The American College of Surgeons (ACS) Chapter Lobby Day Grant Program provides ACS chapters with support—up to $5,000 in grants for participating chapters—to engage members in grassroots advocacy initiatives. Participation has been wide-ranging, with more than 20 chapters hosting a state lobby day since the program’s inception in 2010. Lobby day events help raise the profile of ACS chapters at the state level and present an opportunity to educate lawmakers about surgeons’ legislative priorities.
Issues discussed at lobby days in 2015 include trauma funding, scope of practice, coverage for bariatric surgery, Medicaid reimbursement, and determining the legislative definition of surgery. At each of these statehouse visits, ACS Fellows were able to build relationships with legislators, staff, and key health care policy decision makers. Although the advocacy approaches may vary from state to state, the end result is always the same—increased opportunities to effect change in the laws and regulations that impact surgeons and their patients at the state level. Following is a roundup of the activity at this year’s chapter lobby days.
The Alabama Chapter of the ACS joined the Medical Association of the State of Alabama for a Day at the Legislature on April 8. The event began with a presentation on the basics of physician advocacy, followed by a discussion of grassroots lobbying opportunities. Alabama Sens. Tim Melson, MD (R), and Larry Stutts, MD (R), led a session on effective physician lobbying and provided insights into the Alabama legislature. Donald Williamson, MD, former State Health Officer, Alabama Department of Public Health, gave the keynote address on legislative budget proposals for the Alabama Medicaid program. Dr. Williamson described how proposed cuts would affect the long-term viability of the state’s Medicaid program.
Participants then went to the capitol for meetings with their legislators and committee leadership to discuss the proposed budget cuts and how they would affect the ability of surgeons and hospitals to provide trauma care services. The day concluded with a legislative reception that provided attendees an opportunity to network with other physicians and lawmakers.
The three ACS chapters in California collaborated on their 2015 lobby day in conjunction with the California Medical Association’s annual legislative advocacy day on April 14. Surgeons made the trek to Sacramento, CA, to advocate on a number of issues, including increasing MediCal physician payment rates to 100 percent of Medicare rates (S.B. 243); removing some exemptions from California’s vaccination law (S.B. 277); and requiring payment for telephone/electronic patient management telehealth services (S.B. 289). Gov. Jerry Brown (D) made an unscheduled appearance at the morning issue briefing and spoke with meeting participants. Following the briefings, physicians went to the capitol for legislative visits and attended committee hearings, including one with heated testimony on the vaccine legislation. That legislation eventually passed and was signed into law by the governor.
The Connecticut Chapter of the ACS and the Connecticut State Medical Society (CSMS) cosponsored a lobby day in Hartford on March 11. Several Fellows participated, advocating on bills to establish a legislative definition of surgery, increase coverage for bariatric surgery, and address truth in advertising. The day opened with remarks from ACS and CSMS leadership and continued with a conversation between session attendees and State Comptroller Kevin Lembo. After the presentations, members were briefed on pending legislation and attended individual meetings with state legislators, including Senate Majority Leader Bob Duff (D).
The Florida Chapter of the ACS held its annual legislative days March 24–25. The event kicked off with a dinner and presentations from Florida Surgeon General John H. Armstrong, MD, FACS; Florida Medical Association President Alan Pillersdorf, MD, FACS; former State Rep. Jerry Paul (R); and Tara Leystra Ackerman, State Affairs Associate in the ACS Division of Advocacy and Health Policy, Washington, DC. Dr. Armstrong provided a legislative update from the perspective of the state administration; Dr. Pillersdorf gave an update on key pieces of legislation in the Florida legislature; and Mr. Paul presented on how to be a successful physician advocate, along with his perspectives on life as a political candidate and elected official.
The chapter hosted a breakfast reception the next day where legislators were able to interact more informally with Fellows to discuss current legislation. Fellows then attended a public hearing of the House Committee on Health, where they testified against a scope-of-practice bill (H.B. 547) that would have granted independent practice to advanced practice registered nurses and physician assistants. The bill did not pass.
The Georgia Society of the American College of Surgeons (GSACS) partnered with the Medical Association of Georgia and 11 medical specialty societies for Capitol Day. Joining forces resulted in strengthened advocacy efforts by the Georgia house of medicine. Surgeons were able to reinforce current relationships with legislators and forge new ones at the capitol and later during more intimate gatherings organized by region. Top legislative priorities were discussed, including continued support for the statewide trauma network, Medicaid funding and reimbursement issues, the introduction of the Uniform Emergency Volunteer Health Practitioners Act, and the rural hospital health care access crisis. A highlight of the event was Gov. Nathan Deal (R) having his photo taken with the physician delegation on the capitol steps.
The Indiana Chapter of the ACS held its Lobby Day at the Capitol January 26, drawing more than 20 participants. The event included informative presentations by various Indiana stakeholders, as well as an overview of the Indiana statehouse and legislative issues by Don Selzer, MD, FACS. In addition, state Rep. Tim Brown, MD (R) provided legislative updates and a presentation on how to communicate with lawmakers. Topics presented included a discussion about physician advocacy led by Alexander Choi, MD, who recently ran for a seat in the state legislature; a review of quality programs by John Clark, MD, JD; and a presentation regarding the current environment of health care finance by Jonathan Curtwright, chief operating officer, Indiana University Health Methodist Hospital and University Hospital, Indianapolis. The leading issue surgeons discussed with lawmakers was S.B. 55, legislation that would have allowed medical liability claims of up to $187,000 to bypass the medical review panel and reach Indiana’s Patient’s Compensation Fund. This dollar amount represents a dramatic increase over the established $15,000 limit. Surgeons also focused on H.B. 1043, a bill that would have increased the medical liability cap on all liability awards to $1.65 million from $1.25 million. Both bills, which would have been detrimental to surgical practices, failed largely due to active physician opposition throughout the state.
The Kansas Chapter of the ACS and the Kansas Medical Society hosted a state lobby day in Topeka on January 21. The well-attended event kicked off with in-depth briefings about state and federal advocacy, the climate in the Kansas legislature, and medical liability. Several lawmakers attended the event to provide their perspectives on the issues. Following the briefings, members attended meetings with their individual legislators to advocate against scope-of-practice expansion for advanced practice registered nurses and in favor of tanning bed restrictions and an increase in the tobacco tax. After the legislative meetings, the medical societies hosted a reception that provided an opportunity for members and legislators to further interact.
The Louisiana Chapter of the ACS was a first-time lobby day grant recipient in 2015, taking advantage of the program to become more engaged in state grassroots advocacy. The key issue discussed at the May 13–14 event was group health plan insurance coverage for bariatric surgery. Two advocacy events sponsored by the chapter helped advance this issue—a backyard barbecue with chapter leaders and state Sen. David Heitmeier (D), resulting in his sponsorship of the legislation, S.B. 173; and a legislative dinner with invited legislators and chapter leaders to discuss the bill and other issues of interest. As a result of the grassroots activity of Louisiana ACS Fellows, S.B. 173 passed out of the Senate and went to the House Committee on Insurance. While time ran out before the bill could make it out of the committee, ACS Fellows experienced considerable success in working through the legislative process and getting the legislation to move from one chamber to the next.
The New York and Brooklyn-Long Island chapters of the ACS cosponsored a lobby day with the New York Coalition of Specialty Care Physicians on May 12. The day started with presentations by physician members and government affairs staff from the associations who provided a legislative briefing, advocacy training, and an overview of issues before the legislature. The advocacy training was unique this year, incorporating role-playing exercises for meetings with legislators and their staffs. Training session participants were then critiqued and coached by government affairs staff. More than 100 physicians were in Albany, NY, advocating on legislation under consideration, including scope-of-practice expansion for certified registered nurse anesthetists, optometrists, and podiatrists, as well as health care billing transparency. Several Fellows were able to meet with their individual legislators, including Kemp Hannon (R), Chair of the Senate Public Health Committee.
The Oregon Chapter of the ACS held its Day at the Capitol March 15–16. The event began with a chapter council meeting and dinner during which Bud Pierce, MD, PhD, former Oregon Medical Association president, discussed the state’s health care policy issues. State Rep. Knute Buehler, MD (R), also spoke with the advocates regarding his legislative priorities and provided insights into the legislature from a physician’s point of view. Participants later visited the capitol to discuss the following: an increase in virtual credit card transparency, instituting a timely grace period notification from 30 to 90 days for insurance companies to deny claims, and increasing the wrongful death liability cap to $1.5 million from $500,000. Attendees were also able to attend hearings held by the House and Senate Committees on Health.
The Tennessee Chapter of the ACS joined forces with the Tennessee Medical Association at its annual Day on the Hill in Nashville March 3. Surgeons used the opportunity to meet with lawmakers and attend legislative committee hearings. At the event, physicians opposed legislation that would authorize independent practice for nurse practitioners, S.B. 680/H.B. 456; an increased statute of limitations for health care liability, S.B. 764/H.B. 666; and repeal of the motorcycle helmet law, S.B. 925/H.B. 700. None of these bills advanced significantly in the 2015 legislative session.
In addition to addressing these issues, the Tennessee Chapter used this opportunity to educate legislators about the Tennessee Surgical Quality Collaborative, a partnership between the chapter, the Tennessee Hospital Association, and the Tennessee Health Foundation. The collaborative uses the ACS National Surgical Quality Improvement Program data to improve surgical outcomes.
The Virginia Chapter of the ACS partnered with other surgical societies to host a lobby day January 27 in Richmond. The day began with a briefing and an advocacy presentation from the Virginia Medical Society on a wide variety of legislative and political issues. After the briefing, Fellows headed to the state capitol for meetings with their individual state legislators. These productive meetings enabled Fellows to advocate on legislation regarding prescription prior authorization reform, liquid nicotine restrictions, and injury prevention.
How to get involved
Fellows play an important grassroots advocacy role at the state level. For those chapters and states that do not sponsor a lobby day, there are other ways to make a difference. For example, all Fellows can take action by contacting their legislators on pending legislation through the Surgery State Legislative Action Center or SurgeonsVoice.
Another way to get involved is to attend the ACS 2016 Leadership & Advocacy Summit April 9–12, 2016, at the JW Marriott in Washington, DC. The annual summit is a dual meeting that offers volunteer leaders and advocates comprehensive and specialized educational sessions focused on effective surgeon leadership, as well as interactive advocacy training useful in federal and state grassroots advocacy, and coordinated visits to congressional offices.
Whereas most state legislatures have finished their legislative business for the year, lawmakers have shifted their focus to in-district efforts and the 2016 legislative sessions. At this time, it is imperative that chapters begin to plan for the upcoming sessions by creating an advocacy strategy. The lobby day program is one of the best tools to support state grassroots activity, and the State Affairs team is available to assist with planning a lobby day or helping chapters with other grassroots advocacy initiatives. Contact the State Affairs team at firstname.lastname@example.org with questions or concerns.