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The conduit of credibility

December 2002
Paul A. Raslavicus, MD

To find the best electrician, I do not look in the Yellow Pages. I seek out a personal referral, if possible. Faulty wiring isn't something I want to discover the hard way.

Success in business is very similar to success in political advocacy. Both are about establishing a solid reputation, then earning it again and again, one day at a time. Both are also about persuasion. A winning argument begins with credibility. The work of pathology in Washington is about forming personal partnerships with critical decision-makers, establishing credibility, demonstrating what motivates us, and showing what we can contribute. If the information we need to share is analogous to electronic bits and bytes, our reputation is the conduit that ensures its safe delivery.

We contribute much. Science moves fast: Molecular genetics didn't exist when CLIA was passed, and now HHS has an advisory committee to grapple with the implications. Bioterrorism is a threat, but SNOMED and other sophisticated communication systems are powerful tools to temper it. There is much to be done to protect the public health.

Building relationships in Washington is complicated by the high turnover in Congress. The institutional memory of CLIA, for example, is limited to the few incumbents in office 13 years ago. We must educate each new generation of policymakers—and new generations are only two years apart in the House—about why laboratory quality is a life-and-death matter for their constituents, how readily quality can be compromised, and what the community of pathologists working with the College can do to help policymakers frame good law and sound regulation.

Everyone in Washington is an advocate, and every advocate has a motivation. CAP lobbying has always been motivated by pathologists' commitment to optimal quality in laboratory medicine. We were centered on laboratory quality long before CLIA; much of CLIA is based on the voluntary Laboratory Accreditation Program created by pathologists. When appropriate, we will partner with government. We can protect the tradition and ethics of medicine and ensure that regulation is effective and meaningful. Intelligent laws and regulations, thoughtfully enforced, are our best prevention against loopholes, the short circuits in a system that is meant to protect patients.

Like my electrician, we build credibility by cultivating relationships. We seek out legislators and staff with relevant responsibilities. We testify before congressional committees when bills and regulations are debated. We nominate members to serve on advisory committees. We meet with key legislators and staff. In October, for example, I had lunch with Tommy Thompson, the secretary of the Department of Health and Human Services. Later that month, Jared Schwartz, MD, PhD, and Paul Bachner, MD, made a trip to Atlanta to confer with officials at the Centers for Disease Control and Prevention about how we can work together against bioterrorism. We partner with congressional and administration leadership in multiple ways at multiple times.

The College has unique responsibility as the only organization that solely represents pathologists and has only physicians as its members. We collaborate with other laboratory groups, but much of our effectiveness lies in our ability to maintain our identity as the only organization exclusively made up of pathologists—the medical decision-makers in the laboratory. On most issues we find ourselves in agreement with our clinical laboratory colleagues, but on issues affecting the practice of pathology, the College must and does lead rather than follow.

We do compete with the 50 medical organizations in Washington, not on issues, but for the time and attention of elected officials and policymakers. Therefore, when we communicate, we need to keep the static off the line by staying focused on pathology-specific issues.

As advocates for pathology, one of our best tools is a laboratory tour for a member of Congress hosted by a CAP member. In this relaxed and interesting setting, the senator or representative can learn firsthand what pathology is about and why quality is so critical. Our goal is to host more than half the members of the House of Representatives on CAP-sponsored laboratory tours during the next five years. Our members have led 81 lab tours since 1999. The House has 435 members, so a majority means 218 tours. We're well on our way.

We have abundant evidence that laboratory tours work. Our lobbyists can provide an impressive list of concrete actions showing that educated legislators—those who have toured a laboratory—will support quality laboratory medicine. This is true grassroots political action, and we need your help.

Most of the pathologists who have hosted tours for members of Congress are members of the Pathology Advocacy Network, a grassroots program to connect pathologists with senators and representatives as resources on matters of public policy. Many network members are graduates of the CAP advocacy school, offered in the spring (April 7-9, 2003) and fall.

In building our advocacy network, we need to make sure that good facts are communicated. I often turn to "PathNet" and "Statline," electronic publications written by the CAP Washington office staff, to stay up to date. The biweekly newsletter "Statline" appears in the advocacy section of the CAP Web site. "PathNet," a weekly look at current bills and regulatory proposals, is sent by e-mail to CAP members who have joined the Pathology Advocacy Network.

The College also hosts dinners and fundraisers for lawmakers. These small dinners accommodate easy give-and-take between our representatives and key lawmakers. Our participation in fundraisers is made possible by those of you who contribute to PathPAC. Fundraisers are excellent opportunities to meet and talk with incumbents and new candidates. I cannot overstate the importance of contributing to PathPAC.

While most of our advocacy work relates directly to pathology, we work with the AMA on broader issues, such as liability reform and the Medicare fee schedule. We share common concerns with colleagues in hospital-based specialties; our collective issues often funnel through the AMA. To achieve effective leadership roles in the AMA House, we need your help. If you are an AMA member and have not yet designated the CAP as your specialty representative to the AMA House of Delegates, please do so today by visiting www.cap.org.

As your New Year's resolution, please consider getting involved in CAP advocacy. Each pathologist who opts out creates a small short-circuit in our message. We need to remember that the fire in every furnace starts with a single spark. Let's keep the house of pathology warm, humming with the collective energy of 16,000 credible voices.

At CAPTODAY press time, the Joint Commission on Accreditation of Healthcare Organizations announced that it was entering into a collaborative arrangement with the American Society for Clinical Pathology for laboratory inspection and accreditation.

With the help and direction of its members, the College has set the standard in laboratory improvement. Our lab-director-oriented, peer-driven, and educational program has established a partnership with the medical laboratories of our nation's hospitals. The College intends to keep this partnership strong and of value to all.

To learn more about the CAP Advocacy Network, advocacy school, and laboratory tours, visit www.cap.org, click on "Advocacy," and follow the links, or contact Rebecca Woodcock at 800-392-9994 ext. 7105; rwoodco@cap.org.