Advocacy: Stickin‘ Up for Yourself

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?

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:

• Contact politicians. This is essential, insists Susanne Madden, founder of The Verden Group, a managed-care-focused consulting firm. “If you’re going to spend time doing one thing, you’ll get more bang for your buck [contacting politicians] than if you spent your time sending in chart notes for denials. So take time to write your public officials ... Otherwise, how are these people supposed to know?” Politicians aren’t psychic.

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.”

• Make a trip to Capitol Hill. Okon says, “One of the most effective things is being up on the Hill. We brought a physician up who talked to some very powerful leaders.” And the benefit is bidirectional, because if you do this - even just once - it will help both Congress and you to understand the issues and barriers on both sides.

• Tap into county politics. If you practice west of the Mississippi, you may be justifiably loath to make a pilgrimage to D.C. - it’s quite far, and, therefore, quite expensive. So think locally. Close the office and do a lobbying day at your county or state courthouse, suggests Poughkeepsie, N.Y.-based pediatrician Herschel Lessin. “It’s a real show of force.”

• Run for office yourself. This might sounds ludicrous at first; you barely have time for your patients. But there is, in fact, a slice of the physician and practice administrator workforce that is ideal for taking up a public post: those about to retire. What a great way to keep busy and capitalize on all your years of experience - all for the good and welfare of your profession.

• Invoke the power of your state insurance department. That’s right, tattle. “Always reach out to the state insurance department,” recommends Madden. That is, if your state has one; not all do. “They can be very powerful in terms of getting an insurance company’s attention.”

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.”

• Provide data. “Every practice should share its data to show the difference and the impact on the quality of care,” says Okon.

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.”

• Talk to the press. Everyday, the radio and TV stations and newspapers have to fill dead air and blank pages with information. Why not tap into this free publicity resource to get the word out on your plight? Lessin did just this recently. “Our local politicians pulled fluoride out of the water. I wrote an Op-Ed piece for the paper, saying that medical decisions made by politicians have historically shown to be bad.”

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.

• Talk to each other. We’re not suggesting you phone Dr. X down the street and say, “Hey, what are you charging for a 99213? … Really? Wow, I gotta change my fee schedule!” Being arrested for collusion is far from a resume-builder or a recommended self-advocacy tactic. Still, it’s important to reach out. These days, that’s simple and fast - use the Internet: “Join a forum online. Post a question. Get some feedback,” says Madden. “There’s nothing like hearing the experience of your peers.”

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.”

• Enlist your patients’ help. Tell your patients what’s going on with reimbursements, that charges aren’t getting back to the physician. Madden recommends this, for example: “Say, ‘I see you’re using Medicare. Did you know we’re not getting reimbursed?’” Guaranteed, they won’t already know. Impress upon them that you may have to drop the carrier. Ask your patients to speak on your behalf. This truly helps, says Madden. “When the patients get involved with the insurance companies and local politicians, then things start to move,” she says. “It helps to raise the bar.” Ask them to call their insurance companies and complain, and to alert their employers to how the insurance company is treating its participating physicians.

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 sgrace@physicianspractice.com.

This article originally appeared in the November 2008 issue of Physicians Practice.