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Advocacy in your own backyard

February 2004
President’s Desk Column

Mary E. Kass, MD

Pathologists are doing more with less these days. We delegate when we can, which can be a smart way to get things done, but not everything can be delegated. For example, the College has a fine government affairs staff. Their knowledge, energy, and vigilance are second to none. But the work of the staff cannot supplant the responsibilities of the membership. Nobody else can do my part to advocate as a pathologist in the interest of my patients.

While most of us think of Washington, DC, when we think of advocacy, some of the most important work happens much closer to home. Advocacy is about day-to-day communication with colleagues, hospital staff, administrators, payers, legislators, and regulators. The details may change, but the message does not. My mission is to see that patient care quality is always at the core of conversations about health care delivery.

Sometimes we teach by example and sometimes we illustrate by anecdote. Opportunities to do those things may best be found outside our comfort zones. One good example is service on a hospital quality care committee. Hospital committees are a good place to collaborate with peers and administrators and to get to know them better. In that setting, we find ways to explain why fair compensation for pathology services and institutional support for quality laboratory medicine are fundamental to excellence in patient care.

Contacting payers to challenge payment denials is another form of advocacy. While this can be delegated to some extent, never should we be too busy to see that it’s pursued properly. If we don’t challenge third-party measures that compromise resources available to the laboratory, those restrictions will quickly become the norm.

Payment denials can be opportunities to educate. I wonder how many of those who decide to deny payment appreciate the long-term cost of the short-term savings. In pathology, the big picture is part of the job, and that means creating a dialogue with others whose responsibilities affect patient well-being.

For many pathologists, it is much easier to envision advocating for concerns within the hospital or with payers than working with the state pathology society to monitor and respond to events in the state capitol. This is another step outside the comfort zone, one that more pathologists need to take. Some of our biggest challenges to patient safety and quality care come from state legislative bodies and their committees.

College leaders and staff have been working to make state-level advocacy easier for our members. The CAP state affairs staff analyzes hundreds of state bills each year, and adds those with a significant potential impact on pathology to a "state issues database." The database, on the CAP Web site (www.cap.org), under Government Advocacy in the Pathologists section, provides a summary of each bill and its status, a link to the text, and another link to that state pathology society’s state issues adviser.

Each state pathology society has a state issues adviser, appointed by the CAP president to act as a liaison between local pathologists and the CAP. The state affairs staff in Washington works with the state issues advisers on strategy, assists in preparing testimony for hearings, and helps local pathologists navigate the legislative and regulatory maze.

While some state pathology societies have higher profiles than others, many have shown impressive initiative. This past summer, for example, the Louisiana Pathology Society secured the introduction of a CAP-backed bill that would allow only licensed providers who perform or directly oversee outpatient anatomic pathology services to bill for those services in their state. The bill passed the Louisiana House and Senate unanimously. Signed bills sometimes detour on the path to implementation, however, which is why Louisiana pathologists wisely continue to track the bill through the regulatory process. Surprises will occur in legislation, but they need not be unexpected.

This is precisely the kind of savvy advocacy we can all strive to provide. The need at the state level is great because the volume of dangerous or ill-advised notions seems to be increasing every day. Consider this short list of other events in which the College participated in 2003:

  • We helped reverse attempts by New Jersey pharmacists to expand their scope of practice to include ordering, performing, and interpreting laboratory tests without physician supervision.
  • We helped Connecticut pathologists repeal a policy that capped Medicaid payments to hospital-based pathologists at half the fee schedule amount.
  • We fought legislative attempts in New York to create unnecessary and punitive standards for the release of genetic test results to referring physicians.

Pathologists need to be knowledgeable about national and local issues, and the College can help. If you are ready to take on a more active role, why not consider joining the Pathology Advocacy Network, a grassroots program that connects pathologists with their U.S. senators and representatives as resources on public policy? Joining is simple-just call CAP staff to sign up. Members of the network receive the weekly "Washington Update," an e-mail review of bills and regulatory proposals. Another member resource is "Statline," a biweekly e-mail newsletter linked to expanded articles on the CAP Web site.

At the very least, do some grassroots networking. Send an e-mail to your state pathology society officers. Names, contact information, and meeting dates for state pathology societies are on the CAP Web site (click on Pathologists from the home page task bar, then State Societies.) If you are not ready to commit to an ongoing role, let them know they can call upon you when they need a show of support for a position. One day, they may call to ask you to contact your senator or representative to state your support or opposition to a bill and to explain why he or she should agree. Legislators do respond to constituent contacts, and they do pay attention to phone calls. Your call could be the one that changes someone’s mind. That one vote could be the one that carries the cause.

Not all of these activities will come naturally to every pathologist, but these tasks are ours to do. In my experience, getting busier with things that matter to me dilutes the sense that someone else’s priorities are driving my day. We are entering an era of great empowerment for pathology, much of it waiting just outside our comfort zones. I plan to spend some time there, and I hope many of you will, too. Dr. Kass welcomes communication from members. Send your letters to her at president@cap.org. To join the Pathology Advocacy Network, call 800-392-9994 ext. 7107.


Dr. Kass welcomes communication from members. Send your letters to her at president@cap.org