A Legislative Juggernaut: TMA Refines Its Advocacy Process

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From the President & EVP - October 2007  

By William W. Hinchey, MD, TMA president, and Louis J. Goodman, PhD, TMA executive vice president/chief executive officer

The Texas Medical Association had two choices when the Texas Legislature adjourned in May after a session that saw TMA produce remarkable results for physicians and patients. We could spend the next year and a half congratulating ourselves for a job well done. Or, we could pause for a few moments to collect our thoughts, then get back to work, planning to be even better in the next session.

TMA leaders chose the second option. In fact, we decided not to prepare for just the 2009 session but for the 2011 and 2013 sessions as well. That's how you earn the reputation as America's best medical society.

That preparation began at TMA headquarters in Austin in mid-August with a gathering of the TMA Board of Trustees, members of the Council on Legislation and Council on Socioeconomics, TEXPAC officers, the TMA Alliance president and president-elect, TMA legislative and political consultants, executive officers of the Harris, Dallas, Tarrant, Bexar, and Travis county medical societies, and TMA staff. We conducted a two-day postmortem on the 2007 legislative session and examined what we need to do next to better represent the interests of Texas physicians and their patients at the State Capitol and in Washington.

We had a tremendously successful legislative session this year. Was it perfect? No. Could we have done better? Yes. Can we do better in the future? Yes. We need to constantly refine and improve our advocacy efforts because, as Board of Trustees Chair C. Bruce Malone, MD, pointed out, "Advocacy is the No. 1 reason physicians join TMA."

Trustee Austin I. King, MD, compared the meeting to a morbidity and mortality conference. "You look at the things not from the perspective of what you did right, but from what you did wrong. We can pat ourselves on the back all the time, but we don't learn from that. We need to dissect what happened and see what we can do better. You can always do the job better." 

The Process

TMA President-Elect Josie Williams, MD, a nationally known expert in developing processes to achieve quality, says identifying a process for advocacy and then sticking to it is critically important.

"It's about staying on message. It's about understanding the way we got there and what we will always do and what's winnable," Dr. Williams said. Moreover, she added, the process must never stray from the idea that medicine will always do what's best for the patient.

With that in mind, the strategy session's goals were to:

  1. Evaluate the accomplishments of this year's legislative session,
  2. Create a shared vision for future advocacy,
  3. Develop short- and long-term strategies for continuous improvement of advocacy, and
  4. Align and optimize resources to meet the challenges of advocacy opportunities over the next three legislative sessions.

The participants were divided into several breakout groups to evaluate how TMA did on 10 major issues it worked for in the 2007 session: Medicaid, scope of practice, graduate medical education, professional liability, responsible ownership, physician licensure and discipline, insurance, public health, health information technology, and taxes. Because of our broad and diversified membership, the association had almost 25 important issues in the last legislative session, and prioritizing the ones to examine at the meeting was a tough chore. We selected the issues that affected the most physicians and patients.

Each group was armed with background information on how the issue was framed, the relevant TMA policy, the specific goal, the resources employed, and the result. The groups then were asked to determine whether TMA was successful, how success should be measured, how the process can be improved, and how TMA can build on its success for the next three legislative sessions.

Added to all this information were surveys of legislators, physician leaders and individual members, and TMA's policy and advocacy team on the association's effectiveness this year.

Overall, the breakout groups and the survey respondents agreed that TMA was successful, more in some areas than in others. TMA received a B+.

That's not good enough. We can do much better. A+ is the only grade we will accept. After all, you had to get an A+ to get into medical school, so your medical association should not be held to a lower standard. 

Building Relationships

Many very good ideas came from the breakout sessions' evaluations. These include stronger coalitions with our partners on Medicaid, a clear offense and defense on scope of practice, and more positive messages on professional liability.

However, the suggestion that rang loud and clear throughout the day was that physicians across Texas - not just those active on our councils, boards, and committees - need to establish contacts with their local lawmakers. Working with your local county medical society to build relationships with your senators and representatives and then staying in close contact with them allows you to educate them on the issues. Most of them have no background in health care, and they rely on physicians to help them make informed decisions.

"A physician who has a personal relationship with a legislator is potentially helpful to our cause," said Albert Gros, MD, chair of the Council on Legislation. "Any contact at all with a legislator is extremely helpful."

The fact is lawmakers want to hear from physicians. They've told us so.

"The main complaint of the legislators is the lack of input between sessions from their constituent doctors in their districts," Dr. King said. "TMA needs to identify our agenda and then communicate that to the local county medical societies and let them push those issues right now with their legislators. If we wait until right before the session starts, that's too late."

"The legislative process is all about relationships," added Darren Whitehurst, TMA's director of public affairs. "The more we strengthen the relationships, the more we build key contacts, the more we get our physicians involved in the political action side in TEXPAC, the more successful we will be in the legislature. We will succeed or fail based upon physicians' involvement in the political process."

Physician involvement, which has proven so powerful in the past, gives organized medicine a clear advantage over our opponents. "They have Astroturf. We have grass roots," is the way David Marwitz, one of our political consultants, put it.

The TMA Alliance is a vital part of those grass roots and remains a great asset in our contacts with legislators. The alliance has a long history of involvement in political issues, from evaluating candidates and campaigning for them, to working side by side with physicians in the halls of the Capitol.

Alliance members often are the people who provide the first connection between physicians and lawmakers. "We've been very careful to keep that door open, and legislators appreciate it," said TMA Alliance President Mia Price. "They like hearing from us, and we can serve as an intermediary as well as an advocate for physicians and for medicine. The future of medicine is what we're talking about here."

Michael Darrouzet, executive vice president and chief executive officer of the Dallas County Medical Society, called the meeting a turning point in TMA history.

"The results of the meeting surely will strengthen our organizations and our relationships with each other. At the very least we will know we are not alone, and at best we will lead the way for medicine into the next century," he said. 

Where We Go From Here

To help keep TMA's advocacy structure strong between legislative sessions, Dr. Malone said, the board will develop a "go to" list of physician leaders and their key contacts whose help TMA can enlist on important issues.

"We have some very strong physician leaders who are politically connected," he said. "The board is absolutely going to respond to this expanded family strategy session. We called the meeting because we felt that our advocacy efforts could be stronger. The board wants to use as much of the resources we have as possible."

We will take all the recommendations from the meeting and put together a plan to guide us through the next three sessions of the Texas Legislature and our efforts in Congress. That plan will include:

  • Working with our county medical society partners to help members develop and maintain contacts with their local lawmakers,
  • Formalizing better communications with the coalitions and other partners with whom we collaborate on various issues,
  • Formulating a patient-centered and nonpartisan (medicine's issues are not Republican or Democratic) agenda well ahead of each legislative session and engaging legislators early in the process to garner their support,
  • Making sure we have the data and expertise readily available to back up our positions,
  • Identifying our champions in the legislature who will shepherd our bills to passage, and
  • Developing strategic messages that resonate with the public and generate public support for our positions.

This same plan also will serve us well when it comes to lobbying Congress. We spent a lot of time during the second day's session analyzing our efforts to reform the Medicare payment system. The Children's Health and Medicare Protection Act, which is in play as we write this, has elements that are good for patients and physicians but other elements that are just bad medicine. We are working with our congressional delegation to remove the objectionable provisions of the bill; in the meantime, however, there are divisions among our membership. Some support the bill because it reauthorizes the federal Children's Health Insurance Program and stops planned cuts in physician payments, while others are adamantly opposed to it because it places restrictions on physician ownership and makes deep cuts in imaging payments.

We cannot allow our opponents to divide us. "They have us fighting among ourselves and that's where they want us," Dr. Williams pointed out.

We must stay together and speak with one voice to do what's right for patients. How? We'll continue to communicate with the membership and specialty societies to make sure everyone understands what we support and what we oppose.

We'll push our positions in personal meetings with our representatives and senators. We'll mount a grassroots campaign with county medical societies to get our message out. We must stay at the table and be involved in the process.

Here's the bottom line of what we're trying to do in Austin and Washington: We want to create a legislative juggernaut and duplicate the success of the tort reform effort in 2003. We can do it. If we put all our resources together in a unified, systematic, and focused way, no one can beat us and no one can achieve more than we can because we have a history that demonstrates we can do it. That's what the meeting was about: improving our process and putting our resources together in a way to achieve our goals more effectively than anyone else. 

October 2007 Texas Medicine Contents
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