April 1997
Volume 61 |
Number 4
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PRESIDENT'S PAGE
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| What Are the Issues
and What Is the Message? |
Phillip O. Bridenbaugh, M.D., President
About the time you get this NEWSLETTER, some 400-plus
ASA members will have spent two days in Washington, D.C., attending
our annual ASA Legislative Conference. For those of you who have
not attended one of these conferences, it consists of one-and-a-half
days of talks given by members of Congress, congressional staff,
officials of regulatory agencies, pollsters or media types.
The last half-day is designated for all of the attendees and
their state society colleagues to make personal visits to the
offices of their senators and representatives. The objective of
these visits is to acquaint the members of Congress and/or their
staffs with current federal issues of importance to anesthesiologists.
Unfortunately, all too often, the issues are unique to anesthesia
and/or represent matters related to professional income and may
be of little interest to Congress.
What Are the Issues Facing ASA Members Now?
How do ASA members determine what the issues are? The obvious
way we as voters and citizens learn the issues important to our
nonprofessional life is through the media, primarily television
and newspapers. The way anesthesiologists learn the issues important
to their practice is through their membership in ASA and their
state component societies.
In addition to the very informative articles in these monthly
NEWSLETTERs by Michael Scott, Director of Governmental
Affairs, and Karin Bierstein, Practice Management Coordinator,
there are special letters to every ASA member from Mr. Scott or
me calling your attention to the very important or urgent issues
that need your special attention - and call to action. At the
ASA Annual Meeting, there is often a "Legislative Update"
and, usually, practice management workshops as well. Finally,
ASA presented its third annual ASA Conference on Practice Management
in February to more than 400 anesthesiologists and some of their
administrative assistants. There, such legislative issues as fraud
and abuse statutes and antitrust laws were discussed.
Specific Issues
Following up on failed legislation from the last Congress, and
as an essential part of balancing the budget through Medicare
reform, will be the introduction of legislation to convert the
Medicare Fee Schedule to a single conversion factor. Since
the details of how this came about have been discussed by Mr.
Scott in previous NEWSLETTER articles, it is more important
that individual ASA members ask themselves what they really know
about this issue and how it might impact on their practices.
Because anesthesiology has its own Medicare Fee Schedule, it
has a different conversion factor than every other medical specialty.
This means any legislation proposing to change to a single conversion
factor will have to include language specific to anesthesiology.
If this bill is to be written and ultimately passed in favor of
our specialty, it will have to be convincingly explained to many
members of Congress and their staffs why anesthesiology should
be treated differently than other specialties. Can you do that?
A second major issue for many of the surgical and medical specialties
as well as anesthesiology is the proposed change in the practice
expense portion of the Medicare Fee Schedule. This issue also
has been discussed by Mr. Scott in a previous NEWSLETTER
article. Although this issue really involves a regulatory change
by the Health Care Financing Administration (HCFA), the change
is the result of a legislative mandate. Preliminary reports from
HCFA suggest decreases in Medicare reimbursement by 20 percent
to 40 percent for many of the surgical specialties, and the only
way to prevent those changes from being implemented in January
1998 may be through introduction of legislation.
Even the most knowledgeable member of Congress will probably
find it difficult to understand the technical aspects of this
legislation. It will be a difficult issue to explain when you
call on your senator or representative unless you have done your
homework first.
There is no doubt that other important legislative issues will
emerge as the congressional year unfolds. These two issues, however,
illustrate a point I wish to make; i.e., how do we convert complex
issues relating to the practice of anesthesiology into messages
that request congressional support?
What Is the Message?
The important answer to the question of "What is the message?"
is not its technical content, but rather its simplicity,
brevity and public interest. Lobbyists and media trainers will
emphasize the need to select one or two key points that can be
stated and repeated indelibly in a very few minutes. If that message
is received, questions relating to details of importance, cost
and public interest may follow.
Having said that, one can reflect about whether we have a better
chance of success by making a 15-minute call on members of Congress
in their Washington office as a group of anesthesiologists, or
by making individual personal visits when they are back home in
their local office. I believe we may have more identity and credibility
as an important member of their hometown support group when we
make a personal call at home, rather than as a visitor to Washington,
D.C. Do not misunderstand, both are important, but the more complex
the issue, the better the chance the message might be heard in
the quiet and less stressful environment of the legislator's home
office.
More important than where the message is delivered is
what the message is and how it is delivered. Seen
through the eyes of a member of Congress (who is likely besieged
daily by a variety of constituents soliciting Congressional support
or action on their "pet" issue), medical issues presented
to members of Congress are often viewed as technical, income-related
and of little consequence to the local electorate or the American
public. Most of us have never been trained in sales techniques
(that is why we have lobbyists!), but it seems logical that we
must "package" our issues in such a way that they become
important public issues, worthy of Congressional support.
How do we do that? One very effective way is for each anesthesiologist
to be thoroughly informed about the "big picture" of
the legislation and not just the narrow issue of what it will
do to "us" if and as soon as it is passed into law.
What are the public issues of a single conversion factor
and physician practice expense regulations? Politicians, the media
and the public like to hear personal testimony about what happened
to their doctor's practice and what it means. If our issue is
also an issue of organized medicine, more of the public becomes
concerned. When access to medical and specialty care becomes threatened
by lack of government support for the expense of providing quality
care, the patient (i.e., the voter) will be interested.
This is no longer just an income issue. Once the physician, the
anesthesiologist (you!), has personally explained the relevance
of the issue to the local lawmakers, then it should be easier
to follow up with their staff (by sending ASA fact sheets) and
provide them with details of how their staffs, with our
help, can effect a mutually desirable outcome.
What Does ASA Do to Help?
Earlier, I cited our annual legislative and practice management
conferences as means of learning about the issues. Also noted
were the monthly columns that staff and ASA leadership write in
the monthly ASA NEWSLETTER. On a more proactive level,
I find, as a member of the American Medical Association, that
the weekly AMA newspaper, American Medical News, has outstanding
articles dealing with all of these legislative and regulatory
issues. Furthermore, they are reported as they impact on all of
organized medicine and the public.
Anesthesiologists are not meant to be a single, abandoned shrub
in the desert, but rather a tall and visible tree in the forest
of organized medicine. ASA works closely with AMA and vice versa.
In these chaotic times of "health care reform" (or is
it deform?), our membership in AMA is an investment in
keeping the practice of medicine in the hands of qualified physicians
rather than third parties and cheaper nonphysician providers.
ASA offers spokesperson training sessions at the ASA Annual Meeting
and Legislative Conference. Those of you who have attended these
courses have commented on the benefit you received when you next
called on your state or national legislators or did media interviews
for television and newspapers. Such programs can also be done
at your state component society meetings.
Finally, our Office of Governmental Affairs has a wealth of ability
and resources to assist you in this very important activity. Printed
material and fact sheets are available on all national and state
issues. More than likely, the ASA staff knows (or can find out)
more about your legislators than you do. This is especially true
regarding their positions on health care and anesthesia-related
issues, the committees on which they serve and how they usually
vote. I find it reassuring, in talking to my members of Congress,
to be as well-informed bout the issues on which I seek their support.
In summary, we must believe our political issues are important
to our neighbors and out patients if we are going to convince
our politicians to support us. I believe they are - we just have
to deliver that message!
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