In 2010, the American College of Surgeons (ACS) began a Chapter Lobby Day Grant Program that provides funding to chapters that intend to sponsor lobby days in their respective state capitals. Over the course of the last three years, many chapters have taken advantage of the grant program in an effort to energize and engage their leadership and members in grassroots advocacy. As of press time, 19 ACS chapters have participated in this program, including Alabama, Connecticut, Florida, Georgia, Illinois and Metro Chicago, Indiana, Kansas, Maine, Massachusetts, Michigan, North Carolina, New York and Brooklyn-Long Island, Northern California, Ohio, Oregon, Tennessee, and Virginia.
By sponsoring lobby days, chapters have laid the groundwork for advancing surgical issues and effecting health system reforms at the state level through meetings with their elected state officials. Chapter member visibility with state legislators helps to remind lawmakers that ACS chapters are the voice of surgery in their states, and it is anticipated that relationships forged today will result in legislative successes tomorrow.
Most chapters have wrapped up their lobby days for 2013, given that most state legislatures meet between January and June. This article provides a snapshot of several 2013 lobby day activities and accomplishments.
The Alabama Chapter meeting took place February 5 in conjunction with a legislative reception sponsored by the Medical Association of the State of Alabama. Several members of the medical community attended the “State of the State Address” that Gov. Robert Bentley (R) delivered that day.
The Alabama surgeons who attended the event were able to meet with several legislators, including the chairs of many important committees. During these meetings they discussed funding for the state trauma system, workforce and professional liability issues, graduate surgical education, Medicaid funding, and scope of practice, among other topics. Those meetings spurred further discussion regarding how surgeons could offer expert input on future legislative efforts pertaining to health care.
The Florida Chapter and the Florida Chapter Committee on Trauma members met in Tallahassee, FL, February 19–20, for 2013 Legislative Day events. The activities began with participants and state representatives convening at a reception. The casual setting provided an informal opportunity for chapter leaders to introduce themselves to legislators before lobby day events at the state capital, which began with presentations from Chris Nuland, Florida Chapter lobbyist. Mr. Nuland discussed relevant state health care issues and provided talking points for participants to use when meeting with legislators on proposed bills. Jon Sutton, co-author of this article, provided an overview of resources that the College provides to chapters and of state legislation that the ACS is tracking across the country.
Following the presentations, participants met with their representatives and some health committee members during the final week of meetings before the general session began. Having the lobby day before the session provided an opportunity for the chapter to do some legwork on critical legislation, including a modest tort reform bill that the legislature passed, which limits expert witness testimony to those health care professionals in the defendant’s own specialty. A scope-of-practice bill also passed that allows optometrists to prescribe certain pharmaceuticals but prohibits them from performing surgery.
The Georgia Society of the ACS hosted two new events during its lobby day program, March 20–21. First, a dinner for the chairs and physician and nurse members of the House and Senate Health Committees took place, followed the next morning by a legislative breakfast at the state capitol.
The dinner provided an opportunity for a core group of surgeons and legislators to engage in many productive conversations, and thereby fostered the development of personal relationships between ACS members and legislators. The Board of the Georgia Society of the ACS was so pleased with the event that they decided to host a dinner each night of next year’s lobby day events: one for the House and one for the Senate. Surgeons who attended the dinner appreciated the convenience of meeting with legislators in the evening so that it did not affect their regular work hours, and legislators said they appreciated the opportunity to focus on issues important to surgeons without the daily distractions that come with meeting at the capitol.
The breakfast at the capitol the following morning provided an opportunity for legislators and their staff to connect with Georgia surgeons. Especially memorable for some participants was the fact that the state House and Senate adopted resolutions declaring March 21 to be Georgia Surgeons’ Day.
The Indiana Chapter held its third lobby day program February 4, earlier in the month than in previous years, offering surgeons the opportunity to address a broad array of legislation with lawmakers. Nearly 30 surgeons participated in the event, as well as a couple of speakers, including Indiana State Sen. Mike Delph (R), who gave an informal presentation on the legislative process. He stressed that surgeon attendance at the event was very important and truly a part of their civic duty.
Other speakers included Mr. Sutton, who addressed the resources and programs available to Fellows through the state affairs area of the ACS Division of Advocacy and Health Policy; and Mike Rinebold, director of governmental relations for the Indiana State Medical Association, who spoke about health care-related legislation that is expected to affect all physicians.
Two speakers provided updates on the Affordable Care Act: Seema Verma, a consultant who developed the Healthy Indiana Plan, provided an update on state health insurance exchanges, and Greg Kiray, MD, Indiana University Health Physicians Service-Line Chief for Primary Care, provided an update on the meaningful use provision of the law. Attendees received handouts with pertinent information on bills moving through the legislature. After a group discussion and brief lobby training, attendees met with legislators at the Capitol.
The measure of success was evident as two bills discussed in meetings were enacted. These laws pertain to scope of practice and end-of-life patient care.
The Kansas Chapter collaborated with the Kansas Academy of Family Physicians to jointly sponsor a lobby day program on January 23. This collaboration allowed the chapter to capitalize on the leverage that the Kansas Academy of Family Physicians has built through the presentation of lobby day programs over a number of years and to provide speakers and legislators with a larger audience. Seven chapter leaders attended, including the Chapter President and President-Elect.
The first portion of the day was reserved for the chapter to meet with the executive director of the Kansas State Board of Healing Arts, which is responsible for approving state licensure for appropriately qualified health care professionals. A key issue discussed in this meeting was the development of a system that allows out-of-state health care practitioners to have their licenses recognized in Kansas during a declared state of emergency. The executive director of the board agreed to initiate conversations with the governor on this topic to ensure his continued support but cautioned that for the policy to receive consideration, it would have to include certain essential components, such as a governor-issued declaration identifying the nature and area of the disaster; a specific time when the disaster would be declared over; evidence of current licensure in their respective state; professional liability insurance coverage; and no disciplinary actions on record. Following a lunch with presentations by the Kansas Medical Society and the Kansas Academy of Family Physicians, attendees went to the capitol to meet with their legislators and participated in committee hearings.
The New York/Brooklyn-Long Island Chapters and the New York Coalition of Specialty Physicians presented their annual lobby day program on April 23. The day included visits with more than 100 legislative offices and began with a panel discussion on key pieces of legislation, such as nonphysician scope-of-practice expansion, out-of-network reform, and various tort reform bills that could dramatically increase liability insurance rates if enacted.
More than 16 members of the Ohio Chapter and the Ohio Committee on Trauma attended a legislative dinner on February 28 with six state legislators who are experts on health and human services issues. Conversations over dinner ranged from pending legislation that would affect breast reconstruction mandates and the use of surgical technology, to the need to reform Ohio’s statewide trauma system. Both surgeons and legislators noted that the dinner was a success in that it provided a unique opportunity to exchange ideas on important issues affecting the health care system and the practice of medicine in Ohio.
A total of 15 surgeons participated in the Oregon Chapter lobby day on March 11. Event speakers included Rep. Mitch Greenlick (D), chair of the House Healthcare Committee; Sean Kolmer, a policy advisor to Gov. John Kitzhaber, MD (D); and Bryan Boehringer, a lobbyist for the Oregon Medical Association.
Surgeons and their legislators discussed a number of important pieces of legislation and issues. One bill that gained a lot of attention centered on disclosure and offer as a means of tort reform. Although the bill did not fundamentally address the claims resolution process, it did address certain aspects of tort reform, such as apology and early disclosure, which could remedy some problems in the tort system.
Community Care Organizations (CCOs)—a network created by state policymakers to reduce health care expenditures—was another topic covered during the event. Lobby day attendees discussed how the CCOs would actually function versus how they are described in theory, including their potential impact on reimbursement rates—an issue on which hospitals and CCOs sometime disagree and which may lead to legal disputes. The lobby day ended with members meeting with legislators at the state capitol and attending a Health Care Committee hearing.
More success anticipated
As this overview demonstrates, numerous successful models are available for chapters to use in planning and conducting lobby days. State chapters are encouraged to participate in the ACS Chapter Lobby Day Grant Program and develop strategic alliances to help advance important state legislation.
To learn more about the grant program, contact Jon Sutton, ACS State Affairs Manager, at firstname.lastname@example.org.