Sharing Your Expertise Through Lobbying

By Laura Fonda Hochnadel
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You are probably inundated with emails from patients, insurers, vendors, and colleagues. Among those emails may be correspondence from the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) summarizing its latest webcast, or an AOPA in Advance SmartBrief from the American Orthotic & Prosthetic Association (AOPA) with legislative news, or a call to action from the American Academy of Orthotists and Prosthetists (the Academy). The contents may seem dry, or perhaps you don't think they apply to you-after all, you are a clinician, not a political activist. And, don't you pay membership fees to these organizations so they can handle the details while you take care of patients? Don't you have enough to worry about? Experts and citizen activists tell another story.

"Just because you do not take an interest in politics doesn't mean politics won't take an interest in you," said Pericles, a 5th century Greek statesman, orator, and general of Athens. No one's life is untouched by politics; without participating, your voice will not be heard, and yet you will still be affected by the consequences of the political actions of others. Your vote counts.

"Lobbyists and AOPA staff can explain issues to legislators and their staff, but we [as the organization] do not vote," says Tom Fise, JD, AOPA executive director. "Clinicians, your fellow employees in your practice, and the patients you serve all vote, and no surprise, politicians are most interested in folks who vote."

New Year, Clean Slate

January heralded the beginning of the 115th Congress (2017-2018). The prior Congress' legislative slate has been wiped clean; all proposed bills not signed into law have been archived. Most proposed bills never make it far in the process, which can be disappointing to those who worked for their passage.

"It can be discouraging to expend time, energy, and resources that yield little results, but we have realized that it is all about educating others and laying a foundation," say husband and wife team Teri Kuffel, Esq., and Charles "Charlie" Kuffel, MSM, CPO, FAAOP, co-owners of Arise Orthotics & Prosthetics, Blaine, Minnesota.

Yet bills can be reintroduced, and there are always new issues to be addressed, says Fise. "2017, and the swearing in of the 45th president and the new 115th Congress do mark a new beginning," he states. "We are hopeful to carry forward some of the strong momentum generated in 2016 that started with the AOPA Policy Forum and the Prosthetic and Orthotic Care Modernization Act. I expect that we will be advancing some of those same concepts, but we need to be nimble in framing our objectives to be responsive to the needs of O&P each year."

AOPA is an independent organization with its own focus and mission, and it maintains its own lobbyists. H.R. 1530/S. 829, the Medicare Orthotics and Prosthetics Improvement Act of 2015; H.R. 1526, the Medicare Audit Improvement Act; and H.R. 5045, Preserving Access to Modern Prosthetic Limbs Act of 2016, are bills that AOPA fostered in the prior Congress, "working with its lobbyists to identify legislators of like mind, and working with them to introduce and advance bills," Fise says.

Nonetheless, AOPA works closely on advocacy and lobbying efforts with its partners in the O&P Alliance: NAAOP; the Academy; the American Board for Certification in Orthotics, Prosthetics and Pedorthics; and the Board of Certification/Accreditation. (Editor's note: Space did not permit us to interview all O&P Alliance members.)

While also an independent organization, the Academy works through the O&P Alliance rather than lobbying on its own, says Chellie Blondes, the Academy's executive director. Advocacy has always been part of the Academy's mission statement, but there is renewed effort in legislative and advocacy matters, she says, which was spurred by the results of the needs assessment survey the Academy conducted last year.

"The number one area of interest for our members who responded to that survey was advocacy. Eighty-four percent of the respondents said that advocacy on behalf of the profession is critical," she says. "Education and the Annual Meeting were a close second."

That is the reason the Academy took a deeper look at how it was supporting the advocacy needs of members. As a result, the Academy established a Public Policy Committee to focus on advocacy issues that directly impact O&P practitioners; identified volunteers and staff members, including Blondes, for whom government relations is a priority; and will assist the Alliance whenever possible, including compiling a list of researchers who have agreed to share their expertise when called upon.

Further, the Academy plans for an undercurrent of advocacy to permeate all aspects of its Annual Meeting & Scientific Symposium, March 1-4, in Chicago. "We have a session at our meeting called 'The Future Political Climate of Healthcare' that will be offered on Friday, March 3, at 3:35 p.m.," Blondes says. While this session is offered annually, it was moved from a morning timeslot to the afternoon to make it more convenient to attend, and it has been lengthened from 60 to 90 minutes, she says. At the session, the Academy's Alliance representatives, board members, and other active members will "discuss what has happened in the past year, what they foresee happening, and what the profession needs to be aware of, and what actions we are potentially going to need to take moving forward," Blondes explains.

Getting Involved

AOPA and the Academy offer simple ways for interested members and stakeholders to get involved, AOPA through its AOPAVotes website (www.aopavotes.org), and the Academy through an electronic tool called Voter Voice (www.votervoice.net/aaop/campaigns).

Voter Voice is a system the Academy uses to target members and help them easily contact their senators and representatives. For example, if a letter in support of a bill needs to reach the Senate Finance Committee, an email can be sent just to those senators' constituents, urging them to send a pre-written letter. "All they have to do is go in, click on the link, insert their name and zip code, and it is sent automatically from them to the senator. We have made it as easy as possible for our members to reach out to their government representatives," Blondes says.

The AOPAVotes website is the place "to learn the status of key legislative and regulatory topics, to find summaries and key talking points, as well as to easily communicate their concerns and priorities to their legislators," Fise says. AOPA's Policy Forum, slated for May 24-25 in Washington DC, is another venue whereby O&P clinicians can get involved with lobbying. The first day, attendees are given a lesson in political activism and participate in discussions about O&P-related legislative efforts. The second day, attendees meet with their legislators to discuss the talking points reviewed the prior day.

"The AOPA Policy Forum...is a great opportunity to visit these folks in Washington," Fise says. "But you can see them at home as well, via a visit to their state or local office." He also suggests inviting your legislator to visit your facility and meet your employees. For the legislator to "see what you do for your patients is another remarkable opportunity."

Jeffrey Brandt, CPO, CEO and founder of Ability Prosthetics & Orthotics, headquartered in Exton, Pennsylvania, was thrust into purposeful lobbying efforts after the Draft Local Coverage Determination (LCD) for Lower Limb Prostheses was introduced in July 2015, he says. Ability submitted a data-oriented letter outlining the detrimental effect implementation of the LCD would have on the practice's patients who are Medicare beneficiaries. Brandt's proximity to Washington made it practical for him to rally patients and his employees to picket and attend the open comment session along with him and several other Ability practitioners, including Jeffrey Quelet, CPO, clinical management officer. Brandt's efforts were further propelled by his attendance at the 2016 Policy Forum. He now devotes about five hours per week to lobbying and advocacy efforts and has joined an AOPA committee to stay apprised of its work and to give back to the industry and profession.

"If I don't have the discipline to sit down and start to carve some time out every week toward these topics, I'm going to be sitting here in five years saying, 'Gosh, I wish I would have helped out or been more active,'" he says. "I have amassed some experiences and data over the past decade that I can give back and help move the ball down the field." The Kuffels began "hobby lobbying" eight years ago at their state capitol, working for insurance fairness for people with amputations. Soon after, they began attending Policy Forum and working at a national level. Their annual visits to Washington reinforce the relationships they have already established with their members of Congress. They even bring patients with them. "We decided to make the most of our visits and bring amputees so their voices could be heard," say the Kuffels.

Making Connections

Arise O&P and Ability P&O have also hosted their members of Congress at their offices. The Kuffels and Brandt agree the meetings are impactful because it gives their legislators a chance to see how patients benefit from O&P care and to learn about the profession. So, when they are pitched about signing onto legislation that has the potential to help, they are more amenable, Brandt says. "It really imprints on the congressman or congresswoman what we do every day and they see the clinical value and outcome of our efforts. All of them pretty much leave saying, 'I need to do some additional research, but I'm excited about this; it's something I can get behind.'"

Brandt says getting to this level of interaction with legislators takes groundwork and persistence. He admits it took a curt, fifth email to make initial contact with one of his members of Congress. He also advises that when calling your members of Congress, it's important to find out who in that office will be an everyday point of contact, whether it is a specific healthcare aide, or the person who schedules appointments. He even learned their congressional schedules. "When they are in session, they are in Washington, so they are not back in their districts, for the most part, hosting meetings," he says. "It's recognizing how the system works. I can't go to Washington and fight on behalf of my patients if I haven't gotten the pleasantries out of the way and people don't know who I am."

The fruits of their labor are worth it, agree the Kuffels. "We have come to realize that forming these relationships takes time, but they are purposeful relationships. Because we have maintained direct contact with a particular few, we are contacted to answer questions about legislation concerning the O&P industry," says Teri.

The Kuffels and Brandt urge that the "small dogs in the fight" not be overlooked. The Kuffels count the legislative staffers among their most important political contacts. Brandt says you never know who is going to ascend the ranks in his or her political career, citing Senator Tammy Duckworth (D-IL), as an example, as she now has more political clout than as a representative.

Regardless of how or where you apply your lobbying efforts, the important thing is to get involved. "Many people are called to help in a clinical sense, then discover a compassion for others created by the connections made with their patients," says Charlie. Teri adds, "It is that compassion that fuels advocacy. So take the next step. Go to the AOPA Policy Forum this year and bring a patient with you. Our patients and their stories are extraordinary, and that's what makes a difference."

AOPA is a valuable resource to reach out to, and its website provides information on grassroots advocacy. Follow the O&P Alliance and NAAOP. Contact the Academy to see how you can sign on to its efforts.

"I think it is important to remember that no one expects us to be experts in communicating, necessarily, with congressmen," Brandt says. "Lawmakers expect us to be experts in prosthetics and orthotics. But we must become more of an expert at utilizing these relationships to liaise opportunities for our patients to share their stories with elected officials."

Laura Fonda Hochnadel can be contacted at .

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LEGISLATIVE STRIDES DURING THE 114TH CONGRESS

Although no O&P-specific legislation became law during the prior Congress, strides were made on several fronts, as follows:

On February 20, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final regulation that interpreted essential health benefits (EHBs) under the Affordable Care Act (ACA), effective for plan years 2016 and 2017, and regulated the definition of "habilitative service," thus creating a federal minimum coverage for these services and explicitly recognized coverage of habilitative "devices."


The one-prosthesis-per-amputated-limb-per-lifetime restriction offered in the state of New York's benchmark health benefits plan sold in the private insurance market was rescinded.


The Draft Local Coverage Determination for Lower Limb Prostheses, introduced in July 2015, was put on hold. CMS has convened a multidisciplinary workgroup to develop a consensus statement that informs Medicare policy and to identify evidence gaps and recommend study designs and outcome measures. A consensus statement is expected to be generated this year.


In April 2016, CMS announced that a definition of "orthotics and prosthetics" that is separate from durable medical equipment was added to the Glossary of Health Coverage and Medical Terms. This document provides guidance to private insurance companies when defining and establishing coverage for EHBs.


On December 5, 2016, the DC District Court compelled the U.S. Department of Health and Human Services to eliminate the extensive backlog of Administrative Law Judge (ALJ) cases pending decision by 2020; ALJ review is the third of four levels in the Medicare claim appeal process.


The 21st Century Cures Act, which provides over $4 billion in funding to the National Institutes of Health (NIH), was signed into law on December 13, 2016. Among other things, provisions in the law would enhance NIH's capacity and focus on O&P research, stated the National Association for the Advancement of Orthotics and Prosthetics.