Patients, providers (and payers)

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Let's start with the obvious: Your biggest gripes about practicing medicine have little to do with practicing medicine. That's what this year's Physicians Practice survey — and all its previous surveys — show.

We've just gone through the annual Medicare fee cut debacle; we're recovering from a United Healthcare cyber ripple (via Change Healthcare) that impacted 1 of every 3 claims; we've seen prior auth requirements placed on commonplace care as never before; and we are witnessing vertical and horizontal integration galore. It's dizzying, distracting and demoralizing. There isn't time to do what you — and we — love most: caring for patients.

Our background

We work in a small ambulatory infusion center: Brooke is a nurse, and I am co-founder and mascot. We care for patients with lifelong chronic conditions; we help keep their illnesses at bay to keep them out of the hospital and boost healthy lifestyles. We also care for patients with acute conditions, offering same-day infusions as an alternative to emergency room visits. You would think the payers would want to make this an easy task. Sadly, administrative walls stand in the way of caring for these patients.

We care for patients — it's what we do, and it’s what we love. We strive to keep the behind-the-scenes fights — prior authorizations, denials, formulary changes and incumbent stresses — away from our patients. Despite having two employees dedicated to the authorization process, the whack-a-mole nature of obtaining approvals for the care and resulting payment of those who need it is a daunting chore.

We — nurses, doctors, managers and the rest of our teams — must work together to effect change. The Davids must come together to battle Goliath.

What can we do? What can you do? Sit on the sidelines and complain about it? Or mobilize and empower employees and patients to call state and federal legislators demanding administrative simplifications? It is astounding that United Healthcare has grown without restraint to control 1 of every 3 claims and to employ 1 of every 16 doctors in the United States. And most of us sat on our hands while it happened, if we even knew it was occurring.

Along those lines, some providers send the dunning e-mails drafted by our specialty organizations about the annual Medicare cuts. But how many health care leaders and workers providers spend time fighting for permanent changes? Not enough. And those of us who do fight these fights need more help.

If you don't speak, your voice won't be heard. It's that simple. Legislation is a contact sport; you have no voice if you sit on the sidelines — and will have no one to blame but yourself. All of us are affected at some level, at some point, whether it be through our child, mother, co-worker, brother, or friend.

Here are 11 ways you can, and should, engage in grassroots advocacy for your practice, your patients and yourself.

1. Voter registration. Provide voter registration forms for employees. Prominently display the forms in your waiting room for patients. Legislators know unregistered voters do not affect their electability.
2. Take a head count. Count the potential votes your practice represents. The results may be surprising. Including your providers, employees and their families, your organization represents a significant number of constituents.
3. Engage your staff. Share the grim facts. Medicare cuts cut deep. United Healthcare has billions of dollars in revenue, but its cybersecurity breach has threatened your ability to meet payroll. Ask your employees and their families to call their legislators and let them know it's personal. On Election Day, make sure each employee has time to vote.
4. Engage your patients. Your patients' care is at stake. While you would never compromise patient care, providing the same level of care or spending the same amount of time with each patient when the bottom line sinks is tough. Ask for your staff’s help with contacting legislators.
5. Vote. Yes, vote. Studies show that medical professionals are much less likely to be registered voters or vote than any other professional class. Politicians know this well. And while we are on this topic, if we had a nickel for every physician who tried to get out of jury duty and a dime for every physician who griped about uneducated juries, we would have retired a decade ago. When you're called for jury duty, serve. Period.
6. Educate your legislators. Get to know your legislators. One effective tactic is to invite your legislators to spend time in your clinic. Most do not understand all the red tape in the way between good care and your patients. Have them sit and watch an employee wait on hold on the phone for an hour to get authorization approval. Your legislator may send an aide to your office in their place; this step remains a worthwhile endeavor because having the support of these aides is critical. Become a resource for them.
7. Contact your legislators. Send e-mails and letters and call your legislators. Whenever your professional society asks that you contact your legislator, do so. Ask your staff to do so as well. Make your voice heard.
8. Wear all the hats that fit. You are more than just a nurse or a doctor. You also wear the hat of primary advocate for your patients and are responsible for the livelihood of your employees and their families. Ensure your legislators understand that your responsibilities extend far beyond your family and have tentacles that extend deep into the district they represent.
9. Don't forget the little guys. Local and state elected officials carry weight with their federal counterparts — and sometimes replace them. Ensure your local and state officials understand how federal legislation affects medical care in their district.
10. Know the costs. Ask your manager to summarize your direct and indirect patient care costs. Share this information with legislators.
11. Share this article. Without a sustained and collective effort, progress won't be made.

That's it. Nothing new, simply another call to action. Administration simplification will only happen with you.

Invest your time and effort into shaping the future of our health care system. Or don't — it's your choice. Unless multitudes of us get off the sidelines and stay involved, the choices will continue to be made for us, and administrative burdens will continue to be at the top of surveys of what we like least in the jobs we love.

Brooke L. Clinebell, RN, BSN, CPN, is an experienced nurse who is passionate about advocating for patients of all ages in whatever capacity necessary. She is currently continuing her educational journey to MSN-FNP toward this end.

Lucien W. Roberts, III, MHA, FACMPE, is mostly retired from a career leading medical practices. He finds joy in waiting on patients at Infusion Solutions in Richmond, Virginia, and fighting the good fights on their behalf.