A Call to Action
Any reader of Radiology Business Journal knows that the complexity and intensity of managing a radiology practice are increasing exponentially. Likewise, we face myriad external factors from Washington that change almost daily and that are, seemingly, out of our control: health reform, the Physician Practice Information Survey, cuts due to the sustainable growth rate, the DRA, pay for performance, changes in equipment-utilization rates, reduced payments for imaging contiguous body parts, changes in practice-expense RVUs, and more. The magnitude and fluidity of the issues, and the lack of access for individual radiologists, contribute to a sense of futility, as there is a limited amount that an individual, a large practice, or even a small coalition can do. This is, however, no time to bury our collective heads in the sand. For the national issues, we are fortunate to be represented by organizations such as the ACR®, the Association for Quality Imaging, and industry groups like the Access to Medical Imaging Coalition. Some ad hoc, grassroots groups have formed to carry our influence to the doors of Congress. In two recent examples, efforts in New York have been successful in bringing bills before Congress to limit reductions to reimbursement for imaging. Though unsuccessful (to date) in preventing an increase in the equipment-utilization rate, surely they have brought our issues to the attention of many, and we hope that they have influenced the process. While the efforts in Washington are ongoing and important, we must not forget that there are 50 other venues for significant legislative gains for radiology: the state capitol buildings. As the late Speaker of the House Thomas (Tip) O’Neill (1912–1994) said, in quoting his father, “All politics is local.”1 Each year, more than 100,000 bills are introduced in state legislatures. A large and increasing number are related to health care. Most are related to general health care, and therefore relevant to radiology, but many are specifically related to radiology. The figure lists a sample of the types of issues that might come under the jurisdiction of state laws. The ACR’s government-relations staff screens all state bills, finds 250 to 500 relevant results, and alerts the appropriate state chapters, providing staff assistance on an as-needed basis. The process, however, is limited in that these are generic screenings, and they are done outside the context of the individual states’ political environments. State medical associations also have legislative staffs, and they screen and introduce bills. These efforts can be fairly robust, but are not always in the interest of radiologists. It would be a grave mistake for radiologists to ignore the potential harm, damage, and benefit that can result from state legislative action. Most efforts along these lines are undertaken by state chapters of the ACR, which have access to advice and assistance from the college and from a network of colleagues around the country. Some of these chapters contract with lobbyists, either on an ongoing or as-needed, issue-specific basis, for significant contributions to the legislative and regulatory initiatives of the chapters. Good lobbyists can plan overall legislative strategy, identify and provide access to the key legislators and regulators who can influence and facilitate the process, draft legislative language, and facilitate legislation through the process. Because they are always around the houses of government, lobbyists are the eyes and ears of their clients, providing quicker responses to issues (known and unanticipated) by monitoring the legislative process in an efficient, accurate manner. Relationship, Relationship, Relationship The single most important element in a successful government-relations program is the development of relationships. Trust develops only through relationships, and they are an essential factor when dealing with very busy commissioners and lawmakers who are besieged by countless spokespersons for interest groups. These relationships take time to develop and sustain, and must be nurtured even in years when you do not have an issue before the legislature. These are opportunities to educate lawmakers about radiologists, what we do, and where we work. You would be surprised at the lack of awareness about our specialty in these circles. Sometimes, you can be there for them as an expert who can answer questions that they might have about issues that are brought to them by others. Successful state legislative initiatives also require certain organizational personalities that are not necessarily innate to physicians and their societies. Patience, persistence, and resilience are necessary in these endeavors. Commonly, the significance of legislation or regulation is directly proportional to the duration, frequency, and intensity of the interaction that it takes to get it passed. Success almost certainly will be preceded by years of defeat, referrals to committees, testimonies at hearings, and minor victories. We have all heard that politics makes strange bedfellows, a statement made by Charles Dudley Warner (1829–1900) in paraphrasing Shakespeare. Sometimes, your ally on one issue is a legislator who may not have supported any of your prior initiatives. You need to recognize the opportunity and seize it. Successful state initiatives require that we compromise. It is rare that bills progress without opposition, changes of language, delays in implementation, requirements for future study, and other roadblocks. Most of the time, a point in the process will come when a decision must be made either to make (sometimes significant) concessions or to face an uncertain outcome or defeat. Compromise might not be advised, but when it can be successfully accomplished, it could add to our credibility among the powers that be. Credible state-legislative presence is not a status achievable overnight. Nonetheless, the scope and significance of the issues involved are, perhaps, even greater (and more directly related to our practices and departments) than those of the issues under debate in the current chaos in Washington. Alan D. Kaye, MD, is chair of radiology, Bridgeport Hospital, Connecticut, and is the ACR’s speaker.