Advocacy is often the first topic of conversation I have with almost every neurologist I meet, whether it be at a committee meeting, as a visiting professor, or just in my personal interactions with AAN members.
This focus on advocacy arises from concerns about the potential and real changes to the health care delivery system being discussed in Washington. Reimbursement for services has a substantial impact on both private and academic practice as it becomes difficult to make ends meet, especially for those who focus on and direct patient evaluation and management, as opposed to procedures.
Today, the Academy is in a great position to advocate not only for the profession of neurology but also for our patients. But it took a while to get there.
Initially, there was concern that we would lose something as a specialty if we became engaged in advocacy. But eventually, I think we recognized that without a persistent and articulate voice, the value of neurology would not be considered in the competing demands for federal and state resources. To protect our specialty and the access of patients to the expertise of neurologists, we had to become effective advocates for what we do.
The Academy began a dramatic increase in the AAN’s advocacy efforts in the early 2000s. For the first time, advocacy staff was hired solely to represent the AAN and a concerted effort was made to develop relationships with patient groups. A Washington, DC, office opened in 2005 and a political action committee, BrainPAC, was created in 2007. At the same time, the AAN participation in committees dealing with coding and reimbursement and quality measures was bolstered.
It is my own view that former US House Speaker Tip O’Neill’s quote that "all politics are local" is not quite correct. I think that all politics are personal. In the politics of neurology and health care it is critical that we cultivate personal relationships with key figures in Washington and make our case personal. Our daily presence in Washington and BrainPAC accomplish that for us. Our successes since opening the DC office are measurable. We have had legislation introduced and passed that specifically benefits neurology and patients. Members of Congress routinely contact our staff for help with crafting legislation and asking for our support. Our views are considered like never before.
In my opinion, it is important that our advocacy efforts primarily focus on issues that directly impact neurology. Our membership has wide-ranging political views from ultraconservative to ultraliberal and everything in between. Our Government Relations Committee mirrors these widespread political views. This can be a perilous situation when faced with issues that go far beyond affecting just neurology. A perfect example is the continuing consideration of the Affordable Care Act (ACA) which began in 2009. The AAN has members disappointed, if not angered, by our refusal to take a position on significant issues such as the adoption of a single-payer system, at the same time others demand support for a complete repeal of the ACA. These issues transcend specialty care and neurology. There are major systematic problems with our current health care delivery system including lack of access for many and unsustainable escalating cost.
But as a relatively small organization with limited resources, the AAN’s position on a bill like the ACA is unlikely to change the final outcome. On the other hand, there are components of bills like the ACA where we can have a very real impact. That is where we target our advocacy.
Regardless of our political views and passions, as neurologists it is important that we all participate in the political process on behalf of our profession and patients. Increasingly, decisions in Washington and at all levels of government directly impact day-to-day patient care. Our patients depend on us to effectively advocate for their treatments. I encourage you to get to know your elected officials and interact with them or their staff about issues that are important to you on a regular basis. Work for and contribute to candidates you believe in and cultivate long-term relationships with policy makers. Consider running for office yourself. The Academy can help in a number of ways including Neurology on the Hill and the Palatucci Advocacy Leadership Forum. Both are extremely valuable experiences. I hope you will join us in the political arena on behalf of yourself, your profession, and your patients.