The Helping Families in Mental Health Crisis Act (slated to be introduced in the United States Congress in 2015) contains many provisions designed to increase mental health care quality and access. The bill:
- Clarifies HIPAA privacy laws, allowing fuller disclosure to parents and caregivers of minors.
- Provides exceptions to Medicaid's Institutions for Mental Disease exclusion rules in order to increase beds for inpatient psychiatric care facilities.
- Authorizes court-ordered "assisted outpatient treatment" for at-risk patients who refuse medication.
- Promotes telepsychiatry programs in rural communities.
- Increases support for research and training.
- Provides legal protections to physicians who volunteer in community mental health clinics.
- Promotes the use of best practices and evidence-based medicine by federally supported programs.
So why is Congress now taking a strong interest in mental issues? Well, it probably doesn't hurt that the bill's sponsor Rep. Tim Murphy (R-Penn.) is a former psychologist and strong ally of the mental health community. However, the bill also represents decades of advocacy by providers who were concerned about the quality and availability of mental health care.
To highlight the systemic barriers these patients face, providers lobbied Congress both individually and through their professional organizations. They wrote letters of endorsement, served on round tables, campaigned for candidates, testified before Congress and coordinated legislative meetings and events. Some helped enact similar legislation at the state and local level. And perhaps most importantly, they spread awareness about an important social justice issue that affects millions in our country.
While the bill still has a long road to travel through Congress, its existence is a great reminder of what conscientious healthcare providers can accomplish on behalf of their patients. In the remainder of this post, we'll examine the concept of advocacy and discuss how providers can improve care for patients.
Why Physicians Need to Get Involved
Many professions lobby lawmakers and regulators on behalf of their own interests. However, healthcare professionals have a long tradition of advocacy on behalf of patients. In a healthcare context, Earnest and colleagues define advocacy as:
Action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that he or she identifies through his or her professional work and expertise.
The practice of patient advocacy is endorsed by several professional societies, including the American Medical Association and the American College of Emergency Physicians. There's also a movement afoot to incorporate advocacy training into health professions curricula.
While advocacy has always been an important part of healthcare practice, it's especially relevant today given the sweeping changes mandated (but not yet realized) by healthcare reform legislation. Harold F. Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, really hit this point home in his presentation at ACEP's 2015 Advocacy and Leadership Conference.
The biggest problem with reforming healthcare, Miller says, is that we often frame issues as win-lose. A good example is the current fight over risk. Payers have been proactive in lobbying for measures that shift their own risk to patients, doctors and hospitals (high-deductible health plans being a notable example).
Unlike health plans, physicians have a moral obligation to put their patients’ interests above their own. For this reason, Miller says, it's crucial that providers lead the conversation on behalf of patients and communities. The goal would be to create a win-win-win system of healthcare delivery.
Providers may not have ultimate lawmaking authority, but they can do a few things that Congress can't. For one, they have the insight to redesign the system in a way that reduces spending without harming quality. Along these same lines, they also have the know-how to design payment systems that make good care a viable option for providers and payers.
Examples of Successful Advocacy
The above scenario may sound overly optimistic, given the challenges facing healthcare. However, patient advocates working through their professional organizations have won significant victories at all levels of government. Some notable examples:
- The federal Emergency Medical Treatment and Active Labor Act (EMTALA) prohibits US hospitals from denying emergency care to uninsured patients.
- The Society of Hospital Medicine successfully lobbied both houses of Congress to introduce bills related to observation status. The proposed law would allow observation time to count toward Medicare's minimum three-day inpatient stay required for skilled nursing coverage.
- The federal "prudent layperson" standard mandates insurance coverage of emergency care for people experiencing symptoms of an emergent condition — regardless of the final diagnosis.
- California's Maddy Emergency Medical Services (EMS) Fund provides partial reimbursement to emergency physicians who provide lifesaving care to uninsured patients.
- Emergency physicians in Sacramento County recently gained the ability to write and release involuntary psychiatric holds. The new policy helps prevent unnecessary ED stays for patients and relieve crowding at inpatient facilities.
Tips for Getting Involved
Ready to fight for change on issues impacting your patients? If you've never thought of yourself as an advocate, here are some tips for getting started.
Learn the process. Often the first step in change is tracing the problem back to its legal or regulatory roots. Patient care is impacted by federal, state and local laws — as well as agencies that apply those laws.
In the example above, California state law didn't prohibit physicians from writing psychiatric holds, but Sacramento had never offered them the training needed to do so. This changed when the local medical society approached county officials and explained the benefits of changing this policy.
Make your voice heard. One of the easiest ways to advocate for patients is to tell legislators what side of the issues you're on. This can be as simple as a brief email or phone call. Because politics tends to be a numbers game, this approach works best when coordinated by a professional organization or citizen's group. In many cases, the sponsoring organization will even offer talking points you can use during the conversation.
Get involved in your professional organization. Healthcare issues are complex and systemic, and a lone advocate faces an uphill battle. That's why advocacy efforts are often organized by professional societies such as the Society of Hospital Medicine, the American College of Emergency Physicians, the American Academy of Physician Assistants and the American Nurses Association.
Professional groups tend to be keyed in to the "hot" issues impacting patients and the profession. They understand the legislative process and have an existing infrastructure connecting their leadership to policymakers. When a society represents tens of thousands of individuals, its voice speaks louder.
Learn the ropes. Becoming an effective advocate takes time and experience. One of the best ways to gain this is to work alongside colleagues who are expert advocates. Volunteer to serve on a committee, become a point person for an issue or run for a leadership position.
Be a catalyst for change. If there's an issue you feel passionately about, gather support among your colleagues. Then bring your proposal to the leadership of your professional society or raise it at the next legislative meeting.
Stick with it. While advocacy sometimes works quickly, it can also be a very long process. A recent example is the repeal of the SGR reimbursement formula, which took 17 years of consistent lobbying by providers and their professional societies.
How do you advocate for your patients? Comment below to tell us about it.
[Image credit: "Governor and Lt. Governor Testify on the Death Penalty Repeal" by Maryland GovPics licensed under CC BY 2.0]