How Can Physicians Use Their Voices to Make an Impact on Healthcare?

Alok S. Patel, MD; Jennifer E. Bell, MS


May 10, 2019

This transcript has been edited for clarity.

Alok S. Patel, MD: How's it going, everyone? I'm Dr Alok Patel, here at the Society of Hospital Medicine Conference. I just finished an amazing talk with Jennifer Bell, who has 20 years of experience lobbying and is one of the founding members of Chamber Hill, which is a lobbying firm specializing in healthcare—which we all care about.

Jennifer, that was an amazing chat. I feel like you're really talking about "Schoolhouse Rock meets medicine"—how a bill becomes a law. One quote of yours, which I'm going to steal because I think it's phenomenal, is that if you're not at the table, you're on the menu.

In your opinion, is it important that doctors show up in 2020 to get their voices out there when it comes to making laws in this country?

Have Government Officials Hear Your Voice, Not the Other Way Around

Jennifer E. Bell, MS: Well, the federal government has a huge role in paying and regulating healthcare. If your voice isn't out there, you're going to take whatever you get. The government is going to decide for you, whether they have your input or not. I'd say that 2020 is not the last time that we need your voice, but it is such a critical year.

Patel: That's what you mean by "we're going to wind up on the menu?"

Bell: Exactly.

Patel: I think doctors are really good about being loud regarding problems. We're great at tweeting, writing blogs, and saying that things need to be changed.

What is an actual actionable item for a physician or a hospital? If someone says, "This needs to be changed and I need to talk to a legislator," what is something that doctors can actually do?

Bell: Well, I'll tell you one thing. You should register to vote. I know that sounds kind of silly.

Patel: It doesn't.

Bell: I'll tell you right now, I bet some of your readers and listeners haven't registered to vote. Whether it's a local, school board, or federal election, you have to get your vote registered.

That said, being able to interact and tell people how the rule or the law impacts you is so important. You have to call up someone, raise your hand, and say why it matters. Not only that this is a problem, but also how it matters to me. How does it matter to the patient or to the constituent?

That kind of connection really helps people understand that it matters. But what can they do about it? If it matters to you, then you have to be able to say, okay, well, what's the solution? Where can I find compromise?

Patel: When something happens in the news or there's an article written about new legislation, people go online and say to call your senator, write to your representative, and that physicians should speak out. Does that actually make a difference?

Bell: It does. I've interacted with members of Congress and their senate offices, and they actually keep tallies. They'll do pros-and-cons lists, and they'll vote according to what their constituents are saying.

It is pretty amazing. An email box, a phone, or voicemail seem so far away, right? But it actually matters.

Approach CMS--They Want to Hear From Physicians

Patel: What about when I look at Centers for Medicare & Medicaid Services (CMS)? I hear many of my colleagues talk about how they're controlling coding and billing, and whether they are treating the patient or trying to increase their reimbursement.

In that situation, is it worthwhile for doctors to directly address CMS or should we go to our legislators? What can doctors do about that?

Bell: I would say both. The CMS program and other agencies want to hear from providers. They provide public comment periods, websites, and open-door forums because they want to hear from the people that they're impacting.

Now, they may not make the decisions that you want, but they do have an open door for your input. That said, often bureaucracy is a bureaucracy for a reason. Sometimes, the legislative body—the members of Congress—have to up the ante and the conversation to influence the agency.

And that's where physicians' voices are so critical. Whether it's talking to the legislator or to the agency, that input matters. Again, if you're not heard, it's because you're not saying it.

Patel: Doctors need to be louder; we need to turn it up.

Bell: And be consistent. It's not only 2019, 2020, or when a rule comes out that pays you less or overregulates you. You have to be constantly talking.

Talk About Compensation and EHRs

Patel: What are some of the bigger issues you've heard doctors speak about, either with your firm or just in passing?

Bell: Often it comes down to pay—compensation for what we do and trying to do more with less money. It's a big issue. I get it. People need to make a living and pay off student debt. It's an issue that people care deeply about.

Often, we hear about the electronic health record and how physician burden is really crushing their ability to increase their time, whether it's with their patients or at home with their families. It's a burden that the government really has not solved yet.

Patel: Jennifer Bell, thank you so much for chatting with us.

It sounds like the big take-home messages are that we need to register to vote, we need to call our senators and people at CMS, and everyone needs to hear from us because we're on the front line.

Bell: Yes!

Patel: Thank you so much.

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