Health care providers face a variety of challenges, including, but certainly not limited to aggressive clawbacks by payors and unfair competitive tactics by other stakeholders in the marketplace. Independent practitioners are particularly encumbered by such challenges, as they are already juggling increasingly complicated administrative burdens, personnel shortages, and declining payment rates. How does an individual private-practicing physician or a small group practice “fight the good fight” while already feeling stretched to capacity? By banding together. Whether local, regional, and/or national in scope, coalitions can be a powerful vehicle to effect change.
Recently, Frier Levitt Founding Partner, Daniel B. Frier, Esq., and attorney Theresa M. DiGuglielmo, Esq. discussed the process of identifying alignment opportunities.
Theresa: “How can a health care provider determine whether the particular challenges her practice is facing are sufficiently widespread to galvanize a significant number of individual physicians or groups?”
Daniel: “It’s easy for private-practicing physicians to feel isolated. In many regions, they’re beset by the aggressive tactics of hospitals and health systems that are trying to either acquire, or attract patients from, their practices. For many physicians, there simply aren’t enough hours in the day to survey their peers to determine if others are having similar experiences. Our firm’s national presence and representation of all types of providers gives us a lot of insight into the issues that need attention, and I know from my experience of talking to legislators on Capitol Hill that the ‘ask’ is more compelling when there’s a significant number of physicians endorsing it.
If I observe a concerning trend, such as a payor recoupment for a specific test, I mention it to clients who may be affected. Later, when faced with the threat of a clawback for that test, the client isn’t just calling our firm for assistance with the appeal; she’s also fired up because she knows [from having heard about it happening to others] that it’s likely a concerted payor tactic to extract dollars from practitioners who may have limited bandwidth to mount a robust appeal. This is an example of a situation in which there’s important work to be done on behalf of our individual client, but also a larger opportunity to move the needle on the payor’s coverage policies.
I urge existing and prospective clients to call us and share their experiences, as there’s a pretty good chance that other physicians are facing similar challenges, and that common ground may form the basis of a coalition.”
Theresa: “So many of our physician clients report that they’re working long hours and struggling to recruit associate physicians to help them meet patient demand. What do you say to physicians who believe they simply don’t have time to devote to an advocacy endeavor?”
Daniel: “As a practicing healthcare attorney for nearly 30 years and the son of a (now-retired) physician, I’m aware of the stress and demands on physicians. Our attorneys are accustomed to accommodating the time constraints of busy healthcare practitioners, and with the help of technology, we’re able to accomplish a lot without our clients ever needing to adjust their clinical schedules to attend a meeting. As to the ongoing time commitment of an advocacy endeavor, it needn’t be daunting. For example, we represent a large national organization of practitioners that is mobilized around policy change. Within the group is a smaller advocacy committee, comprised of a handful of people who can commit to weekly calls and occasional trips to Capitol Hill. The other members receive regular updates on the progress of the initiative, and while always welcome to participate and contribute their suggestions, they have no obligation to make a specific commitment of time. Still, by banding together around shared priorities, these practitioners have captured the attention of lawmakers who are in a position to help them achieve their advocacy objectives.”
Theresa: “A coalition around a state-level issue might convene physicians of the same specialty within a community or catchment. Don’t competitors make strange bedfellows”?
Daniel: “Physicians who are otherwise competing in the local marketplace can effectively align around policy objectives. You’re not divulging confidential information about your respective practices when you band together to advocate for a change in a payor’s coverage criteria for an important lab test. There’s power in numbers.”
Theresa: “How do you address concerns about the expense associated with an advocacy effort?
Daniel: “Depending on the audacity of the objective, costs can range from minimal to significant. I’m proud to say that our team has been able to accomplish a lot on behalf of our clients without the involvement of a professional lobbying firm. For bigger objectives, such as those that seek to change a Federal law with well-funded opponents pushing back, we may recommend a collaboration with a lobbying firm. Whatever the cost, it’s more easily managed when shared among a group. Another important consideration is that successful achievement of the advocacy objective often repays the cost of the effort several times over.”
How Frier Levitt Can Help
Frier Levitt’s Advocacy and Government Affairs Practice Group collaborates with our clients to advance their policy objectives. For more information about our work and to discuss opportunities for coalition-building, contact Frier Levitt to speak with an attorney.
