Time to Get Political

The last few years have seen some big political changes around the world, from Britain voting to leave the European Union to the recent US election. Political representatives come and go, but one thing is certain – doctors will always need to defend and advocate for the policies that best serve their profession and their patients. Here, Patrick Godbey describes the important work of PathNET, an organization dedicated to putting pathology’s interests in front of US politicians to protect and promote our profession – and provide some guidance for anyone interested in getting more involved. Pathology needs you...

Making pathology political

Recently, Godbey recounts, he and his wife were on a plane and a call was put out for any physician on the plane to come to the back. “I got up and left,” he says, “and the lady sitting next to my wife asked, ‘Is your husband a doctor?’ 

‘Yes,” she replied, ‘he’s a pathologist.’

‘What’s that?’”

It’s a perfect example of pathology’s visibility problem. Many pathologists have little contact with our patients, and the public is all too often unaware of laboratory medicine professionals’ work. The College of American Pathologists (CAP) is working to change this, and to show the world who pathologists are. But the focus shouldn’t just be on the public – politicians and representatives need some education too.

The Pathology Advocacy Network – PathNET – is an organization that provides support and advice to help CAP members connect with their elected officials. It operates under the guiding principle that no one can advocate more effectively for the specialty of pathology than pathologists themselves, and its membership consists of around 2,300 CAP members. The resources it provides range from sending newsletters, to helping pathologists get in touch with their local congressman or senator, to helping them word letters to the editor. PathNET can arrange visits, meetings and conference calls, or let members know when their next town hall meeting or fundraiser is. Essentially, it helps pathologists get involved in politics in many ways, on both the federal and state level, and has a proven track record of successful advocacy.

CAP’s headquarters are in Chicago, but there is also a very large and active CAP office in Washington, DC, which makes it easier to come into contact with elected representatives and administrative personnel. Just a few weeks ago, four CAP members were invited to speak with Tom Price, the Secretary of Health and Human Services. But there is also plenty of work to be done on a local level. Local representatives care about what’s happening in their districts – they’re interested in healthcare issues, and in patients. “My personal experience has been extremely positive,” says Godbey, “and my local congressman has visited my lab four or five times.”

Staff in the Washington office take care of the day-to-day running of the service, and the level of activity depends on what’s currently happening – if there’s a deal or a movement that PathNET is particularly interested in, they can ramp up their activity. Of course, some pathologists are more interested in politics than others, and some are quite proactive while others need more support. But CAP encourages people to take part to whatever extent they are comfortable with, and PathNET’s members are all volunteers who are interested in making a political difference for our profession.

Pushing for transparency

Here’s an example of how PathNET might respond to an important issue: first, it will receive information that a relevant bill or piece of legislation is being considered, and its members will identify relevant officials and follow them on social media. The next aim is to get as many people involved as possible, sending letters and emails and making calls. PathNET informs people of town hall meetings and encourages them to attend. Some officials have formal healthcare advisory committees they will go to for advice – members seek to serve on those. They’ll visit Washington, DC and state capitals, and PathNET can help arrange the travel. CAP also has an annual policy meeting in Washington where PathNET members discuss their ongoing efforts. Godbey summarizes, “There are a great number of activities we can engage in to ensure our voices are heard.”

A current issue for PathNET is Senate Bill 794, which is related to health insurance. The bill would require Medicare Administrative Contractors (MACs) and their carrier advisory committee meetings, where local coverage policies are discussed, to be open to the public and on the record. It would also require MACs to disclose the rationale and evidence being used to develop their local coverage determinations – and allow for appeal of these decisions, which is currently extremely difficult. This bill would greatly benefit patients, would lessen regulatory burdens on physicians, and would greatly improve transparency. Godbey and his fellow advocates are currently working to get more sponsors for the bill.

Getting signatures and fighting cuts

PathNET’s previous successes? It stopped plans by the Centers for Medicare and Medicaid Services (CMS) to cap payment rates in Medicare’s physician fee schedule, which would have resulted in significant pay cuts for pathology services. In turn, this would have closed many labs, causing patients to lose access. The organization got involved and set up a campaign to block the proposal. Members made over 4,900 individual contacts with Congress, and sent thousands of comments to CMS. “I personally contacted one senator’s office and explained that this proposal would result in greatly curtailed pathology services in south Georgia,” says Godbey. “The senator’s staff came to visit us, and a few days later I got a call saying that if I could provide some details for a letter, they would take it to senate and get as many signatures as possible – but they needed it quickly. I called CAP’s people in Washington, explained the amazing opportunity, and asked for help. PathNET took up the challenge and 24 hours later the letter was in the senator’s office. Capitol Hill responded, and the letter got 42 senator’s signatures, from both Republicans and Democrats. In short, we played a significant role in stopping a cut that we believed was unjustified.”

Another example Godbey gives is the introduction of Medicare payment penalties for physicians not using electronic medical records (EHRs). “Pathologists and labs don’t use EHRs; we use laboratory information systems, so it was impossible for pathologists to comply with the new rule, which would have resulted in significant penalties. But again, we conducted a campaign that got a great result – over 100 members of Congress sent letters to CMS calling for pathologists to be relieved of this requirement. And so in large part because of PathNET’s efforts, pathologists are exempt. Both cases show that grassroots campaigns really can have a big impact.”

Anyone can make a difference

With all the changes going on in the USA today, Godbey sees PathNET ramping up its activity and continuing its good work going forward. “For any pathologists interested in politics, both in the US and elsewhere, my advice would be this: get involved! Attend meetings and fundraisers, and make yourself known. Tell your politicians, ‘I am a pathologist from your district, this is my name, and here are the issues that concern me.’ Develop a relationship, not just with your local politician but with your representatives on a higher level – in the case of the US, know your federal officers, your state representatives, and your senators. Don’t be afraid to get involved on every level.”

It may sometimes feel like an uphill struggle, he says, but individual pathologists truly can make a difference. If you’re thinking, “I practice in a small town in a rural area, and I can’t do it” – Godbey responds: “You can! Get involved and advocate for yourself, your profession, and your patients.”

Patrick Godbey is a practicing anatomic and clinical pathologist with Southeastern Pathology Associates and Southeast Georgia Health Systems, Georgia, USA. He is a governor of the College of American Pathologists, and Chairman of the Council on Government and Professional Affairs.