Practices Adapt at the Expense of Political Advocacy
howard fleishonReaders of this journal tend to be interested in the business of radiology. We recognize the priority of having efficient and effective practices, whatever future health-care environment evolves. Observers would probably agree that many radiology practices have successfully improved their operational performance as market forces have demanded more value. We seem to be swimming upstream, however, when it comes to politics. Threats to our reimbursement models have made the most notable headlines. Legislation such as the DRA and CMS measures such as the Multiple Procedure Payment Reduction (MPPR) have made us all too aware of how tied we are to the winds of change in Washington. Contrary to some of the more prominent headlines, radiology had some significant wins in 2011. Increases in the equipment-utilization rate (which would have resulted in decreased reimbursement) were averted in talks preceding approval of the United States–Korea Free Trade Agreement talks, as well as in the deliberations of the bipartisan committee led by Vice President Biden (leading to the Budget Control Act) and of the resulting Joint Select Committee on Deficit Reduction (the supercommittee). The application of the MPPR to the professional component of one patient’s subsequent studies, acquired in the same session—and interpreted not just by one physician, but by any member of the same practice—was (at least temporarily) avoided. The Vermont Radiological Society coordinated a grassroots advocacy effort to defeat a 24% decrease in Medicaid reimbursement. Maryland’s legislation against self-referral was upheld by the state’s supreme court. These political and regulatory wins are based on years of building credibility and establishing relationships. Representation and influence in local and national politics are vital to the success of all of our practices. Right now, only a minority of those within our ranks can be seen taking up the challenge. We are leveraging only a fraction of the many talented people that we have in radiology. How can we address these challenges? We probably need to consider both short-term and longer-term strategies. Our immediate need is to strengthen our grassroots advocacy. Political activism deserves the support and attention of our practice leaders, partners, and staff. Whether we are dealing with local or federal politicians, it is at the local level that the foundations of these important relationships are developed and fostered. In Washington, we are a relatively small special-interest group. We need to appear larger than our natural numbers. We have to enlist a disproportionate number of stakeholders to get the attention of those who are making these decisions. Unfortunately, legislators frequently have no idea who we are or what we do. In fact, we have a significant story to tell. Our practices are small and medium-sized businesses. We are job creators for our communities. Medical imaging is a vital contributor to any health-care enterprise. It might be uncomfortable or inconvenient for us, as individuals, to reach out to our congressional representatives. We might feel that we shouldn’t have to engage in these battles—or we might feel that we can simply write checks to have others fight for us in Washington. The reality is that we cannot simply abrogate the responsibility to RADPAC and delete advocacy from our task lists. We need to be consistently engaged, aware, and involved. RAN Is Born In recognition of the imperative to harness grassroots advocacy, the Radiology Advocacy Network (RAN) has been developed. Originally named the Radiology Advocacy Group, the program was expanded and rebranded. Although ACR® resources are being dedicated to the effort, the group’s outreach is to the whole family of radiology. The focus is the development of networks that will be mobilized immediately when critical issues are in front of Congress or regulators. The vision is one of prompt and rigorous response when calls to action are sent out by the ACR’s government-relations staff. The effort is based on a model developed by the North Carolina Radiological Society and led by Andrew Wu, MD ( Ted Burnes, MPA, and Melody Ballesteros are the staff involved in this effort. One of the most robust networks developed to date is the residents and fellows advocacy group. Other state advocates are taking up the cause to advance radiology grassroots engagement. At the practice level, more can be done. We need everyone to participate. Lobby your partners and staff to respond to the calls for action. Assign a practice advocate. Make the discussion of radiology-related legislative issues an ongoing agenda item at your corporate meetings. Make ACR membership a corporate policy, as a cost of doing business. Encourage commitments to RADPAC. Over the longer term, radiology needs to incorporate a cultural change to include a greater awareness of health-care policy and politics. Academic departments should incorporate relevant courses into their curricula. The American Board of Radiology could establish radiology health-care policy as part of its professionalism module for maintenance of certification. Occasionally, there are radiologists who run for public office. We need more of them. They should be included as role models for our trainees. As a profession, we cannot be complacent. Recent events and health-care reform have made politics and regulation more a part of our professional lives than ever before. Improving productivity will only take us so far. We need to make ourselves part of the process. We will not simply be invited to the discussions. We might need to knock on (or perhaps knock down) the door. Get involved. Encourage your staff and partners to learn what is going on; challenge your politicians. Talk to your patients. Make grassroots advocacy a part of being a radiologist. Make it part of your practice. Contact Burnes ( and Ballesteros ( for more information about RAN. Howard Fleishon, MD, MMM, FACR, is a radiologist with the North Mountain Radiology Group (Phoenix, Arizona) and is speaker of the Council Steering Committee of the ACR.