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Washington Perspective

The 'secret' world of advocacy: It's not Hollywood, but it works

From the February 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Robert B. Doherty

When people think about what a governmental affairs office does in Washington, they often conjure up an image that is more glamorous than reality. The Hollywood-created image of lobbyists and legislators scurrying from one black-tie dinner to another, of deals being made in smoke-filled back rooms and of money being quietly passed under the table has little to do with the real world of advocacy in Washington.

Most of us rarely if ever attend black-tie receptions. Deals are made—usually in smoke-free congressional offices—but they typically involve careful compromises rather than the flagrant horse-trading of popular myth. Financial contributions to legislators are strictly regulated, and anyone who tries to skirt the rules will likely find themselves in a federal correctional facility.

The "secret" of how Washington really works is that quiet persuasion by skilled governmental affairs professionals, backed up grassroots advocacy from members "back home," makes for a successful governmental affairs program. This month's column will discuss how ACP-ASIM's Division of Governmental Affairs and Public Policy really gets things done in the nation's capital.

Washington staff

Your governmental affairs office in Washington is organized around the following departments and divisions:

  • The public policy staff. Individuals on this staff provide background information and analysis to help ACP-ASIM committees make informed recommendations to the Board of Regents. Their job is not to determine the policies, but to make sure that the College's leaders have the best information available when making decisions. This staff is also responsible for converting the positions of the College into written communications that will be persuasive to policy-makers.
  • The managed care and regulatory affairs staff. Members of this staff focus on influencing regulations and health plan rules that have a direct impact on the environment in which our members practice. They review, analyze and draft comments on proposed federal regulations; field requests from members for help in dealing with the onerous rules of HMOs and other health plans; and meet with agency and health plan officials to negotiate improvements.
  • The legislative affairs staff. These staff members are responsible for persuading members of Congress and their staff to support the College's positions. They do this by becoming trusted sources of information on how proposed bills will affect internists and their patients. They know when the key decisions are being made and by whom, and they are on the scene to make sure that ACP-ASIM's views are heard. They also organize and participate in coalitions of like-minded organizations to support common legislative goals.
  • The grassroots advocacy staff. Members of this staff are responsible for ACP-ASIM's Key Congressional Contact Program, which is a network of informed and savvy internists who are willing to contact their members of Congress to support the College's views on pending issues.
  • The state health policy staff. Because so many public policy decisions are made at the state and local level, individuals on this staff make sure that chapter leaders have the information, resources and assistance needed to influence the decisions of state officials and legislators.
  • The public affairs department. Members of this department are responsible for getting the word out to the news media on the College's views on public policy issues. A favorable or unfavorable editorial in a publication read by members of Congress will often influence how they vote. The news media can also influence the views of the public.

All members of the Washington office work as a unified team in developing a coordinated response to public policy issues. Whenever an issue is identified that requires the College's attention, the staff team of legislative, public policy, grassroots advocacy, state health policy, regulatory and public affairs experts meet to plan a coordinated campaign to bring ACP-ASIM's influence to bear on the outcome.

Selecting issues

Each year, hundreds of bills that address health care are introduced in Congress. Thousands of pages of regulations that govern virtually every aspect of patient care are published in the "Federal Register." And on the state and local levels, there are the thousands upon thousands of edicts issued by third-party payers, lawmakers and regulators. How then do we decide which issues deserve the College's attention?

More often than not, individual ACP-ASIM members let us know about an issue that requires the attention of the Washington staff. For example, several internists around the country recently alerted us to the fact that some managed care plans are arbitrarily prohibiting internists from seeing patients under the age of 18. As a result of these calls, the College's Medical Services Committee is recommending to the Board of Regents that the College oppose arbitrary restrictions on the age of patients that can be treated by internists.

Another ACP-ASIM member recently told us that his Medicare carrier was denying payments for consultations when the consulting physician subsequently initiates treatment of the patient. The regulatory affairs staff investigated the issue and found that carriers in several states in the country were incorrectly applying HCFA's rules on coverage of consultations, potentially resulting in improper denials of claims to thousands of members.

Other times a resolution from the Board of Governors, an action by the Board of Regents or a recommendation from an ACP-ASIM committee puts an issue on our advocacy agenda. In other cases, it is the political intelligence (not always an oxymoron) obtained by the staff itself that brings an issue to the College's attention. This will happen when the College's legislative affairs staff learns of a lawmaker's interest in pushing a particular piece of legislation. It also may happen when the regulatory affairs staff finds out that a federal agency has another proposed rule up its sleeve, months before it ever appears in the "Federal Register."

Results matter

Listening to members. Being able to respond in a timely and decisive manner. Having a dedicated and talented staff that is able to work together as a team. Maintaining an effective grassroots advocacy capability. Making sure that all of the bases—lawmakers, regulators, private sector health plans, state governments and the media—are covered.

Such fundamentals may lack the mystique of the popular image of what goes on in Washington, but they are what is required to be an effective advocacy organization in the nation's capital. Results, not process, are what ultimately matter. But ACP-ASIM's effectiveness in achieving results has always been rooted in doing the fundamentals well. They will continue to guide our advocacy now and in the future.

Robert B. Doherty is ACP-ASIM's Senior Vice President for Governmental Affairs and Public Policy.

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