August 2006 • Vol. 2, No. 3
	Advancing Orthotic and Prosthetic Care Through Knowledge

Grassroots Activism Delivers Results

Worried about insurance parity?
Frustrated about lack of licensure in your state?
Concerned about competitive bidding?

If you figure that despite your vested interest in these and other issues that affect the O&P profession, resolving them is best left to lobbyists and other political "experts," you might want to reconsider. According to practitioners and consultants active in the political arena, individuals can make a significant impact—even with relatively limited time and resources.

"If legislators see it's a real person, a constituent, who's genuinely concerned, that's more effective than a bold statement coming from a national organization or corporation," says Paul Prusakowski, CPO, LPO, FAAOP, immediate past president of the American Academy of Orthotists and Prosthetists. "That gets the message across to policy makers that these issues affect real people."

Prusakowski strongly believes that the best way to influ­ence government policy is through grassroots activism by a large group of concerned people directly impacted by the policy change. And in a relatively small profession such as O&P, that means the active involvement of as many people as possible is especially critical. Academy Board Member Jim Rogers, CPO, FAAOP, observes, "Our resources in our small profession are limited. It's imperative to be involved when you have only 5,000 practitioners nationwide. Just a few people can't do it."

Many people find the idea of becoming politically active an intimidating prospect. Yet it's easier—and more gratifying —than you might expect, say those who have done it. Rogers says, "Most people feel they're not political and they're not comfortable contacting elected officials. But legislators are people, too. You'd be surprised how comfortable it feels once you take the first steps."

Peter D. Rosenstein, executive director of the American Academy of Orthotists and Prosthetists, observes that practitioners often are surprised at the responsiveness of their legislators. "Most people don't take the time to contact legislators so those who do are really welcomed, especially on the state level where districts are small," he says.

Legislators deal with an over­whelming number of issues and bills at any given time and clearly can't give equal priority to them all. Without a personal relationship with someone involved in the O&P profession, it's rare for legislators to put issues important to a relatively small group like O&P at the top of their agendas, according to attorney Peter W. Thomas, general counsel of the National Association for the Advancement of Orthotics and Prosthetics (NAAOP) and counsel to the newly formed Orthotic & Prosthetic Alliance. The Alliance brings together the Academy (AAOP), NAAOP, the American Orthotic & Prosthetic Association (AOPA), and the American Board for Certification in Orthotics and Prosthetics (ABC) in a unified approach to tackling key governmental issues on the federal and state levels.

"Any legislative initiative needs its champions," Thomas explains. "One of the critical ways to develop legislative champions is not to have lobbyists – rather, it's to personally visit as a constituent, or even better, have the legislators visit you and demonstrate your work so you can get them captivated. Then they will make trying to help you a key goal of theirs in public life. It's strictly a matter of personal commitment to building a relationship."

Building that personal relationship starts with an action as simple as calling or writing a letter to your state legislators as well as your US representatives and senators, and sending information about the O&P profession. Discuss your practice and invite them to visit, talk with your patients, and see for themselves how O&P makes a positive difference in people's lives. If possible, make a personal connection with O&P services, such as finding out if a legislator has had a relative or staff member who lost a limb. "We need to make sure the people in government understand that any investment in O&P is an investment in people and their future ability to participate fully in society," Rosenstein says.

You also can attend a fundraiser, assist with an election, or offer to serve on a health advisory committee – or to start one if it doesn't exist. Rosenstein encourages practitioners to ask legislators how they can help, whether it's by sharing knowledge or lending public support. "Too many times, people think the only way you can influence a legislator is with a check, and that's not so," he says.

Thomas observes that relationship-building is not a one-time event—it requires sustained effort over time. But the effort pays off when O&P legislative efforts need support. "Those relationships usually translate into legislators willing to pick up the phone or walk into an office and carry the O&P profession's message in the public policy debate. You'd be surprised how easy it is to get something done once you have a few believers," Thomas says. "For example, on any Medicare bill, it makes a huge difference to have legislators speak directly about O&P issues. But they'll only do it if they have the personal perspective of a real local contact."

Because grassroots activism is as much about educating as it is about influencing, ongoing communication and relationship-building also help legislators and their staffs understand the O&P profession and the issues that affect it. When legislation is introduced, legislators logically turn to the practitioners or patients they know for information and guidance.

"Legislators have to consider dozens of bills a day, and they can't be experts on everything," notes Morgan Sheets, the Amputee Coalition of America's (ACA) national campaign director for Action Plan for People with Limb Loss (APPLL). "People should feel empowered because chances are they know a lot more about their particular issue than the legislator. An informed and passionate constituent educates as much as influences." And because legislators often rely on their staff members for information, she also recommends building relationships with them.

In addition, Sheets emphasizes that legislators know they depend on the continued support of their constituents to stay in office. "Any information you share is incredibly influential because the legislators are there to represent your personal interests. They recognize the consequences if they don't support issues many of their constituents support," she says. She adds that legislators and their staffs view a letter from one person as representing the tip of an iceberg of additional people who feel the same way but haven't made the effort to contact them—so far. "You become the voice for people who haven't yet become advocates," she says.

As a result, when constituents talk, legislators listen. Prusakowski reasons, "Legislators know you won't take time from your busy day to call or write a letter if you aren't concerned and passionate about the issue." And Rosenstein believes constituents have a responsibility to communicate with their elected officials. "I'm a firm believer that the only way to get legislators to focus on issues important to constituents is when constituents tell them what they are," he says.

Outsource Marketing Solutions President Elizabeth Mansfield, a consultant for small and mid-size businesses and practices in the O&P profession, believes grassroots activism is more important now than ever before in light of current reimbursement challenges. The daughter of a retired CPO, himself an above-knee amputee, Mansfield has spent five years traveling around the country assisting practitioners, fabricators, and patient groups in pushing for parity in several states. "Professionals want to do the best they can for their patients, but they don't always do the best job educating the public and elected officials about insurance," she observes. Her experience has convinced her that passing legislation is not necessarily a logical, rational process. "It's about how much noise you can make and how outraged you can get. You have to believe in the core of your being that the squeaky wheel gets the grease, and you'd better squeak," Mansfield says. "Every single avenue you can think of to use, use it."

Mansfield and other experienced activists offer several pointers on making your voice heard most effectively. First, choose to get involved with an issue you feel passionate about —and learn as much as possible about it. The Academy and its state chapters can be a valuable resource for information and contacts, Prusakowski points out. He stresses the importance of creating an "elevator pitch"—a well-packaged short description of the issue, what changes need to be made, and what the impact of a positive or negative outcome will be on individual consumers in the disabled community. "The message must be presented succinctly and clearly so that someone who has no clue about it can understand and empathize, and make that issue their issue," he says.

Next, identify individuals and groups with whom to share the message—both legislators who can be influenced and act on it, and others who can leverage your efforts through their own. These include patients, disability support groups, veterans' advo­cacy groups, and allied health­care pro­fess­ionals such as local practitioners, physical therapists, and other rehabilitation professionals. "You need to do a scan of the community and determine potential allies—see who is affected by the potential legislation and make sure they're aware of it," Prusakowski says. "You build a network of advocates, and give them language and bullet point facts with which to work."

Patients potentially affected directly by legislation can be especially effective grassroots activists. Prusakowski suggests encouraging patients, especially retired ones who may have more time available, to get involved by explaining the issue and what they can do to help. Mansfield observes that parents of patients also make powerful advocates. "There's nothing more effective than an angry mom," she says. And Rogers points out that business owners should facilitate grassroots involvement of their employees, noting, "It has a multiplier effect and it empowers us."

The more supporters that can be mobilized for a cause, the better, because volume speaks loudly—especially when a key vote is coming up. Sheets recalls working in Montana to defeat a bill that would have limited O&P insurance coverage. The bill needed to be voted on twice to pass. The first time, it passed by five votes. Sheets and other advocates contacted Amputee Coalition of America members who then flooded the state representatives with phone calls, ultimately resulting in defeat of the bill. "Absolutely these grassroots efforts work," Sheets says.

Glen Case, MST, CPO, NYSAAOP president-elect, hopes to inspire as many of the approximately 700 practitioners in New York state as possible to provide grassroots support for the most recent effort to establish O&P licensure. He is developing a statewide network of O&P providers that can be utilized to communicate numerous messages to government officials on short notice. In addition, the chapter has held manufacturer seminars to enable practitioners to earn PCE credits while supporting and keeping abreast of licensing efforts. "We need both financial support and personal involvement with the process," Case explains. Although NYSAAOP has hired a lobbyist to assist with its efforts, Case recognizes the importance of individual practitioner involvement. "It will take a village to accomplish this, as they say. We need practitioners to educate legislators about our profession and why we should be licensed," he says.

When contacting legislators about a specific issue, the experts advise that the more personal you can make your message, the better. Signing your name to a template letter and sending it to your legislators is worthwhile, but adding your own personal message strengthens its impact. E-mail is easiest, but Sheets encourages more traditional forms of contact such as phone calls and letters. "It's helpful to have someone on the other end of a phone, or a letter they can hold in their hand," she says. If you choose to e-mail, Sheets suggests taking an extra minute to print out a hard copy and mail it for extra emphasis.

Writing letters to the editor of local newspapers provides another opportunity to raise awareness of legislative issues and encourage others to support a particular cause. To increase chances of publication, be sure to find out the newspaper's word limit, then state your case as succinctly as possible. Sheets advises including facts, a personal story, and an action people can take. If possible, try to reference an article previously in the paper, such as on a health topic or an amputee. "This tells the paper, ‘You're writing about this already—I'm just responding,'" Sheets says.

Like other commitments, grassroots activism requires time —a scarce resource for O&P practitioners. Yet a relatively small amount of effort from as many people as possible can go a long way toward accomplishing O&P legislative goals. "Academy members are people- and community-oriented," Rosenstein observes. "Activism just has to become one of the natural things they do, along with all their other tremendous accomplishments." Rogers agrees, noting, "Among individual practitioners, there's a sense that you should give back to the profession. We need everybody—people accomplish extraordinary things with minimal resources. Any step you take opens your eyes, helps the profession, and leads to other opportunities."