Hello, everyone. I am Dr. Marilyn Bui. I serve as the president of Florida Society of Pathologists. Welcome to our webinar, Advocacy, the Why, What, and Now. This webinar is part of the Professional Development Lecture Series by FSP this year. And then today we're going to focus on advocacy because pathologists and laboratory medicine play a very important role in patient care. So we need to continuously advocate our value to better patient care. So today we're going to have one hour and 15 minutes. We have a lineup of excellent speakers. So we're gonna first start with Amy Yang, talk about the Advocacy 101. Then we're gonna follow by Dr. Ron Giffler, talking about advocacy from a pathologist perspective. And Dr. Tiffany Mills talk about the advocacy from a younger pathologist perspective. And I will share some of the advocacy opportunities at FSP and the College of American Pathologists. Then we're gonna have Mr. David Smith talk about a recent advocacy victory with the collaboration and the leadership by the FSP. And for the last 20 minutes, we're gonna have a panel discussion. So without any delay, our fantastic program, we're going to move to the very first speaker and that's our Amy Yang. Amy is our legislative consultant. As you may know, FSP is one of the few state path society is able to do advocacy and the lobbying. And Amy is guiding us on that because she has 23 years experience with a national law firm that is a billiard partner and she is very experienced in advocacy. So her brave bio is all here on the screen. And without further ado, Amy, thank you so much for your guidance and your dedication to the pathologist advocacy effort. And we look forward to hear from you on the training of advocacy. Well, thank you, Dr. Bowie. Thank you all for joining us today. You've dodged a big bullet because this is usually a three hour CME with this PowerPoint presentation and I've pretty much reduced to a 10 minutes. So we dodged that bullet. So knowledge is power. I wanted to go over the agenda. We start with these topics, the elected official, the gatekeepers, the third house, the legislative process. Next slide. Not seeing the next slide. Okay, so the look behind the scenes, lobbying more than the legislature, do this and don't do that. How to lobby year round and why do we have a PAC? Now politics, when you're looking at the dictionary, I didn't make this up. You can look the word up in Webster's dictionary. Politics means many, poly means many and ticks means blood sucking creatures. So that is actually in the Webster's dictionary. Sorry you all, I'm having a few technical difficulties here. So the politics is the art of looking for trouble. Next slide. There we go. Bracha Marx was spot on. As I like to say, nothing is more dangerous than a big idea and a small mind. Next slide. So now let's talk about who we have to put on Chapstick for every morning when we enter the Capitol. The Senate is made up of 40 members and the House has 120 members. The cabinet is the governor, the chief executive officer, financial officer, the attorney general and the commissioner of agriculture. Sorry you all, we're having a few difficulties here. Okay. I apologize. I can't see what's on the screen. I could only see what I see on my slide. So I'll just continue on. So as a lobbyist, we play both offense and defense. When legislation is filed, we determine if it is good or bad for the Florida Psychopathologists. And so we can, for instance, we play defense when there is legislation that is proposed that ties reimbursement to a Medicare level because that does not recognize a professional component. Amber, I'm gonna get off of my screen and go on yours so that I can really apologize. Okay. I don't know why I'm having so many technical difficulties. Okay, next slide. The governor and cabinet. Okay, eyes and ears of the association. So basically what I do is I watch out for the train, I hear the train and I try to block you from getting run over by the train tracks, which is very common in our field. Next slide. There we go. Just as easily as that door can be opened, it can be slammed. It's really important that we all know that if you are not completely honest and tell the truth all the time and make sure that everybody knows which side of the issue that you're on and who may be on the other side. If you do not share that and you are deemed as dishonest on something, then you will basically be blocked out of the system. Next slide. See my slide, I'm sorry. I'm just gonna have to close this out. Okay, I think we're on the wrong slide here, Amber. Okay, the next one. So how do we manage the legislative process? So first a bill is, oh, the slide went back. Okay, partisan influence. Introduction of bills that comes from the speaker's office and the president's office. Referrals, each bill is usually referred to three different committees on the House side and the Senate side. Schedules, we know 48 hours in advance what schedules will be on the agenda for the day after. Behind the scenes, we do a lot of our lobbying behind the scenes. We have to because we've got to know the vote count by the time we get to the committee process. Next slide. And Dr. Bowie, tell me when I'm running over. So partisan influence, constituent issues, leadership agendas, deals deal. Partisan influence, there's a lot of partisanship. We have a super majority in the Florida House and Senate now so that means that there are more Republicans that can basically outvote Democrats so the Democrats have less influence than they used to. Constituent issues, a lot of the legislation that's brought to legislators is from their constituents. They have an idea that they think would be really solid and they get the buy-in from that legislator and that's how we basically sometimes introduce legislation. Leadership agendas, everything is really kind of from the top down in Tallahassee which did not used to be the case. We used to basically be able to kind of come together nonpartisan and work together on issues but now a lot of the agendas are determined from the top down. So we get some of our direction from the Senate President and the House Speaker. Next slide. So we don't lobby just the legislature, we lobby the governor and cabinet, we lobby state agencies including DOH and Agency for Healthcare Administration and that's really where David Smith is gonna come in on this discussion because he is invaluable to us. He works with us on ACCA issues. We have just as many issues at the agency level as we do at the legislative level and so we've gotta be sharp all year round looking for bill proposals during the legislative session and then administrative rule proposals during the rest of the year. Next slide. So when you're lobbying basically, especially when you're in Tallahassee, you pretty much have a five to 10 minute time slot with those legislators. That's why I'm always emphasizing that it's really great for you to meet with your legislators back home because they have a lot more time. You can basically spend a lunch with them. When they're in Tallahassee, you've gotta be very brief, very concise, realistic, accurate and honest obviously but you have a very, very much condensed schedule than you do when you're down in the district and the legislators are more relaxed. So I really urge people to not wait until the legislators are in the Capitol, just basically see them at home and have it more organically and that's the way you build friendships. Next slide. So don't talk to state legislators about federal issues. That happens a lot. So you read something in the paper that's happening in Congress, you end up at your state legislator's office and you kind of, you mix the two issues which really doesn't work well because state legislators only deal with state issues. And try to stick to one issue. Don't try to get all over the map. Try to kind of focus on what issue it is that you wanna talk about that particular day. And you also have to know the timing of things in Tallahassee because if there's a vote in committee like there's a lot of votes today in Senate Health Care, don't try to influence someone on the Senate Health Care Committee after they've just voted on the bill. And sometimes it's hard to keep track of that and that's one of the reasons why I can help with that, the timing of everything. And it's all just human beings, they're just people. Sometimes we get intimidated but they're all, they're just people and they really, really depend on you. You as physicians, you as lobbyists to basically educate them on issues. So you're very, very important to the process. Next slide. So this is where I go back, how to lobby year round. You basically really organically and if not organically at the church or wherever you see your legislators, set up a meeting with them and take them to lunch and get to know them. Next slide. So political action committees, we do have a political action committee at the FSP. They never buy votes, it's really about access and trying to basically influence outcomes of legislation but your money does never ever buy a vote. It does help with access with legislators though. Next slide. How a bill becomes a law, this is very convoluted. Next slide. And this is how a bill really becomes a law, that lobbyists get out in the street and fight it out. Next slide. The moral of the story is laws are like sausages. It is better not to see them being made and we've all heard that before. And also if you're not at the table, you're not, you're gonna be on the menu. So you have to be active really year round, make sure that you know what's going on at the administrative level, at the legislative level. You know, I'm your eyes and ears on all of that but we also need full participation and we appreciate the fact that we've got such an active executive committee and Dr. Bowie heads that up for us and kind of gives us all direction. And that concludes my presentation. I look forward to questions at the end and so sorry about all those technical difficulties in the beginning, I apologize. Dr. Giffler. Okay, I guess I'm next. I'm Ron Giffler. You see my bio there, I would just add that I've been a member of both the Florida Society and the Florida Medical Association for many years and was recently in 2019, I was president, I think 143rd president of the Florida Medical Association and only the second pathologist in the history to be receiving that privilege. So in the years running up to and subsequent to that, I was able to become involved in advocacy in its many ways and I would add some of what I say will be a little bit redundant of what Amy said and what subsequent speakers will say as well, but we're all approaching the same thing basically from slightly different viewpoints and we can't emphasize it too much. My talk's gonna be in two parts. First, I'm gonna try very briefly to go over some of the things you can be involved in as an advocate for the Florida Medical Association that can apply to any other society too, including the FSP and then I'd like to take more time just explaining how you can get involved in these activities. I say you, I mean, those people listening into this webinar either now or later that are not currently active, they're members, but they pay their dues and go to a few meetings but haven't really been that involved and wanna discuss some of the things that you might wanna consider to become more involved. So next, next slide. The Florida Medical Association is the largest medical organization in the state of Florida. We have about 25,000 members representing all geographic areas and specialties. We're involved in three basic types of activity. We provide continuing education programs. We have a foundation which has a leadership academy for younger doctors and that's an area where I would also recommend any young physician interested in getting involved in advocacy to see if they can get a spot in our leadership academy. It's very valuable whether you're gonna go on to work for your specialty society, the FMA or your hospital medical staff or county society, whatever you wanna do, it's very valuable. We have a professional staff from the University of Florida. So it's a very well appreciated program. But our third main activity is advocacy and that's what has interested me the most and what we're here talking about today. So I think I wanna move ahead a number of slides right now. Next. I mentioned our foundation. Okay, our advocacy takes on several different aspects. We directly and through lobbyists go to legislators to promote pro-medicine legislation. We have our own council on legislation to develop policy. We have a PAC. As Amy mentioned, you are not buying votes but you are getting access. Remember the legislator's time is very, very limited, particularly when session is, in session is very active, time is a premium. And so everybody wants to see you. And so say you have 10 minutes left to see somebody and four people wanna see you. And one of them has been supporting you with time and effort and money for 10 years. And the other three are total strangers. Who are you gonna see first? It's only common sense. When you get that access though, you have to have a good argument, clear, concise. And that's one of the things we'll take up in a little more detail is how to be a good advocate. Also, as Amy mentioned, the key contact program is what we call it, but meeting with your legislators throughout the year and not just showing up in session one time, asking for a particular favor, but supporting them and communicating with them throughout the year. Next slide. And our advocacy at the Medical Association for most of its history was focused on the state, but in the last five or six years, we've developed the outreach in the federal level. We have a federal lobbyist. I've been to Washington several times myself, meeting with the Florida legislators and including their representatives in Congress and the Senate. So next slide. Our session meets last year in March. This is a year earlier. They meet early in the year, varies from year to year, usually depending on January through March or April. And it's a very hectic time. And there's hundreds and hundreds of bills every year. And only some of them, which are still hundreds themselves, affect healthcare and our staff and our lobbyists and lobbyists for all the specialty societies. And Amy has to review these constantly. They're not only as submitted, but they're amended and changed throughout the year, throughout the session. And you have to have a lot of time and effort and energy to keep track of all this. Amy happens to work for Ballard, one of the biggest national lobbying firms. And coincidentally, their building in Tallahassee is right next door to the FMA's building. So we're neighbors. Next slide. Last year, we got money for new residency slots, which is very important. Next slide. We also got more money for care for children. For years, we've had Medicare paying one of the lowest in the entire nation. If you schedule in, at least in the pediatric area, we got those finally raised. Next slide. Why don't we keep going? Next slide. I wanna get to a coming session. We have an ongoing set of issues. These are recurring. We want to simplify prior authorization, tort reform. There's always need for more tort reform. And particularly, as mentioned previously, we want to promote good bills, but also fight bad bills. And the trial lawyers are always trying to make it easier to sue more doctors under more circumstances. And that's something we have to fight as well as scope of practice expansion. Now, the way things work right now, pathologists are not directly affected by scope of practice, but we're all in the same boat in one sense. We're all physicians and the people we deal with are administrators of managed care companies, insurers, hospitals, and to the extent that any physician's role is diminished or replaced by someone that never went to medical school, it's not good for all of us. So that's something we continue to fight. Next slide, please. We're at the federal level, of course, very much affecting pathology, Medicare payment rates, which are horrible and continue to be decreasing when everybody else is getting increases. This is really very bad. The No Surprises Act and the arbitration process for out-of-network bills, this is very much affecting all pathologists. And there's something we're trying to deal with all specialties at the national level, and that's still a work in progress. Next slide. Next slide. That's our annual PAC dinner. You see me there. And I think the back of the head there is Rebecca Johnson. So you're a representative. Our PAC has been very successful. Keep, yeah, yeah. Lower left, I think that's Rebecca Johnson, although we don't see her face. Next slide. I wanna move on to how can you get involved? The first thing is you have to understand that you can make a difference. There's a lot of apathy. A lot of doctors think it's a waste of time to try. The big influences, the big money people, the hospitals, the insurers call the shots. It's not true. You can make a difference. Our presence in Tallahassee is well-respected and listened to. We don't always get our way, but we get heard, and sometimes we do get our way. It is very much worth participating. And the issues that we're involved in concern all pathologists. Some of you are in small private practices and issues regarding billing and joining networks are very much in the forefront of your mind. Some of you may be working for large entities and feel you're more or less immune to some of these things, but it's not true. No matter who you work for or what your practice setting, there is somebody looking at the revenue your fees break in and the regulations involving the work you do. And ultimately, we are all in the same boat. The other main issue for a lot of doctors, and I wanna say this, this is involved myself as well personally, you have to get out of your shell. Pathologists, as a specialty, tend to be shy and introverts. You know, just give me a room, four walls and a door, a microscope, a dictating machine, a stack of slides, and don't bother me. Lunchtime, you run down to the cafeteria, you grab a sandwich, bring it back to your room, close the door again. No, you have to change that. You have to get involved. You have to be sociable. Next slide. You have to really change. You have to be active. Eat that lunch in the doctor's lounge or the doctor's dining room, no matter how busy you may be. It's time very well spent. Attend meetings and volunteer, join all your specialty societies, not just the FSP, CAP, your state medical association, your county medical society. It's very important. All these societies, they're looking for members. It costs money, but it's worth it. It's a real investment in your future, in your professional career. And if you wanna look beyond your own time as a practicing profession, for the future of your profession. So it's costly, but it's a real investment, not just paying a lot of dues to a lot of societies, but donating money to candidates, either directly or through the various paths. They are constantly running. No sooner is an election over, than they're starting the new election cycle. It's never a case, well, I just gave or I already gave. There's always the next election. This cycle of election and electioneering and discussing the issues never ends. There's never really hardly a break. Next slide. Learn how your government works, especially you knew you're getting started. The program Amy gave was excellent, but we need the three hour version, not the 12 minute version. And anytime you have an opportunity, learn more how government works. Whether it's through live presentations like this, you can subscribe to websites that constantly tell you what's going on in the political world, or even read books or magazines, just keep at it. Learn to speak, speak up and practice speaking. Now, since COVID, a lot of our speaking has been done virtual like this meeting, but historically and catching on against some is speaking to live crowds at live meetings. They require different skills, but learn to practice how you use your hands, how you make eye contact. It's something that you can learn and practice and get better at. Also learn a little bit about PowerPoint. You don't have to be the one making the slides with all the bells and whistles and noises and moving arrowheads, but know something about it, know a little bit how to move slides around, maybe delete some or add a few because you don't always have a great team behind you when you have to make a presentation on short notice. Get out there and meet your representatives and regulators as already mentioned. Don't just wait till the session. Those are great suggestions, Dr. Giffler. I think I'm done, yes. Perfect, perfect. So now we're transitioning to our next speaker, Dr. Tiffany Mellis, do you like to introduce yourself? Thank you so much. I love that I get to follow Dr. Giffler because I now realize we have a lot in common. We both went to MB Anderson for our fellowships and we were both the president of our organization or both the president of our state medical society. So I hope that the content of what I have to say really mirrors his content. I really appreciated those thoughts. I first want to thank Dr. Bowie and the Florida Medical Society for including me in this virtual event. You have such an active, engaged, energetic and inspiring membership and it's a real honor to be here. You are definitely known as the pathologist society that everyone wants to be and you've done such a fantastic job of engaging the people in your group. And I have a lot to learn from all of you as well. Before I begin, I want to give a little bit of background about myself being a full-time practicing pathologist. I am also a mom to a six-month-old and a four-year-old. I am a wife to a fellow business owner and also the founder of my own private lab. But most importantly, for the purposes of this talk, I am a physician advocate and the past president of the Iowa Medical Society. And we represent over 6,000 Iowa physicians, which may not sound a lot like a lot of physicians to these Floridians, but that's actually about 85% of the physicians in Iowa. We are just a small rural state compared to you all. So I think it's really important. And one of the things that I definitely want to focus on for my part of this talk is what it means to be a pathologist voice in the greater group of other specialties, because I think it's so important to have within that concert of medical specialties, the pathologist voice. I also want to talk about that particular achievement in hopes of encouraging and inspiring any of you who may be interested in getting involved while juggling many other roles and responsibilities. And maybe I can even convince you that it is fun in the process. And I'll start by just mentioning that when I first moved to Iowa, that was going to be my first full-time real pathology job after all of the training and the medical school education. And so at that moment, I really struggled with the decision of whether it was the right time to get involved. And I think as the presenters have mentioned before me, there is so much that we need to learn and so many things you need to be aware of to be an effective advocate and to be an effective position leader. And so I felt a little bit intimidated by all of that. And that combined with all of the other responsibilities in my life made me really question whether perhaps I should just wait in the sidelines for a while. But I decided that I didn't want to do that and I would just start and see how it goes and just show up. And I'm so glad that I did that because it turns out my life has not really gotten less busy and I think that I provided a really unique, important perspective. So next slide, please. Today, I want to share my journey as a young pathologist advocate and that involves navigating an intricate dance of balancing my family, balancing my professional responsibilities and also the importance of embracing the unique diversity that comes with being a younger voice in our field. And as a young pathologist, my journey has been a whirlwind of excitement, challenges, growth. And I think that in our field, pathologists are often perceived as kind of traditional and being a younger advocate has allowed me to bring some fresh perspectives to the table. And so embracing that diversity of age and experience has been crucial and it's really opened up a lot of doors for me to be able to provide some new perspectives. And I feel like in this slide here that I'm showing you, I have been able to kind of channel a lot of really important relationships within state and federal legislators just because I'm somebody that has been a little bit different than who they might've been expecting to walk in the door when they have a meeting with a pathologist about some pathology CPT code changes. And we were able to really connect because I think when you bring your whole self to the table, which might include a story about your sleepless nights with your newborn or the satisfaction of clenching a rare diagnosis under the microscope, you become relatable to that legislator. And that authenticity can break down stereotypes and it really can help you build long-term relationships and trust. And for me, really effective advocacy, it hinges on having that long-term relationship and knowing that they can trust you and they know who to go to when they have any questions about a healthcare issue, something related to physicians, patients, or in particular, obviously pathology. You wanna be the person that they call. Next slide. So I'm gonna give just a few kind of hopefully simple and easy to follow tips that I've learned along the way. And this slide are the do's. So what I would recommend is don't be intimidated and overwhelmed by all the details. You gotta start somewhere. So do show up. That is how I ever got started along my journey is I just decided, you know what? I'm gonna reach out to my medical society. I'm going to see what events they have and I'm just gonna go and see what it is they're doing and learn from them. Anybody can do that. And that is going to be the first step on a long journey potentially. And then next is make it about people. In the world of advocacy, being yourself is critical. Whether we're advocating for policy changes or discussing the importance of pathology in healthcare, our personal stories matter. So by sharing our experiences, struggles, and triumphs, we humanize our profession and make it more accessible to those unfamiliar with who we are. And I feel like it's not just spite my messy, busy, complex life that I can be a successful advocate. It's actually because of it, because I am relatable and obviously our legislators also have very busy, complex lives. And when we can overlap and have things that we connect with then we can really build a real relationship. And I think making it about people is really critical, particularly for pathology in general, because it's easy for them to think of, you know what? These lab tests that happen, they happen within the lab in a black box. I don't really understand how this relates to the people of Florida, the people of Iowa. Healthcare is going to your doctor's office and having them see you eye to eye, but it's our job as pathologists to help them realize how what we do impacts people and how the decisions that they're making, which might impact pathology, will impact the people of their state and their healthcare. That's our job and nobody is gonna do that for us. We have to show up and do that. And like Dr. Bui said at the very beginning, you have to have fun while you're doing it. First of all, you probably aren't gonna want to do it if you don't think that it's fun. But second of all, I think that people catch on to that energy and people realize when you're passionate and you're having fun, that that means that you're being genuine and it's something you really care about. And it's just, it has really a chain reaction effect. So make sure you have fun. Next slide. I also wanted to include some of the don'ts. So the first thing is, don't be afraid. Don't think that because you are this, that, or the other, that you aren't the right person to advocate for pathology, to advocate for healthcare, to explain an important bill and how that will impact our patients. That's not true. We need a diversity of voices and experience and your unique perspective is really important. So don't be afraid to step out there, be you, share your experience and educate your legislator because I think sometimes as pathologists, we forget what specialized rare knowledge that we have. So we definitely wanna be able to share that with those making decisions for our state. And it needs to be us. Nobody else has this specialized knowledge. And it needs to be us. Nobody else has this specialized knowledge. But as you do that, keep in mind not to be too technical. A lot of your legislators are very busy. Policymakers are very busy. You don't wanna jump into technical jargon and really alienate them right from the beginning. Keep it, tell personal stories, keep it about patients and how it impacts lives. And I think it's good to follow up with a one pager as you leave. And so they or their staffer have the ability to refer back and kind of fill in a lot of the detail work after you have your discussion, make sure you include your personal information so that they can get back with you if they have any questions. But at the time of the meeting, don't just jump into all the technical details and jargon because they're gonna get overwhelmed and they're kind of shut down and it's probably not gonna be as effective. My final recommendation is don't be too partisan or at all partisan really. If you wanna be really effective at advocating for issues, remember that it's about issues, it's about people. And I think with rare exceptions, probably legislators wanna help people regardless of what their beliefs are. So be able to talk to people on both sides of the aisle and don't alienate them. Definitely don't get inflamed or angry. Just remember that everybody wants to help people and do good. Next slide. So this is the background photo is me on my inaugural night becoming the first female pathologist of the Iowa Medical Society and a bunch of my pathologist partners joining me and supporting me, which was a really special night and one that I feel especially proud of because I feel like it's so important. Like Dr. Giffler was saying for pathologists to make friends with all the physicians in your hospital, all the physicians in your multi-specialty group in your neighborhood, in your community because we're not just trapped in our basement with our microscope, with the tissue that we work with. We're part of a greater medical community and our voice is so important in guiding diagnosis and treatment. And so I think that you need to step out of your office, step out of your comfort zone, have fun while doing it and teach people and guide people about why pathology is so important. And you live in the state of Florida, which has got an amazing state society. Take advantage of all the incredible opportunities that they have for you and have fun while you're doing it. And if you need any support, encouragement, please feel free to reach out, connect with me. I would love to, and help you realize that if I can do it, anyone can do it. Thank you. Next slide. So this is a really inspirational. That's the reason we want you to be here. And thank you so much. And I serve as the president of FSP and also the vice speaker of the CAP House of Delegates. I feel like there is a great synergy between those two organizations because we're all doing the advocacy for pathologists, pathology and the laboratory medicine. So I actually was recruited by the past president of FSP, Dr. McNeil from the House of Delegates of the CAP to join FSP. So you can see this inter-connection is very important. So today I'm gonna share in the next slide, some of the great opportunities that we have, the next slide, at our state and the national level. Because as the leaders, we're trying to provide the opportunities and to put resources behind you to encourage your engagement and advocacy. So at our state, please join the path pack. So make the money does the work. And also we welcome you to meet your local state legislators also provide laboratory tours for them so they can understand what we do. Or you can also send letters to the editor to local news media. At the federal level, at the CAP, you can do something very similar. So on the right here, we show at FSP, we have a very strong path pack. And the people on the right, please look for your own name, your colleague's name, your friend's name, they have donated to the path pack. So after this conference, we're going to have a drive to continue to ask people, please donate to the path pack. Next slide, please. So this shows some of the examples advocacy can be really, really fun. For example, I had an opportunity to be introduced by Amy to our local legislator, Kimberly Burfield. And she and I, we met over a cup of coffee, talk about the pathology and the laboratory medicine and urged her to use FSP as a resources. Whenever there is a policy involved with the pathology, please counsel us, let us to be the field agent. And over here, you can see Amy and Dr. Giffler is also having fun giving a check to Dr. St. George who is running to be a officer, which later on is going to become a very important partner for the healthcare related decision-making. And on the right hand is the CAP visit heal days, we showed up in person to the Senator Rubio's office. You can see this is our team member. Before the meeting, everybody is reviewing our talking point, divided who is going to do what, who is going to do the introduction, who is going to talk about it, who is going to do the wrap up, who is going to send the thank you letter. And also here after the meeting, everybody taking a picture with the legislative aid. Next slide, please. So this is the CAP heal day. And in the COVID time, we did a virtual one. So you see our Florida has a very strong group, everybody showed up. And also some people did it in the hotel room and here you see some of the Florida members. So after COVID, we're doing it in person. So there is this app, the CAP will send it to us to make schedule for us. The app even have a map to show us where to go and we have to change to the flat shoes to walk from offices to offices to meet the legislative. And this one in between, I changed to the high heel for the photo opportunity with Dr. Emily Volk. Next slide. And we also want to thank, these are the Florida society pathologists contributed to the heal day visit. Half of them attended more than one of them. So please, if you see this pathologist, thank them and also be inspired to be like them and contribute to the next heal day. Next, please. So I want to be the first one to share with you that for the next heal day visit is gonna be April. So this is a free conference for all CAP members and please join us and go back to the slide. And the very important announcement, you're gonna be the first one to hear that FSP will sponsor 10 FSP members and a pathologist to go to the 2024 CAP heal day visit. And we will provide $500 each stipend to support your advocacy effort. Next slide, please. So this slide shows advocacy can be really, really fun, has some surprise rewards. For example, I contributed to the PathPack, our Southeastern region actually won the PathPack competition. So we got invited to this hotel Washington and in this place you can oversee the Washington monuments, you can meet some of the federal legislators in person, chat with them, pick their brain. Next slide. And this hotel is very neat because you can see White House right over there. So this is just showing in addition to all the friends you made during the advocacy and you can also have a lot of fun, a lot of lifetime experience that you will otherwise not be able to experience. Next slide, please. So now we're going to introduce Dr. David Smith. The reason I said doctor, because he is the son of a pathologist and he has been supported FSP every year when you go to FSP meeting, you will see his company, MedReceivable will sponsor FSP and the most importantly, he is our partner in Avenue Recovery and all that. So David, please tell us and share us your words of wisdom. Well, first of all, thank you so much for the introduction. Can you switch to the next slide? Okay, so the first thing I wanna do is I just wanna circle back on something that doctor, let's go to the first one, I'm sorry. The first one regarding the Florida Medicaid fee schedule. So the first thing I wanted to say was, I wanted to circle back on what Dr. Giffler had said regarding the importance of advocacy and the importance of making sure that your voice is heard and everything that we continue to do, not only as an individual for myself, but as a representative for all of my clients, everything that we're doing really represents and helps every pathologist in the state of Florida. And none of this could be done without the support of the Florida Society of Pathology, the Florida Medical Association, Amy Young, and I did forget to put on here Steven Weinstein as well. We all are constantly talking about every single issue that possibly comes up and hits the reimbursement front. And as everyone knows, the reimbursement issues are changing every single day. So approximately four years ago, we had noticed right when COVID really started taking off that some of the new CPT codes that were provided and created during COVID were not included in the Florida Medicaid fee schedule. And this created all sorts of issues, billing issues down the road for really every pathologist in the state of Florida. And I was happy to announce that really after about three and a half years of working with the group on the screen, as well as with the folks in Tallahassee, we finally got a reimbursement updated to $9.27 per professional code for every COVID test that's performed now. Now you might say, okay, well, what's the big deal? We have a lot less COVID testing going on at our hospital than we did two or three years ago. Well, it's the layer effect that we've made it very clear to the state of Florida that we are always gonna be the eyes and ears and advocates for the pathologists. And we are always going to work with the FSP and the FMA and Amy to make sure that we're bringing those issues to the forefront. Because the reality is if we didn't bring it to the forefront, nobody else would. So the first thing I would say is I encourage you all to really get a good understanding of what's going on on a day-to-day basis, because this does impact you, even if you are an employee of a private group or you're an employee of a hospital-based, corporately-owned group, every single dollar counts. And this is a penny, nickel, and dime really business as it relates to the collections associated with pathology. Can you go to the next slide? So reimbursement issues in 2023. I wish I could say we had no reimbursement issues in 2023. But the reality is that they are ever growing. And just when you think you have a control of one particular product with one particular carrier, the issues will significantly change. So the first question I would pose back to you is what's your current billing company doing to report those issues to you? What are they doing to report them to the FSP? Because if it's affecting me and my clients, it's affecting you and most likely everybody else on the call and everybody else in the state. The second question I would ask them is how are they appealing claims? How is your billing company appealing claims? Why is that so important? Well, I can tell you that I think in all the litigation that we've done in the past 25 years, which is over 100, it's probably over 120 cases, we've never lost. And the reason why we've never lost is because we've stuck to a very, very standard level of practice. And one of the main things is appealing claims. If you don't appeal claims, you really don't have the right to go after and pursue the insurance company. And what we find in most cases, especially as people come to us regarding litigation for old claims when we take over a client, is we find that previous groups were not appealing their denials. And the reason why they don't do it in most cases is because it's a very expensive process. And it's expensive because in most of the cases, you don't get paid. So whether you're getting underpaid or you're not getting paid anything at all, it's just important to ask them what their process is so that if you go down the road of working through litigation, you've got a strong defense on your side to make sure that you can be successful in the process. Also review the matters that you find with the FSP. Feel free to contact me, even if it's not my client. Again, if you find an issue with your group, it probably affects my groups. And we take every issue very seriously. So even the smallest of issue can start out as a few denials here and there for a particular carrier. And if it's not dealt with in an aggressive and or an assertive manner, I should say, it can really take off and get out of control. And the last and not least is don't be afraid to look for litigation support. Sometimes litigation support doesn't necessarily mean that you're going to go to trial. It doesn't mean that you're gonna end up in a lawsuit that's something that you don't wanna get involved in. Litigation for the most part usually ends up in mediation. And in mediation is the time when we not only settle old claims, but we also have a clear ear to be able to have a conversation with the managed care folks on the other side to hopefully cut a deal going forward that includes the professional component of clinical pathology. For us, the professional component of clinical pathology is everything. That is really the meat and potatoes of every group. Can you go to the next slide? Also, what is your current process for coding and audits? What are you doing when you have new hires? Are you going through and reviewing documentation with them and making sure that every doctor in your group is using the same standard level of documentation? Why is this important? Well, it's not just important because if you have an issue with Medicare or Medicaid, it's also an important with commercial care. We recently saw an issue with UnitedHealthcare where they had requested from a provider 500 anatomic pathology reports because they claimed that they were missing an obvious piece of the puzzle in their dictation. Well, what did we do? We went back, we reviewed it with the client, the client went back, dictated addendums to each one of those agreements, to each one of the pathology reports, and we were able to go and have UnitedHealthcare basically pull the refund request off the table and get removed from their list going forward. These issues don't just go away. So it's very important that your coding and documentation supports what you're billing because that ultimately is the best way to ensure the most proper reimbursement. Also, make sure to monitor any of the managed care changes and don't be shy to discuss them with the FSP and Amy. Both of them are, both groups along with the FMA are huge advocates for what filters down to the individual pathologists at the individual level. All of this affects every single person here. And the last thing I would say is be persistent. It's never a waste of time to ask questions. You can always send any one of us an email. And if the FSP gets an email and they think it's appropriate to send to me, then they'll forward it to me, or Amy will get me involved, or we'll forward it on to Steve Weinstein. Other than that, thank you very much. This is great. So I feel at this point, our members should feel really, really pleased and proud. What a fantastic team that we have at the FSP. As I said, I have been the FSP member for 10 years, right? Then I realized our state society is really the best in the country. We have a strong legislative team and a billing consultant. We have our own legal consultant and a very dedicated pathologist working together. So what is the end result of successful advocacy? We get paid fairly, and also when pathologists are doing well, the quality of patient care will be ensured. And one of the pathologists has business in both Georgia and Florida. Because of our advocacy effort, for the same kind of business, he get paid better in Florida than in Georgia. So even he lives in Georgia and he's a member of the FSP. So with that said, I'm gonna introduce Dr. Carmen Gormaz, who is our present elect, and she practice in University of Miami. She is gonna lead the moderate of this panel discussion. Thank you. Thank you, Dr. Bui, and thank you all for wonderful presentations. So I'll start off with some questions for, the first one will be for Amy Young. Amy, for young pathologists that may be in training right now, what would you advise to them in terms of getting involved with the PACS or learning about lobbying and what you do? Yeah, I think that one of the most important things to do is, in matter of fact, I can give you an example. We just had a young pathologist that I set up a meeting with him, with his senator in his district, and they just had a cup of coffee. It was just talking over coffee and really getting to know each other. And then he went to a subsequent meeting that she was very pleased to invite him to. And I think a lot of it is just basically getting to know your legislators. One of the other resources, too, that we have is the Florida Channel, which is, you can go back on a video library and look it up. I can kind of give sites on issues that are really important to pathology that were vetted in a legislative committee. And you watch that channel and you realize this is how you testify. This is how members vote. So I really, you know, having also your legislator come to your laboratory. I mean, they really don't know a lot about what pathology does. And we are an anomaly. We have issues that other medical specialties just don't have. And so getting to know them, getting them to understand our reimbursement parameters and what we actually do in terms of the biopsies, it's really at the root of helping any patient with their healthcare as a pathologist that can certainly analyze whether it's a breast biopsy or no matter what it is, COVID, we were extremely important in that process, as we all know, but your legislator may not know that. So. Actually, that is so important what you just said. It's such an important point that, you know, what we do as physicians is really a great unknown when it comes to patients out there. They really don't understand. Even I find that some other doctors in the medical profession sometimes don't know exactly what it is that the pathologist does for them. It's the laboratory, it's the hazy laboratory. So if they don't understand, I can only imagine the legislators. So yes, I think a tour into the laboratory would be a very good start and having them meet with the residents and fellows and the trainees and the young people. So thank you for that. Next question for Dr. Giffler. Dr. Giffler, what do you consider are the most significant challenges in becoming an effective advocate for pathology? You're on mute, Dr. Giffler. Several challenges. I would agree with several of the speakers who said this should and can be fun, but I just, you need to go in with your eyes open and know what it's all about. First of all, this is a team sport. Know what you're there for, stick to your topic, be concise. You're there to talk about Medicare payments, but oh, you love those manatees and you wanna support them too, swimming around. No, that's for another time and another place. Stick to the topic. Another thing, even the youngest physicians are likely to be 30 somethings, maybe early on in advocacy, you may be even 40 or 50 somethings and this is your first meeting and you're steered into the legislator's office. And who do you see? Some young kid, maybe 24 years old, two years out of college with a degree in political science. And they say, this is who you talk to. And you're saying, well, don't I rate the legislator? This is who you meet, this is the process and you need to get used to it. These kids are smart and they're necessary. The legislators can't be expected to know everything about everything. Everybody in the world representing every interest you can conceive of and probably many interests you never heard of, all laws and regulations change in their favor. They all say it's for the public good and for most of them, coincidentally, what they want to put a few more dollars in their pockets. So they hear this all day. So you get your chance, be polite and concise. And as mentioned above all, be honest and sincere. Remember there are other lobbyists competing for time and government dollars. So be careful what you say. Also, unfortunately we live in a pretty polarized society. Florida is probably as polarized as any state, maybe more than some. And so what do you do? Say you're a very left-leaning progressive and your legislator is a very right-leaning conservative or vice versa. You gotta learn to talk to people who believe entirely different things than you do and stick to the medical issues that are nonpartisan and don't tell him a piece of your mind. Don't tell him his party is ruining the country and you're gonna re-educate him. Stick to the issues, which are nonpartisan medical issues for everybody. The only- Dr. Gifford, I think you and I have both seen that where somebody comes in with a combative nature and you can get shut out of doors so easily and so quickly when you have that kind of attitude, that you're right. You're done, they won't forget you. Yeah. The last thing I'd like to say is you have to do this for inner satisfaction. Don't expect a lot of your peers, particularly members of your own group, to suddenly realize what a great thing you're doing. For many of these people, the time you spend lobbying and studying at night or going to these meetings, eating rubber chicken countless nights, to them, that's no different than they're spending their time on a boat fishing. So you have to do it for the enjoyment, just as your colleague enjoys going fishing. And don't expect a whole lot from anyone other than people like yourself that enjoy the lobbying and enjoy the process. And you'll know you've done something good for your profession. Wow. Thank you. Strong words, Dr. Ron Gifford. Thank you. Next question, Dr. Millis. You mentioned that it's important for pathologists to have a voice in advocacy as compared with other specialties. Can you elaborate on that? Sure. I think that as pathologists, we are often the hidden doctors. I mentioned that we sometimes are located in the basement. We sometimes hide behind our microscopes. We sometimes avoid phone calls. Some of us are prone to being introverts. That's definitely the stereotype for pathologists. And it's so easy for people, including even medical professionals, to not understand what we do. And what we do is so important in guiding treatment and care. And so I think that even more so, we need to be our own advocate, be the educators about pathology, step out of our little space, and go and talk to people, and tell them about what we do, why it's important, and how it impacts patients. And nobody else can do that but us. We need to be proud of all the specialized knowledge that we have. And we have so much detail and background in being able to diagnose that biopsy and guide the molecular diagnostics for the treatment program. But we also need to be able to talk on a higher level and just explain why this cancer patient is impacted by the care that the pathologist has given them and why our reimbursement rates are really important to maintain and not cut so that you can make sure you continue to have quality pathology services in your state. So I think that us pathologists need to open our mouths, get out there, join the group of voices talking about healthcare policy, because when we don't show up, everybody else does, and they make the decisions without us. Definitely. Wow. Good stuff. Dr. Bui, Hilde, tell us about Hilde and what all happens, and do people need to be experts to participate? You don't have to be expert at all because it's a learning process. So the first is to be willing to do it, just jump in by register to the CAP Leadership Summit. So that meeting, usually day one is the House of Delegates meeting. You'll learn a lot of IWKC issue and what member cares, what's on their mind, because people care about get paid, the scope of practice, and then now the big thing is the LDT, FDA is regulating that. People feel that's going to really devastating our molecular testing, and it's not good for patient care. So we need the guidance, we need to organize on that. So people gather together. So the day two will be some training on the legislative issues at a federal level. And also there are some keynote speakers, sometimes very proactive and the inspiring type of conversation you can learn from it. And then they teach you, they make appointment for you on the app. So there are times you can have like five visit in a day, but each visit, it's only like 30 minutes, and you're not alone. You always have team member with you. Some of them are very experienced. And if you are brand new, you're all by yourself, there will be a CFP staff walk with you. And then the CFP will provide information on what are the issues, what's the talking points, and then you have the opportunity to practice with your colleagues before you go there. So when you go there, you basically just talk about pathology, which you're familiar with, why you're passionate about it, why we are the enabler of patient care without pathology. All the other physicians is like the pilots without the navigation. And we're the foundation of healthcare. This type of thing, you talk about it, then you're getting to the issue. And very often, and you will ask them, have you met a pathologist before? They will say, no, I haven't. So that's the opportunity for you to educate them. And if you're running into people you have met for the past five years in the same person, you'll go directly into the issue, what you're talking about. And then they will say, oh, this is great. And show me some of the references and share with me what's the reading material you have. Then they will say, when we have meeting, I'm gonna follow up with you. And then you send them the thank you letter, which has a template. And it's very easy to do. And so you really do not have to be expert. Just show up once, I guarantee you, you're going to get addicted to this activity because that's what happens to me. It is a lot of fun, isn't it, Dr. Bui? It really is. Yes, yes. Because I'm from academic background. I don't personally involved in bidding and all that. Then I realized after I get involved with FSP, this is important for every single person, not just the private practice pathologists. They will experience more acutely because they're in the front line. But in academic center, this issue is equally important. And also the scope of practice, we have to really protect our scope of practice. So the quality patient care will be really provided. So the bottom line is, you do not have to be an expert, but eventually you will learn to be better in doing this. Wow, thank you, Dr. Bui. And Dr., I mean, Mr. Smith. Dr. Smith, he has a honorary title. Well, there's two doctors in my family. My father-in-law is an ENT and my father was a pathologist. Yes, so, but I'm not a doctor. And I don't claim to be one. You don't play one on television? No, but pathology is probably my, outside of my wife and children, pathology reimbursement is my favorite thing to talk about. Well, this is very, very good. It's a good fit for me. It's been a good fit for a really long time. Because with all the cuts and reimbursements, so I too, I practice in academia and we focus all of our attention and energy on the diagnosis, on the ancillary testing. And the last thing we think about is the coding and the reimbursements. That's somebody else's problem. And so, which is a real issue, right? Because we have to get paid to support the very services that we're trying to provide. So, and I know you spoke about this at length, but if you had to sort of summarize, like the key points again, so that we can get properly reimbursed and aware of the new coding laws and so forth, what would you recommend? Well, I mean, number one, you have to have a comprehensive review of what your current process is on a regular basis. And if you don't know what that is, then that's a first part of the problem. Because even in an academic setting, and I will say in an academic setting, it's usually a larger problem because no one really is focusing on the dollars and cents of the various things that go on. And the reality is what we find with our practices, our practices range somewhere between 45 and 70% of their total reimbursement comes from directly from the professional component of clinical pathology. And that's from, yes, that's exactly right. That's exactly right. And so that's why even at an academic level to say it's not important or to not think it's an intricate part of what you're doing, the trickle down theory absolutely makes sense. So if you understand how the data is being captured, number one, if you understand how it's being built, number two, if you understand what's going on with your managed care contracts, number three, if you understand your patient mix, they just came out with the new statistics in Florida that showed that Florida is the number one state in the country with exchange plan lives. We have over 3, we have 3,151,000 people under the exchange plan. Texas is the next closest at 2.3 million. Why is that important? Well, if we're not fighting for the professional component reimbursement for the exchange plan business, then all we're doing is eroding, we're eroding our ability to collect dollars associated with the professional component of clinical pathology. Yeah. And that's a huge issue. And that's where the advocacy really comes into play in working with Amy and working with Dr. Giffler and the FMA. And I mean, you'll find that I'm saying the same things because I wanna be deliberately persistent about it because it's important that everybody understands that if it's impacting my clients, I can promise you, it's impacting you and your facility and all the other pathologists around you. So. I would just add on your talking points when there are still many people that don't understand what we do in clinical pathology, remind them of the extraordinary time and effort. And indeed we were indispensable in the rapid development of all these tests for COVID when that happened. Exactly. That's right. All which are the professional component of clinical pathology. So when I think back about all the things that we've done in the last four or five years, besides all the litigation and managed care contracting reviews and those kinds of things, which we do, and I love that, like Dr. Giffler said, that's like sport to me. I love it. High tech sport. It is, it really is, it really is. But, and you know what? And I do it because I really believe in it. You know what I mean? I grew up in the lab. I saw what went on there at Miami Children's Hospital my whole life. And I understand just from having multiple conversations with all my clients, how many FTEs they have associated with the clinical lab. So I always love that when we're in litigation and the insurance company is like, oh, nobody does anything with clinical pathology. That's all automated tests. Okay. Well, you know, you don't want to go to a hospital where there's not a pathologist who's overseeing, excuse me, supervising all aspects of the professional component of clinical pathology because it's a significant piece of the puzzle as it relates to, you know, how they diagnose a patient. So you can run a test in the ER that may get reimbursed $6 that could change your life. So to me, I think there's value to that. So- Yeah, there's a great value of the professional component of the clinical testing. That's why FSP, FMA, you and our legal counsel all working together. So Florida is one of the few states is still paying the professional component of the clinical testing. So that's a huge victory for our advocacy effort. So thank you everyone. This is a very passionate group. And I hope that our audience really get a taste of what advocacy is, why, and what, and how. So this is going to be recorded as enduring learning material. So let's just give a round applause to all those expert of panels. And now this is the holiday season. I like to take this opportunity to wish you and your family have a happy holidays. Thank you.

Advocacy

Pathologists

Florida Society of Pathologists

Legislative Process

Patient Care

Medical Societies

Engagement

Reimbursement

COVID-19 Testing

Legislators

Hill Day