By: Patricia (Pat) Kroken, FACMPE, CRA, FRBMA
Originally Published in RBMA Bulletin September/October 2022

We tend to think of advocacy on the large scale, where our collective input is gathered by the Radiology Business Management Association (RBMA) and American College of Radiology (ACR) to address the potential impact of pending governmental regulations.  Together we have shown our united “big voice” can result in favorable changes as we present a valuable perspective on specific issues. 

While these larger organizations effectively provide core factual information about the role of radiology (and the bigger issues faced by our specialty), when responding to a call for action, it helps to add local flavor.  This reminds the practice’s Congressional members of how pending legislation impacts the folks back home, especially if information is presented in a professional manner.

A few action items, hopefully developed before another major issue slams us, can be utilized for practice advocacy in multiple situations so let’s take a moment to consider where else our voices may need to be heard and identify how some central themes can serve multiple purposes.

1. Hospital administration

Your practice may have held a professional services agreement with the hospital for several decades, assuming therefore, everyone knows who you are.  This, however, is how radiology Requests for Proposal can happen as a new administrative team vows to make its mark and you end up scrambling to prepare a new proposal to save your contract.  Proactively making sure your hospital system leadership is well-informed about what your group has to offer can be a wise investment in time and effort.

2. Independent Dispute Resolution under the No Surprises Act (NSA)

Under the NSA, your practice will need to persuasively make a case for a negotiated payment rate from non-contracted insurance companies through the Independent Dispute Resolution (IDR) process. Some of the same baseline preparation involved in advocacy efforts can be applied here as well as you develop a practice fact sheet. What things can help your practice stand out and support being paid at a favorable rate?           

3. State legislative activity

State legislatures frequently deal with bills that will impact our practices, including business-focused regulations that are not necessarily healthcare-specific. Your voice at the state level can make a difference in whether or not new legislation is enacted.

4. Local regulations

You can potentially have even a larger impact influencing policy development at the local level, especially if you are one of the larger radiology groups in the community.

Become a Spokesperson for Radiology

It is too easy to assume someone else will communicate the message for radiology.  In many cases our professional associations carry the banner, but there are also considerable local media opportunities to tell our story, in addition to communicating with lawmakers.  Sometimes we forget our practices are important community citizens.    

A fact sheet of concise bullet points can be distributed to both legislators and the media. It is important to present accurate facts to policymakers and the media and a fact sheet helps maintain a higher level of accuracy as you tell your story.  (Don’t force a reporter or legislator to frantically take notes because this increases the likelihood of errors.)  Local media outlets will often welcome the local slant of a national story and this offers the opportunity to influence voters in your community as well. Citizens often do not realize how legislation may impact them directly and will frequently step up in support of maintaining valued resources.

Local reporters will respond well to a fact sheet so it is often not necessary to send them an entire prepared story as a press release. On the other hand, a well-articulated letter to the editor can also forward the cause. Just remember – no whining or gross exaggeration. The facts are compelling on their own, especially since many of our communities can face a loss of services (or employment) if severe reimbursement cuts or other burdensome polices are implemented. The emphasis should be on the “what’s in it for me?” from the patient’s perspective – or that of others doing business with your group.

As a starting point, the advocacy/press packet can include various fact sheets focusing on the following areas:

Profile of your practice

The history of your group (when it was started and how it evolved), number of facilities served, number of radiologists and their subspecialty areas, modalities offered, accreditation and general information regarding procedure volumes (“more than 100,000 mammograms per year”). If radiologists and/or administrative staff are involved in community events or organizations, this should also be mentioned.

Economic impact

What is the practice’s economic impact on the community? For example, noting the number of non-physician employees, non-physician payroll and benefits, goods and services purchased in the community, uncompensated care provided, and “good corporate citizen” donations or support will get the attention of legislators. Radiology practices are normally good employers, often paying above-market wages and offering excellent benefits.  This helps establish your authority as a source and emphasizes your important role in the community.  

Radiology trends

Bullet points regarding radiology trends can be adopted from industry and association resources and for example, could address the following items:

  • Advances in areas such as vertebroplasty, uterine artery embolization, and the health benefits for patients
  • Radiology’s role in stroke diagnosis and treatment
  • The role of the radiologist including specialized training and other supporting information explaining what a radiologist does
  • The growth of imaging modalities and advances in technology
  • Imaging quality – best when done by a radiology professional
  • Other pertinent developments and clarifications

Putting it to Work

Most legislators (State and Federal) maintain websites, where you can communicate via e-mail and sign up for newsletters, announcements of local town hall meetings, and other updates. In addition, there are websites such as https://www.govtrack.us/congress/bills/ where you can track the progress of proposed national legislation and find out how your congressional members are voting on the various issues. State sites will vary in sophistication but will frequently offer summaries of pending bills as well as details of laws that have been passed. Since radiology and/or medical associations will also communicate about pertinent issues, it is wise to periodically monitor the various sites to see what is under discussion.

Senators and Representatives also maintain local offices and will visit periodically when Congress is not in session. This provides an excellent opportunity to arrange for face-to-face meetings regarding pertinent issues or to invite the legislator to visit with a group of constituents, such as a local RBMA chapter or state radiological association. Legislators understand the critical nature of their relationship with constituents and will normally respond to questions and concerns – especially if they are voiced in a professional manner. In other words, keep the meeting on track in terms of addressing specific issues and don’t use it to vent a long-standing list of frustrations. Again, the fact sheets will provide excellent leave-behind materials for reference and will probably end up in the hands of a staff member assigned to healthcare issues.

Finally, any correspondence should define the action requested, whether voting for or against the proposed legislation. Telephone calls and e-mail submissions help establish the scope of concern regarding the issue and when done effectively, decision-makers can be flooded with several hundred thousand communications within a short period of time. The more the issue can be supported in terms of its impact on patient care, access to procedures or the cost of healthcare, the stronger the message to the legislator will resound.

One Voice? Many Voices!

The frustration of any single individual or group practice is compounded by the feeling we are all helpless in a rapidly swirling environment, but there is strength in the expression of each single voice. Political activism will involve some effort but there has never been a more critical time to get involved, be visible to your legislators, and make your voice heard. Those who do not participate will be left to only react to an increasingly negative business climate and reaction alone is not a sound business strategy.

Patricia Kroken, MSN Healthcare Solutions Director of Education and Corporate Communications

FACMPE, CRA, FRBMA

Prior to joining MSN Healthcare Solutions as Director of Education and Corporate Communications, Pat Kroken had nearly 30 years of experience in radiology management as both a practice manager and consultant to radiology groups, billing companies, software vendors and hospital radiology departments.

Pat has had more than 200 articles published, is a regular contributor to the Radiology Business Management Association (RBMA) Bulletin and a frequent speaker on practice management topics. She served two terms as President of the RBMA, is Editorial Advisor for the national RBMA publication, The Bulletin, and represented the “business side of radiology” as RBMA Liaison to the Radiological Society of North America (RSNA) Associated Sciences Consortium for 7 years. 

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