs, and mailing lists are of “immense value. They’re the fastest way to let someone in Topeka know about something that happened in Massachusetts, and not to repeat the mistakes made in Massachusetts. You see in these messages, ‘OMG, you just saved me six months of work. I had no idea there was a class-action lawsuit against [XYZ insurance].’”
You’ll have a choice with online discussion formats: physician only, or open to all. One Web site, www.sermo.com - essentially “Facebook” for doctors only - has become very popular of late. The exclusive nature keeps marketers and the general public from muddying discussions. The downside, though, is that you run the risk of only ever hearing about the physician’s side of an issue, which could knock your desire for a balanced perspective off kilter. Other sites, including PedTalk, allow anyone to join, and although sometimes a nutjob or two will cut a swath of twaddle through a discussion, Hart insists that this open-door policy is still best. “It’s a place that has real discussion instead of propping up a flag and not discussing both sides.”
Madden, who is a regular participant in PedTalk discussions, says that although discussion threads get a lot of lurkers, she loves how “we get a dialogue going, and it moves the education forward.”
Keep the faith
Self-advocacy is not easy - no argument there. “You have to have a high resistance to failure. Most doctors don’t have that,” says Lessin. “You have to be committed.”
Such commitment can be especially hard for small or solo practices, he points out. His own practice, The Children’s Medical Group, is more insulated, with 22 pediatricians in seven offices across three counties. “I can find coverage if I want to go do something. You’ve got to earn a living, but if you’ve got partners it’s easier. And, you’ve got to get educated.”
“Physicians need to get out and see that many others have the same problems,” says Chip Hart of PCC. Sadly, this doesn’t happen too often, he says. “The only time I’ve seen physicians from other practices get together for a beer is at a state or national meeting. They just don’t do that. As a rule, they don’t have the time. They also have a slight competitive and collusion-avoidance bent.”
Bottom line: It’s your livelihood - who should care more about that than you? “We didn’t go to medical school to be businessmen,” says Lessin. “But no margin, no mission.”
Shirley Grace is an associate editor at Physicians Practice. She can be reached at firstname.lastname@example.org.
This article originally appeared in the November 2008 issue of Physicians Practice.