No one is quite sure when the word draconian came to be the semiofficial modifier of the word cuts, when used in conjunction with the noun DRA. Mark Newton recalls hearing it often during the campaign to convince federal lawmakers that their Medicare cost-saving bill was a disaster in the making for radiology.
“From the government’s perspective, the DRA was a success—the cuts saved 12.7% on Medicare expenditures, and yet patient access to imaging services did not suffer. You take that, along with Medicare’s growing need for more control over spending, and you have plenty of incentive for Congress to want to contemplate further cuts.”
Newton, CFO of a radiology group in Hudson Valley, New York, was a local leader in the effort to derail the DRA, and he worked hard at encouraging others to speak up, be heard, and make a difference. Ultimately, the forces favoring full implementation of the DRA prevailed over grassroots coalitions like Newton’s; his consisted of 40 other New York radiology practices and their thousands of patients, all opposed to the imaging-antagonistic mandates spawned in the nation’s capital.
Their efforts, however, were not in vain, for they proved instrumental in protecting imaging against additional proposed financial hits. The lesson: What Newton accomplished, anyone can.
When the DRA first surfaced in late 2005, the ACR and other groups urged their members to get involved in organized bids to block the DRA. Newton’s practice, a 20-radiologist group with two imaging centers (formerly known as Dutchess Radiology Associates, but using the oddly coincidental name DRA Imaging PC at that time), took that call to action to heart.
While Newton and his colleagues did all that the ACR asked of them, he could not help noticing the wide variation in participation among other practices in the region. “It seemed that one or two had become very active, while most of the others were apathetic—some a little, some a lot,” he recalls. “The reason they did little or nothing was that they assumed that their voices would not be heard, or that it would be pointless to try to change Congress’ mind.”
In the course of attending local ACR meetings at which the DRA was discussed, Newton eventually learned that fellow member Kirk Lawson, administrative director of radiology at NYU Langone Medical Center, New York, New York, was likewise alarmed by the spotty response of the region’s imaging community to so potentially serious a threat to practice viability. Newton and Lawson compared notes and realized that they might be able to take up some of the slack, were they to begin working together as a team.
“By combining efforts, we could have a bigger voice and maybe accomplish more,” Newton says. “It also seemed to me that our two practices, speaking out as one, would have more credibility. A way that DRA proponents tried to diminish us was by claiming that opposition to the measure came from just the isolated radiology practice here or there, and that we didn’t represent anybody’s interests other than our very own.”
Another advantage Newton and Lawson recognized in working together was, Newton says, “We would be able to develop more creative approaches to eliminating obstacles and communicating our positions. Good ideas tend to emerge easier and faster when you put at least two heads together.” Newton and Lawson didn’t need a mind meld to appreciate that the grassroots effort that for which they were sowing seed could be a very powerful form of advocacy.
“The reason that grassroots campaigns are so often effective is that they bring to your advocacy a combination of policy, constituent, and political activism,” Newton says. “This gives members of Congress something they very much want, which is feedback from their constituents so that they can know how best to please the voters back home. It also gives members of Congress opportunities to interact more directly and personally with those constituents,” the better to communicate reelection messages.
Waging a grassroots campaign can entail a few or many steps, depending on one’s level of commitment to the cause (and availability of time and resources). Newton and Lawson readily acknowledged their own limitations, especially inasmuch as they were political neophytes. Their main source of guidance, as rookies, was the book Our Iceberg Is Melting by Kotter et al.1 “It provided a great framework for understanding how to