Successful Medicaid Battle in Vermont
One state chapter mobilizes against reimbursement cuts.
The Vermont Radiological Society (VRS) was alarmed late last year when the Department of Vermont Health Access (DVHA), which had already cut Medicaid reimbursement for diagnostic imaging services by 25 percent, then proposed an additional 21-percent cut in reimbursement for 2012. This proposal coincided with end-of-year holidays, leaving only a short window for submission of formal comments.
The VRS, along with the ACR Council Steering Committee's Vermont Liaison Alexander M. Norbash, M.D., M.H.C.M., FACR, from the Boston University Medical Center, made an exemplary effort to mobilize against this proposal by securing support from both the Vermont Medical Society (VMS) and Vermont Hospital Association (VHA). In the end, the DVHA revised its proposal, resulting in an approximately 2-percent cut in reimbursement instead of the proposed 21.4 percent.
Kristen K. DeStigter, M.D., from the University of Vermont College of Medicine and Fletcher Allen Health Care in Burlington, Vt., president of the VRS, recalls that the state chapter acted promptly to activate grassroots support. "The coalition formed for the battle with DVHA in 2011 quickly mobilized, and the support of the VMS, VHA, and the College expanded visibility in the media and added legitimacy to the cause," she explains. DeStigter elaborates that despite the incredibly short comment period, the grassroots network produced 23 unique comments from radiologists all over Vermont, which is almost half of the practicing radiologists in the state, in addition to key supportive comments from the VMS and VHA.
Norbash credits ACR staff members and the ACR State Government Relations Committee (SGRC) for assistance in quickly organizing an effective operation. With the partnership of the VRS and the VMS, the coalition engaged its state legislature through a direct and effective grassroots campaign. "The value of the ACR in this particular instance was the ability of the ACR SGRC and Brad Short, ACR senior director of member services, and Eugenia Brandt, director of ACR state affairs, to rally the necessary resources as part of a clear and effective strategy," says Norbash. "In doing so, the ACR established the value of radiology to the Vermont legislature — not just on behalf of radiologists in Vermont but also the physicians and citizens of Vermont. This serves not only as a clear test case of the College's nimbleness and legislative effectiveness at the state level, but more importantly, as a roadmap for the numerous and inevitable future conflicts other states should expect to encounter."
But what take-away lessons can all ACR state chapters learn from the emergency situation in Vermont?
Stay on Message
Crafting one strong message and sticking to it is perhaps the single most important guidelines to running a successful advocacy campaign. One way to accomplish this is through the development of cohesive talking points, which provide members with a foundation onto which they can add their own insights and craft individual responses. Key message points included service access, radiologist recruitment and retention in a competitive national markets, and the non-self-referral situation for radiologists. Additionally, DeStigter notes, "By following national standards like the ACR Practice Guidelines and ACR Appropriateness Criteria®, radiologists are the physicians best positioned to assure quality and appropriate utilization of expensive advanced imaging studies." Crafting a strong message is important because it effectively determines how the campaign resonates with members of your state legislature and regulatory agencies. Stephen M. Koller, M.D., from Porter Medical Center in Middlebury, Vt., secretary-treasurer of the VRS, underlines the importance of tone. He explains, "The VRS's response to the cuts was polite and appropriately concerned but not hysterical or overtly threatening."
Cast a Wide Net
In addition to crafting a strong message, reaching out to needed allies can be equally influential in a legislative fight. When it faced similar reimbursement cuts in Vermont in 2010, the VRS did not seek allies in as many places as it should have, described DeStigter. So, this past year, they expanded advocacy efforts outside of the VRS internal radiology network. Many of the feedback letters directed to DVHA were copied to members of the Vermont House and Senate appropriations and health-care committees, as well as to the chairs of the Green Mountain Care Board (a group meant to guide a new and improved health-care structure by 2014) and VHA. "Sending these letters gets attention and generates buzz while discovering unexpected allies," says Koller.
The long-term effects of successful action in Vermont will play out for some time, notes Christopher G. Ullrich, M.D., FACR, chair of the ACR SGRC: "Win or lose on this immediate issue, it is but one episode in a marathon political and regulatory process. If you can use this crisis to build more sustained political pressure, it is possible to readdress these issues, particularly if your worst fears about access and service start to prove true."
This experience of the VRS demonstrates that successful ACR chapters need to organize internally, develop broad coalitions, cultivate legislative relationship, and engage state regulatory agencies. "Your state fate is in your own hands," concludes Ullrich.
By Eugenia Brandt