Speaker 1: You are listening to Your Practice Made Perfect, support, protection, and advice for practicing medical professionals, brought to you by SVMIC.

Brian: Hello. Thanks for joining us today. My name is Brian Fortenberry. On this podcast, we're going to be talking about the importance of physicians involved in the legal legislative part of practice, because they don't think about that necessarily very often. I have two great people here today joining us to talk about that, Sherie Edwards and Yarnell Batey. Thanks for being here, guys.

Sherie: Thanks for having us.

Yarnell: Thanks for having me.

Brian: Well, before we get started, I'm really going to kind of hand it over to you to let you talk and discuss. But before we really even get to that point, tell us a little bit about yourself, about your background in this area. Sherie, you want to go first?

Sherie: Sure. I am the Vice President of Corporate and Legal for State Volunteer Mutual. I have been with SVMIC for almost 20 years. Hard to believe that, but it will be 20 years in November. Over the years, my role has changed. Started out in claims, moved to corporate in 2011, and I've been handling the legislative work for the company since probably about 2002. I started just overseeing it, reviewing bills, and then it morphed into actually directing our lobbyists in the different states that we do business, and also lobbying myself when there's a big bill. That is my involvement, and I get to work with really great people at our different medical associations, like Yarnell.

Brian: Yarnell, thanks for being here again. Tell us a little bit about yourself and about your background.

Yarnell: Certainly. I am Senior Vice President and General Counsel of the Tennessee Medical Association. The Tennessee Medical Association is a 180-year-old professional organization for physicians. We're a volunteer membership organization of specialists from across the state. My particular oversight is the legal department, the government affairs department, and the insurance advocacy department. I've been with TMA for 18 years, almost.

Brian:        Well, fantastic. Lot of experience. I tell you what, Sherie. I'm going to let you kind of jump in here, because you have a definitive background when it comes to this, and legislation and certainly government and how things run can be tricky at times, can be complicated.

Sherie: It can be a little bit scary, too.

Brian: It can be a lot of scary.

Sherie: It can be a lot of scary. 

Well, Yarnell, you and I are both involved in this process. I'm down there four months during the year talking to legislators, looking at the bills that are coming in. That's part of my job, and I know you're very dedicated to that, and you have a dedicated team that takes care of the government relations. All of the medical associations, wherever our listeners might be located, have dedicated government affairs or government relations teams that go and talk with legislators about different bills that are before them.


Brian: Right.

Sherie: Given that we have those dedicated people, why should our listeners, physicians, practice managers, other healthcare practitioners, get involved in the legislative process?

Yarnell: I'm asked that a lot, and I like to take practice managers and physicians through a little exercise. I ask them to close their eyes and imagine their medical office. Look at the door, walk in, go up to the front desk, the exam rooms, if you have a lab or imaging equipment in your office. If you think about it, everything that you've just envisioned is regulated by the state or federal government, and sometimes both. 


Regulations on medical advertising, your door, your sign, how you and your healthcare staff represent your credentials, whether you're a physician, a nurse practitioner, physical therapist. Our friend HIPAA, who we're all familiar with, patient notices on your wall that are required by the state, registration of your medical equipment, all of these are the results of regulations promulgated by the government. 

Then, think about parties who don't have your best interest in mind. Who might be out to get you? Well, trial lawyers want the medical liability gains earned over the last decade to go away, or at least be eroded severely. Health insurers want more leverage to reduce your reimbursement and line their pockets. The government wants to place layer upon layer of regulation on you to confuse you and give an excuse to recoup your hard-earned money.

The government also wants to tell you how to prescribe, who's scope of practice can perform health-related care. healthcare entities want to use laws to reduce competition in the market. So, who is going to fight for you to stop them? 

Sherie: Isn't that our job, though, as lobbyists? I mean, physicians and practice managers, if you think about everything they have to do every day, and they are so incredibly busy, isn't that what the lobbyists are for?

Yarnell: Lobbyists are important, yes, absolutely. But they're only people until lawmakers hear the same message from the people the lobbyists represent, the grassroots. It's the ones that the lobbyists represent who have the real power.
Brian: You know that is interesting, because you've got these people that are making these regulations. To me, people that go into healthcare, whether it be physicians, healthcare providers, nurses, no one ever goes in saying, "I want to do government legislation." I mean, that's not what they went into medicine for, right?

Sherie: Right. Exactly. It's a process that people don't understand. It's a process that's a little bit scary. In the present day, when you're just bombarded with the news about what's going on in Congress and the state legislature, and as we're recording this, we're in election season, so these ads coming at us, the last thing you want to think about at the end of the day or during your day is having to deal with a legislator. But, it is very important that physicians do that. 

But some physicians think, "Well, nobody's going to listen to me. I mean, I'm a doctor. Why would they listen to me if I go down there?"

Yarnell: Absolutely. Physicians have a lot of respect on Capitol Hill and in Congress. They're the subject matter experts, if you will, in healthcare. A lot of legislators have nothing to do with healthcare in their other job. They might be jewelers, small business owners. They might be real estate agents. There are lot of jobs that have nothing to do with healthcare. But the legislators have to address those healthcare issues. So, unless they have a physician on speed dial to inquire about the position on healthcare matters, they really have no go-to except for the lobbyists represented on Capitol Hill.

Brian: Well, and you two know it best. You don't often go into court and represent yourself. At least, a wise person doesn't. You get expert advice. You reach out to people who know this industry the best. If they're not listening to physicians and people in the know in the healthcare world, it's like going to represent yourself in court, and you don't know the law, right?

Sherie: That's the truth. We have seen firsthand, both Yarnell and I, how physicians getting involved in the process can really make a difference and turn the tide in legislation. As an example, Brian, you remember the last couple of years, we as a company and TMA have been fighting the patient compensation system legislation that was going through our state legislature here. It was also in Florida, and in Georgia, and in Ohio, and in Maine, and in Montana.

The advocates for that bill had a lot of money behind them, and they were in the ear of our legislators all the time, taking them out to dinner, talking to them, letting them know that this is the best thing since sliced bread. We had grassroots campaigns, both our company and the companies in the other states, getting our physicians out to call the legislators.

Doctors' Day on the Hill, we had a bunch of people in white coats down there, going to every legislator who was on the judiciary and the health committees, telling them how bad this bill was for doctors and educating them on what really happens in the office and what this would really do to their practice. Through that grassroots effort, they were able to not only kill the bill, the company itself that was pushing the bill folded tent and moved on to something else. 

Brian: Wow.


Sherie: I know you saw that, too, this year with the opioid bill. Can you talk a little bit about that?

Yarnell: We did. You're referring to Governor Bill Haslam's Tennessee Together bill. The crux of the bill was that it would set limits on the amount of opioids that physicians and other prescribers could prescribe to their patients. As introduced, it was a very confusing bill, and it had a lot of pitfalls that could have gotten physicians in a lot of trouble not only from a medical malpractice perspective, but also from their licensing board. One mistake shouldn't lead to disciplinary action. But if you have a confusing bill, then that's the natural consequence. 

Brian: Right.


Yarnell: We were able to get physician subject matter experts to engage in the process, to meet with legislators, to come down for our day on the Hill when all the legislation was being debated. The great thing about subject matter experts like physicians is that they can relate the specific treatments, the surgeries, the type of interventions that they perform hundreds of times a year, and can give real examples of patients who need the opioids in an amount that is more than what the law would have allowed.

We were able to, from that, get exceptions built into the law that allow surgical patients, hospice patients, cancer patients, patients like that that need more than a three-day supply of opioids. 


There's a mechanism now for physicians to supply more if needed.

Sherie: That wouldn't have happened ... I mean, the original bill, you could tell there was no physician input to it. Things like this, the opioid bill, the Doctor of Medical Science bill that was floating around, that would have given physicians' assistants a bump up in their title with an 18-month online course, things like that, physicians being involved, practice managers being involved, really made the difference. It's so important to have those subject matter experts down on the Hill. You want to be the go-to person if there's question. I know I've been lucky enough to be able to become that in insurance regulations. I know you've done that, too. We really need physicians to get involved so that the legislators know who to pick up the phone and call.

Yarnell: And practice managers as well, I would add. Sherie, you talked about the Patients for Fair Compensation law that would have completely changed the healthcare liability laws. Well, practice managers were able to testify as to how that would hit their bottom line in terms of having to pay double, almost, for premiums to insulate themselves.

Brian: They're really seeing the money part of that and how that worked.

Yarnell: Which is important. I mean, a medical practice is a business. If they're not paid, then they can't keep their doors open.

Brian: Right. The thing that I think is important, at least as I listen to you guys talk, is there is going to be legislation regarding healthcare. We know that. It is a moving target these days, and it is changing. There's not the question of if there is going to be legislation, there is definitely going to be. Do you want to be involved as a healthcare provider in what that looks like, or are you going to sit back and then just going to have to follow whatever comes down the pike, right?

Sherie: Exactly. I think one of the messages that we want to get across is some physicians will think, "Well, nobody's going to listen to me." Especially at the federal level, they may think, "Nobody's going to listen to me." I have had the privilege of being at Capitol Hill in Washington with some of our physicians walking through, and I will tell you, our legislators really want to talk. They really want to find out what's happening in their home districts. 

SVMIC belongs to a group called the Access to Healthcare Group, HCLA, and it's made up of companies like ours, and then also the specialty organizations, and they work at the federal level to help influence legislation, meet with the legislators, try to shape legislation. One thing that's going through right now is the Good Samaritan bill that would allow physicians to go across state lines to work in natural disasters without having to worry about licensure issues.

Brian: Okay, like with hurricanes and things that have come up lately.

Sherie: Exactly, and so we're working very actively now to try to get that through the Congress before the new legislative session starts in January. We've been talking, and hopefully we have convinced our listeners that they really need to get involved in this process. 

Yarnell, what are some things that they can do?

Yarnell: A lot of physicians and practice managers, for instance, might be fundraisers for a charity or their church organization, so you ask, "Well, do you know the names of people who give you money?" Probably so. "Do you know the names of the people that give you a lot of money?" Yes, absolutely. That's the same thing from a legislator's perspective. 

Now, donating funds to a legislative campaign doesn't buy you votes. It doesn't buy you anything, but it does give you access. If you're the one, if you're the physician on that legislator's speed dial for healthcare issues, you have a voice, and you can listen. The way the system is set up, one of the ways that legislators can get you noticed is if you donate money to a campaign, if you volunteer for a campaign, help pass out flyers, be at the polls on those days. There's little things like that that you can do. But campaign contributions are a great way.

But there are other ways, establishing relationships with legislators, and I don't mean going down there every time you need something. I mean establishing a relationship, like a friend. And so you can reciprocate, you can get to know your federal and state lawmakers. You can request meetings just to discuss general issues, sit down and have a Coke with them and talk a few healthcare issues. I would encourage lawmakers to look to you for advice, to be that person. If you go to church with a legislator, if you're the physician of a legislator, there's a great opportunity to have side conversations on issues that really mean a lot to you.

You can just send information to legislators that they may find interesting, articles, studies. We all know that medical marijuana has been a big issue in healthcare in the last few years, both at a state and federal level. I know our members have various positions on that. I also know that a lot of members will just send articles to their legislator or studies on that issue. They're not espousing a particular issue, but they're providing information, and that provides credibility I think.


Sherie: Going back to campaign contributions, some people go, "I'm not really too sure who to give money to, because I'm not sure of their positions, and I don't have the time to research it," which is the beauty of a Political Action Committee or a PAC. I know TMA has a PAC. I know Arkansas has one. Kentucky Medical Association has a PAC. How does that work at the association level? How do you decide who to give the money to?

Yarnell: Well, the Tennessee Medical Association PAC is IMPACT, Independent Medicine's Political Action Committee. We accept donations from physicians across the state, and we have that money available to contribute to political campaigns. We primarily will contribute to campaigns of legislators who are known to be physician-friendly on our issues, may have sponsored our bills in the past, may have voted with us on a consistent basis. We want to keep physician-friendly legislators in office, and to do that, it takes political contributions.

By lobbying, we monitor who votes physician friendly on medical issues, and we track that, and we're able to not only contribute to those who are physician-friendly, but if they're legislators that on a consistent basis favor our opponents, then we might target their opponents in the next election and contribute against them. That sends a message that if you're not going to vote with us, then we're going to support someone else to replace you.


Brian: The truth of the matter when it comes to just about anything, but certainly it seems like in the political arena, is there is strength in numbers. 

Yarnell, when you guys were saying it's important to interact with them, with the relationships maybe at church or other organizations you have, those individual relationships are great, but the strength of the numbers of a Political Action Committee probably has a little more influence, right?

Yarnell: Both are important, certainly. There's no question about that. The level of importance varies from legislator to legislator, so you have to do both. That's why you have to contribute, but you also have to have those grassroots relationships, make those contacts, have those face-to-face sit-down meetings and establish a relationship.

Brian: It's a multi-disciplined approach, almost, is what you're talking about.

Yarnell: It is. That's the only way that you can achieve success.

Sherie: I know one of my favorite days down at the legislature is Doctors' Day on the Hill, and it's so amazing to see these busloads of doctors come in from all over the state in their white coats and go and visit with all of their representatives and their senators. Having that mass of white coats there really sends a message. TMA does a great job with that. I know the other medical associations do that too.

How can physicians and practice managers stay on top of what's going on in the legislature in Tennessee and in elsewhere? Because we're not trying to be Tennessee-centric today, but I work with TMA more than I do the other two societies. How can they stay on top of what's going on?

Yarnell: Well, that's a great point, because in a typical two-year legislative cycle, there may be 3,000, 4,000 bills introduced. Only a fraction of those are healthcare, medical-related, so how do you filter what it is that you as a physician are interested in? I think the best way to do that is to join your State Medical Association, because we do that for you. We cull through every single bill filed, and we identify generally between 350 or 400 bills that directly relate to healthcare or that are bills that could be amended to impact healthcare or physicians in some way or another.

We're tracking all of those bills. We know which ones are calendered for a committee, which ones move, which ones just stay there. As bills move, we're engaged in every one of them. In order to follow that if you're a physician, medical associations like ours have a multitude of ways to get the word out. For instance, during the legislative session, we have a weekly e-news blast. It's called Political Pulse, and it goes out to all of our members and practice managers who sign up for it, and it gives a summary of where the important bills are in terms of committees and votes. 

It also gives a nice summary of what's coming up in the next week. We might have a call to action where we ask physicians to specifically contact their legislators voting for or against, as the case may be, a certain issue that's coming up in a committee, because as we know, in the process, you don't have to have 132 votes. You just have to get bills through committees that might be 10 or 12 members. If you get a bill killed in that committee, it's gone for the rest of the session.

Brian: It never sees the 130-something votes.

Yarnell: Never sees the light of day. Exactly.

Brian: I gotcha.

Sherie: From a practice manager's standpoint, MGMA has a chapter in each state, and they do the same thing. They have their advocacy groups. They have their email blast. That is a really great resource, too, and then State Volunteer, SVMIC. Our website, if there is a hot legislative issue that we need to let people know about, we will put that on our website. But on the other side of that, if a physician is seeing something, sees a bill that they've got concern about, they should pick up the phone and call me.

Brian: Sure. It goes back to communication a lot, as well.

Sherie: Absolutely.

Brian: Communicating with your medical association, with your professional liability carrier, and being able to voice your opinion. What I'm hearing you guys say is there are organizations out there that are willing to fight for you. They're willing to help you. You just have to get involved, right?

Sherie: Absolutely.

Yarnell: That's what it takes.

Sherie: I'll tell you, the ultimate getting involved is to run for office. If you're listening and you're interested in learning more, you can look at the show notes, because we will have links there to the different medical associations and their advocacy groups. I love to talk to our insureds. I love to talk to our practice managers. My information, my contact information, will be in the show notes, too. Just pick up the phone and call me or email me. I'm usually in my office, except during legislature. 

Brian:        Fantastic. They can call SVMIC...

Sherie: Yes, they can.

Brian:        ... to get in contact with you.

Sherie: Yes.

Brian: Yarnell, they can contact the TMA if they want?

Yarnell: Absolutely. If they're a member of TMA, they can contact me or a member of our government affairs staff. If they're not a member, this may be an excuse to join. We do provide that voice and that mechanism to establish a grassroots relationship with their legislators.

Brian:        Fantastic. Well, Sherie and Yarnell, I can't thank both of you enough for being here to talk about this incredibly important part of what is involved in healthcare these days with the legislature. 

As you said, Sherie, we'll put some links in our show notes as well to direct people to these areas for help. Thanks again.

Sherie: Thank you, Brian.

Yarnell: Perfect. Thank you.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect, with your host, Brian Fortenberry. Listen to more episodes, subscribe to the podcast, and find show notes at SVMIC.com/podcast. 

The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and change over time.