Using Advocacy to Benefit Your Practice
By Alpha Lillstrom Cheng, JD, MA
As a small business owner, your time is at a premium.
There is always more you want to accomplish, so anything you spend your time on beyond the necessities of running your practice must be justified and have a benefit. We know that you are regularly encouraged and asked to contact your legislators on behalf of the profession and the patients for whom you care. While it will take time and effort, the time you spend on advocacy is also an investment. Your engagement with lawmakers and community leaders increases the visibility of the restrictions you face, the profession itself, and can benefit your bottom line.
Bolster Your Bottom Line Through Policy Changes
The prosperity of your practice is dictated by many factors—some of which you can control and others you can influence. You can make a big impact on your bottom line by taking the time to engage with policy makers and explaining the value of rehabilitation therapy to those who can change payment policies. Many individuals have received physical therapy themselves or know someone who has. While they may have a cursory understanding of what it is like to be a patient, the vast majority of policy makers have little to no understanding of how the business side of being a physical therapist impacts your cash flow and patient care.
Medicare policy is written at the federal level. Most private insurance companies consider Medicare to be the baseline from which to develop their commercial insurance products. In order to effect changes to this fundamental factor of health care coverage and reimbursement rates, one must engage legislators. This engagement can take many forms. The most common is through direct communication with your federal lawmakers.
Your legislators are tasked with representing your interests on the national stage, so it is paramount that you reach out and communicate with them about the PPS legislative priorities and how those priorities reflect the needs of your patients and your practice. Check out the monthly legislative updates blog for clear tips and guidance on what you can do to engage at any given time. In keeping with the priorities of the Section, most of the legislation that PPS supports would promote access to care, protect or improve reimbursement rates, reduce administrative burden, or expand the reach of existing federal programs in order to include physical therapists.
Members of Congress often wait until they hear from constituents before cosponsoring a bill. In many cases they want to hear from more than one person asking for them to support legislation. While each lawmaker is different, it generally doesn’t matter if you call, write, or use social media to ask for their support—the most important thing is that you make a clear request for them to sign on to a bill. One of the primary ways to improve payment and access to care is through the passage of legislation. Your active engagement in the legislative process can make a big difference.
Impact of regulatory policy
All federal legislation passed by Congress and signed into law by the president must be implemented by a department or agency of the executive branch. The Department of Health and Human Services (HHS) is responsible for implementing most national health care policy. The Center for Medicare and Medicaid Services (CMS) is an agency within HHS. Each year CMS publishes proposed rules, which are used to update Medicare policy. Some proposed rules are one-offs or are triggered by a significant change in law; however, a few are annually occurring updates. The best example of this is the Medicare Physician Fee Schedule (MPFS). In the MPFS, CMS not only updates the Medicare reimbursement rates for the following calendar year, but it also uses the proposed rule as a vehicle for other Medicare policy changes.
Each year the Section’s lobbyist reviews those proposed rules that are relevant to and would impact physical therapists in private practice. In some cases, PPS members are asked to share information about the effect the proposed policy would have on their practice. PPS then files a written response (known as a “comment”) with the relevant agency, usually CMS, explaining the repercussions of the proposed regulations upon private practice physical therapists. The publicly available response is also posted on the PPS website for all members to read. Check out the Advocacy tab on the PPS website to read comment letters that PPS has submitted on behalf of its members. Scroll down to the Archives to find documents as far back as 2012.
Improve Visibility of Your Practice
In addition to the primary impact of working with lawmakers, there are significant secondary benefits of engaging in political advocacy. By being a vocal representative of the profession, you become the face of physical therapy for the lawmaker and his or her staff, while also increasing your personal and professional prominence as a private practice physical therapist. Your public persona—whether at a town hall meeting or on a social media platform—will be noticed by others in the community. The recognition you gain as a business and thought leader in the physical therapy, health, and wellness fields can improve the visibility of your practice. This increased exposure can result in an uptick in referrals, a boost in self-referred patients, as well as an expansion of your network.
Publicity and Marketing
Getting involved in advocacy and taking the opportunity to speak publicly about the value of physical therapy can open many new doors to your practice. As a small business owner you are familiar with the importance of marketing and advertising. Think of advocacy as another form of publicity.
Look for opportunities to speak to community leaders in the towns and neighborhoods where your clinic is located. For example, many local chamber of commerce chapters have legislative breakfasts with lawmakers. Capitalize on these intimate gatherings by commenting on a PPS policy priority or asking the legislator to cosponsor a specific bill. When you are speaking at these events, remember that the other participants are also listening and learning about the value of physical therapy. Audience members may reach out to inquire about physical therapy or your practice—opening the door for you to gain a cash-pay client or to make the case for a new contract with a local manufacturer who wants to discuss occupational safety and health, to name just a couple of examples.
Fundraisers are another valuable venue for meeting and mingling with other community leaders and activists who understand the importance of advocacy. These engaged individuals are often eager to swap stories and pro-tips for how to connect with a specific legislator and hook their support for an issue. While you are waiting to talk to the star attraction, there is ample opportunity to talk up your business, describe how the quality care you provide improves outcomes for individual patients, and point out that the entire community is better off as a result. When you speak to the lawmaker, tell them about your role as a physical therapist in private practice—sharing both your perspective as a small business owner and a health care provider with strong ties in the community. Be sure to ask to have your picture taken with the legislator so that you may use it for publicity; post it on a social media platform and tag them. While posing for the photo, invite the member of Congress and their staff to visit your clinic for a tour.
When you hear that there will be a town hall meeting in your community, plan to attend in order to educate your lawmakers while also promoting the profession to the general public. If you can, bring a few of your colleagues and wear the same colored shirts with your practice’s logo on them so that you will be a clearly identifiable group of people with common concern. Research the host legislator’s position on health care issues so that you can prepare to participate fully. Prepare a typed statement and a brief question, which also includes your name, practice name, and address. Sometimes the host will ask you to submit questions in written form; in those situations just hand in your paper. If you can ask the question in person, introduce yourself as a private practice physical therapist and mention where your practice is located and the number of people you employ, then briefly thank the lawmaker for something they have done that benefited your practice. Finally, ask for them to cosponsor a specific bill. Your portion of the conversation should last no more than two minutes.
After the event is over, seek out the legislator’s staff and ask for a business card. Then hand them your business card, the typed statement and question you prepared, as well as the relevant PPS-branded one-pager. This will allow them to easily reference the points you made, even if they weren’t taking good notes during the town hall. When you follow up a week later, you can tell them that you handed them the written information and make the same points in your email or phone call. This repetition will make the task easier for you while also acting as a reinforcing reminder for the lawmaker and his or her staff.
Any time you chat with a policy maker, invite them to your clinic for a site visit because that will provide them a unique opportunity to understand what a private practice physical therapy clinic looks like, who you serve, and where you are located. When they visit your clinic they will be a “captive audience” for you, your staff, and those handpicked patients whose plans of care best illustrate the need for policy change in keeping with PPS’s legislative priorities. While some patients will be thrilled to have had an up-close conversation with their lawmakers, please make sure you get permission from the patients in your photographs before posting those images online to reduce potential for any HIPAA violation.
Solidify Your Role as a Community Leader
Small businesses are the engines of their local economy. As a private practice physical therapist, you are also improving the lives of those in your community in a concrete way. Your skills enable people to return or remain active members of your community. As a result, you are perfectly positioned to be a respected leader with a vested interest in many aspects of the community.
Consider joining organizations such as the Rotary Club, Kiwanis International, Chamber of Commerce, or other benefit societies. As a member of these types of organizations, you will broaden your network and increase your visibility in the community. You will also be in the position to ask your organization to invite lawmakers and candidates to speak at a monthly meeting or social gathering. You could volunteer to extend the formal invitation and be the contact for the lawmaker’s staff when finalizing the logistics; this relationship could pay dividends as your legislator becomes a more senior member of Congress and looks to you as a community influencer.
By being a part of one of these organizations, you are in the position to talk to your fellow members and any visitors about the value of physical therapy provided in a private practice setting. By sharing examples of how the patient care you have provided has enabled someone to rejoin the workforce and how many people you employ, you are able to improve fellow business leaders’ understanding of the value of having an access point to rehabilitation therapy in the community.
Engage as a PPS Key Contact
There are a wide range of opportunities for advocacy—with the lawmakers directly or through their staff, in-person and using social media, and by way of discussions with fellow community leaders. PPS’s Key Contact program strives to provide our PPS member volunteers with the support they need to be successful and effective advocates. Grassroots involvement is the lifeblood of PPS advocacy. Our goal is to have a private practice physical therapist paired with each of the 535 members of Congress. Please consider joining the PPS Key Contact team if you’d like to get more involved in advocacy. The application is available on the PPS website.
As part of the PPS Key Contact program, you not only are part of a network of well-connected and well-supported activists, but you also receive training and tips to hone the skills necessary to tackle complicated issues, understand how policies impact both access to care as well as payment, and most importantly how to engage policy makers in hopes of improving those parameters so that both patient care and reimbursement can be more favorable for your fellow physical therapists in private practice. As an advocate on behalf of the Section, you will be updated when policies that will impact your practice are introduced or being debated.
Over time, your assigned member of Congress can come to associate you with the physical therapy profession and gain an understanding of the local economic impact of your small business. It is not uncommon for them to treat you as a touchstone on whether proposed legislation would be favorable to private practice physical therapists. As a trusted resource, you can share insights about how policy would impact patient care while gaining access to the inner circle of a legislator’s advisors.
While this article focused on federal advocacy, everything discussed here can also apply at the state level. The investment of time and energy can make a big difference, and every little bit counts. Advocacy in any form raises the profile of physical therapy and teaches people how the care you provide to members of your community improves their quality of life and enriches the local economy. This increased awareness can result in policy changes which benefit your bottom line as well as expand your local network to increase your patient volume.
Alpha Lillstrom Cheng, JD, MA, is a registered federal lobbyist and a principal in the firm Lillstrom Cheng Connolly, which has been retained by PPS. An attorney by training, she provides guidance to companies, nonprofit organizations, and political campaigns. For six years, she served as Senior Policy Advisor and Counsel for Health, Judiciary, and Education issues for Senator Jon Tester (Montana) advising and contributing to the development of the Affordable Care Act, as well as working on issues of election law, privacy, government transparency and accountability.