Change Comes with Political Power of the Home-Grown Variety

Nov 1, 2000 12:00 PM, Tiffany Kobashigawa and J.P. Pieratt

BUSINESSES RUN ON PEOPLE, be they customers, referral sources, vendors or employees. How well you understand, serve and communicate with them determines how well you run your business.

The same holds true in the political arena. Whom you know, how well you understand the issues and how well you communicate can make the difference between having to live with legislation such as the Balanced Budget Act of 1997 and getting last fall's Balanced Budget Refinement Act passed.

During the last decade, the home medical equipment industry has learned rather painfully that it must develop more political power and access to survive. Again, that comes back to people - not just HME industry lobbyists in Washington, but individual providers willing to get involved at the grass-roots level.

How do you establish a meaningful dialogue with a senator, congressional representative or state legislator? As you will see in the following provider profiles, specific techniques vary, but establishing an ongoing, personal relationship always is the first step.

Facing the Intimidation Factor

Note to Self: Legislators Work for You

IT'S EASY TO LOOK at legislators, especially on the national level, the way people look at high-profile athletes or entertainers - as unknowable and unapproachable. Many constituents, including HME providers, are intimidated by the thought of meeting their representatives.

What you need to keep in mind, says HME provider Steven Knoll, is that these representatives work for you. "It can be intimidating to talk to our nation's policy makers," says the president of Topeka, Kan.-based Knoll Patient Supply. "People say we pay their salaries and so they should listen to us, but it can still be intimidating."

Knoll first tried his hand at lobbying by participating in Capitol Hill visits organized by the National Association for Medical Equipment Suppliers (now the American Association for Homecare). What he learned there, he says, is that you should approach your representatives with the same confidence you show with customers. "We work hard to help customers get over the anxiety of coming into our stores the first time," Knoll says. "And the same goes for us when we visit our congressional leaders."

Once you've made that initial contact, he continues, you start to loosen up quite a bit, which is good because sometimes you have to be rather blunt. "You have to be upfront about what you want," he says. "Being prepared and persistent never hurt anybody."

Today, Knoll says, he no longer has any problem making requests of his representatives. A couple of years ago, for example, he invited Sen. Sam Brownback, R-Kan., to visit his showroom. "It had been over a year since I first began writing and building a relationship with him and his aides," Knoll remembers. The senator said yes.

"On the day of the showroom visit, I got the entire town involved, including the local television station," Knoll says. "And while Brownback was here, he just happened to meet a couple who was in our service center preparing their oxygen equipment for travel and began to tell the senator about how they would be affected by the then-proposed 30 percent oxygen cuts. We then visually demonstrated to him what it took to get an oxygen patient into the Medicare payment system: three 8-foot tables of paperwork placed side by side."

The senator got the point. "He spoke about how he understood our industry's message that the 30 percent cut didn't make sense," Knoll says. Although Brownback had supported the BBA of '97, he worked for the passage of the BBA '97 Refinement Act passed last year, according to his office.

Since that visit, Knoll has stayed in contact with Brownback. Just as important, Brownback has used Knoll as a sounding board on health care-related issues.

Knoll also makes it a point to write the senator every few months and alert him to major issues. "I try to make sure that when he hears from me I have something important to say," Knoll says, "and he is still very responsive to this day."

Getting to Know You

Good Relationships Make Good Lobbying

"LOBBYING IS LIKE any other sales call you would make in any type of business," says Calvin Cole, president and chief executive officer of Austin, Texas-based Southern Therapy. "You need to go in and get to know the person or representative."

Just as in sales, Cole says you can't expect to have all your problems solved on the first visit. You have to cultivate a personal, mutually beneficial relationship.

"The very first thing you do is go in and introduce yourself," he says. "Let them know who you are, that you're from their district and that you have a business that has tax dollars flowing through it, and employees who as citizens are also constituents in that district. Then let them know that you would like to keep in touch with them to let them know what the political issues are. Everyone that I've ever come into contact with has been extremely interested in meeting people that can help them understand those issues."

Legislators must deal with a lot of issues on the national and local levels, so they might know only a little bit about any one issue - and what they do know is often what someone else told them. That's exactly why HME providers should develop relationships with representatives, says Cole.

"You can be very influential to these leaders by getting to know them, and if you develop a relationship with them and they trust you, they'll call you about information on certain issues," says Cole. "I've had reps call me and ask what the health care sector thinks about certain issues, and that's a result of building a relationship. They keep lists of people they can call about certain issues. Every one of them has someone that's connected with the Internet, oil, banking, transportation ... and they should have someone that's connected to the health care arena."

Cole shoots down the notion that congressional members listen only to high-powered lawyers and activists. In fact, he says the average provider might have an edge over such lobbyists. "Lobbying is very simple, and anyone can do it," Cole says. "And sometimes, the more simple you are and the more small-town you are, the bigger you become in their eyes because you're mainstream America.

"If you come in as president of a billion-dollar company, they know you're there for a reason - to get legislation passed that's going to affect your business. But when you're there as a local business owner, you become more real. You become the average citizen to them."

Then, once your representative has a sense of who you are, Cole says, make sure he or she doesn't forget you. You must follow up. "You've got to establish a relationship where they like you and want you to come back - and then you've got to go back." Cole says he has developed just such a rapport with his congressman during the last three years and has lunch with him whenever he can.

"It also has to be win-win for anyone who does business with each other, and the same thing applies in lobbying," Cole continues. "It has to be a two-way street, not one-way. If it is one-way, it's not going to work. If representatives think you always want, want, want and you're not going to help them, you're not going to get very far."

But Cole advises fellow providers that if they're complacent about lobbying, they should not expect to effect change. "You can expect change, everybody expects change, but you can't influence change unless you get involved," Cole says. "You can't sit behind your desk thinking someone needs to tell them this and tell them this. You have to go tell them personally. If they don't hear what's going on, then chances are your issues won't be addressed.

Paying Your Dues

It's Not All About What's in Your Wallet

MANY PEOPLE BELIEVE that the only way to reach politicians is through their wallets. Sometimes that might be the case, but more often than not, proving to an official that you're legitimately concerned about an issue and demonstrating that concern are key.

How does a provider demonstrate concern? Wade Hendrickson, director of Hartley, Iowa-based MedEquip, does it numerous ways, including making a lot of phone calls coupled with a little "butter" to grease the wheels.

"It might take some buttering up and a lot of correspondence," he says, "but [lobbying] can be done by the average provider. It shouldn't - and doesn't - take tons of money to get a response from legislators. They are public servants who must appeal to their constituents."

That's particularly true if the representatives want to be re-elected, he adds.

Hendrickson is also active in local political groups and associations. "I am a member of the State Department of Health and Human Services committee that meets with local and national policy makers," he says. "It's helpful to establish working relationships on a local level and gradually build the relationships through hard work, knowledge and sincere concern for the issues."

Hendrickson says it took him more than a year to develop a good relationship with Sen. Chuck Grassley, R-Iowa, but that his efforts paid off twofold: Not only does the senator now use him as a resource on certain issues, but his persistence coaxed the senator to visit his showroom, where Grassley participated in a question-and-answer session.

"Once I got my foot in the door, I sent out numerous requests and invitations for him to openly and freely come by our store and address industry concerns," Hendrickson says. "[The Q&A session] was meant to be 20 minutes, and he was there for an hour. We had the opportunity to give him materials concerning cuts in the reimbursement of oxygen, and it was a very sincere meeting."

Since their showroom meeting, Hendrickson has strengthened their relationship by communicating with Grassley and his staff throughout the year. "Even if there's nothing new going on, I give his office a call to remind them that I am still around doing my job," Hendrickson says. "We have formed a relationship beyond the issues.

"Not everyone has to be a suit in a room going through documents to get things done."

Working Your People Power

Local Activism of the Most Powerful Kind

THERE'S STRENGTH IN numbers, and that adage is true in lobbying. A lobbying group's unified voice is squelched, however, when its message falls on deaf or ignorant ears.

"It's good to have as many people as you can who know the issues," says Sam Clay, president of Petersburg, Va.-based Clay Home Medical. He knows at least one member of the Virginia General Assembly who is a pharmacist. "When [legislators] have been providers, nurses or therapists for 20 years, you don't need to educate them on the issues of the industry; they know it and live it," Clay says. "And that makes a difference."

Sometimes, they even use the equipment that HME providers sell. Clay says his state HME association, which he used to serve as president, invited then-Lt. Gov. John Hager, who uses a wheelchair, to speak at its annual legislative reception. The visit served as an opportunity to educate Hager on issues involving HME.

"When [legislators] are educated on issues, they are informed to make better decisions, which usually favors our positions," Clay says. He says state and national associations are obligated to educate their representatives about home health care and can have a huge impact.

Strength in numbers is particularly true in the legislative process, Clay says.

"You can't have one or two people trying to educate legislators alone," he says. "I haven't had my local reps to the showroom, and it actually isn't that important to me. What's important is that we have voices speaking on behalf of our industry when laws are written and voted on." That holds particularly true in an election year, he says.

"The challenge for our industry is that no matter who is elected, we have to continue to protect the quality of care that we provide," Clay says. "We have already experienced deep cuts into oxygen and other areas, and quality is going to be affected by the amounts of cuts we are suffering, and patient care is going to suffer.

"The newly elected president's personal stance on these issues doesn't matter. Let's face it, these are groomed politicians who have never had to personally deal with these issues. The industry has to educate legislators and maintain the ability to provide quality care through local representatives."