Advocacy Shouldn't Happen in a Crisis

Lori Grassi, Executive and Legislative Director at the Washington State Chiropractic Association, and Tiffany Stevens, Executive Director of the Tennessee Chiropractic Association, are influential leaders in chiropractic advocacy. With decades of combined experience, they work to shape healthcare policy and promote the role of chiropractic care at both the state and national levels. Their leadership continues to strengthen professional standards and improve patient access across the country.

Episode Highlights:

2:42 – Introducing our guests.

• Tiffany - “I'm Tiffany Stevens. I'm the Executive director for Tennessee Chiropractic Association. I am also the in-house lobbyist for the Tennessee Chiropractic Association, and I have been in chiropractic a really long time. I've had the opportunity to serve in the trenches, operating from a sole propriety all the way to a multidisciplinary office with multiple doctors, staff and a great variety of different services. Business is kind of my background, but I do love healthcare and the representation of that, and I have a few other certifications that help with that. I also am co-author of the Chiropractic Therapy Assistance, which is a national program that we have for chiropractic therapy assistant. I do fully understand the critical role to staff in the office of a chiropractic office.”

• Lori - “I started lobbying in 1981 when I worked at the phone company and stayed in that for a while. I took a break and ran a massage clinic for a while but went back to lobbying because I was bored. I worked at the insurance commissioner's office for a while in Washington State before I went to the chiropractic association in 2001. I was the executive director and lobbyist for 15 of my 25 years but hired a CAE to take the executive director role to go back to just lobbying in 2017. My formal title is Executive of Legislation and Policy.”

4:53 - Most important piece of passed legislation.

• Lori - “There's a long list of various statutes that we've passed in Washington. The most important to me is fair pay, but people translate in that, in their mind, to a windfall of cash, which it is not. It is really more about making sure other professions don't get 100% more payment than a chiropractor for the same service. It took two stages to pass it because the CPT codes for spinal manipulation are different for chiropractors than they are for anybody else, and, in Washington, we have other professions that do perform spinal manipulation. It was a 10-to-12-year project, but it is on the books. Actually, just this year, Nevada’s governor just signed new legislation that goes a different direction, but it still is living in that fair pay category.”

• Tiffany – “Bringing it back to Tennessee, as lobbyists, we want to continue to be better. How do we improve upon what we've already done? Because lobbying is really a marathon. It's strategic approaches to get you a little bit more forward, chipping away at the mountain. I would say there's some small legislation I'm pretty proud of because of the pathway that it took to get us the big wins. For the profession as a whole, my favorite piece of legislation and what I feel is a win was our scope of practice. The healthcare and the profession as a whole have moved forward. It's moved forward so quickly that some of our state government language hasn't kept up. The profession and schools - everyone was doing more than really what some of the black and white was making permissive. Even though it wasn't in the black and white, it was being done as a whole, but we wanted to make sure that that was very clear and what was already being done was codified into law. I would say our scope of practice probably was my personal favorite piece of legislation.”

6:57 – Chiropractic Future Strategic Plan + how to get involved! “To start with Chiropractic Future, you should go on the website to ChiropracticFuture.org because it has a lot about the real true history and how that evolved. To make it a little briefer and more understandable to the entire profession, it is the opportunity for all voices to come together in a way that is strategic and forward thinking, regardless of our independent thought. As a community of chiropractic, we have a lot of different thoughts and a lot of different represented organizations, so there's a lot of different ways to go about it strategically. How do we do it for the profession? When we were researching this, I don't know that there's any other profession that's actually done this. When we were looking for the right people to help us to facilitate this strategic plan, it was just a lot of, ‘I've never done anything like that before, I have no idea.’ As a profession, we do this for companies and organizations, so I really think we were unique in thinking outside of the box to do what is best for the profession. Chiropractic Future is asking the hard questions and having the hard discussions but doing it all with the purposeful thought of a positive outcome that will move the profession forward. If you think about it strategically in a way that everything has to be about figuring out the solution or the compromise or the way forward or how do we agree to disagree, that's what Chiropractic Future is. It's all about the profession. It deals with advocacy, reimbursement issues, and the bigger pictures of research and data that you know so well. It's really been an honor to serve in that role in any role. It's interesting because there are so many different unique voices at the table that you learn something on. For us as lobbyists and advocates for the profession, it just makes you better.”

22:35 - The next big thing for chiropractic in Tennessee and Washington state.

• Tiffany – “For Tennessee, our focus is on fair reimbursement. This has been an initiative we've been working on for quite some time. There are some unique models that we experience here in Tennessee that not everyone does in the country, so we're really trying to put a light on that and address that in a way that that doesn't happen in any other states. We're hoping that the steps we make forward here we can share with others and prevent that from happening. Really, it's addressing the frustration in reimbursement and how it gets creatively decided differently every day and not founded upon something that is really the experience of what we're having in our offices, and that is the success of patient care. I mean, if that were all that it took to be treated fairly at the reimbursement system, this would be a non-discussion. But unfortunately, it's not that and that has been frustrating for us here in Tennessee and our doctors deserve that. At the very least, we're going to keep focused on that. Hopefully we'll have some, some news forward. We do have legislation that has passed the house, but not the Senate. We have made some traction on it this year. It's very clear that they're beginning to see that providers are not being treated fairly in that reimbursement.”

• Lori – “I think Tiffany hit on it. Reimbursement is the critical component in all clinic offices. The state of Washington started with a cost-of-living adjustment and provider fee schedules bill and grew a coalition of 20 different health professions. Then, when we saw that the legislature was not going to move that, we shifted to requiring the carriers do exactly what they say they're doing: negotiate a contract with all providers, but they only do that with hospitals and hospital systems. Like Tennessee, we got out of the house with a big bipartisan majority, 73-23, got to the Senate and hit a wall. We'll be back with our coalition to start that up again, but I think it really depends on state to state on the foundation that's been laid by their predecessors. How much of the foundation has been laid for you to build the bigger pieces of legislation around like fair pay, no referrals required, reimbursement fairness, things that really depend on the engagement of the provider? Are the chiropractors showing up regularly and making new relationships with legislators that get newly elected? Are they giving just a little bit of money to a campaign where it matters? Sometimes just a hundred dollars makes a difference. It's kind of like getting back to the foundation of re-engaging the chiropractors in their future.”

31:54 - Two simple steps to get involved! “Well, the first thing they should do is call their state association. If they're not a member, then they should become one and get involved with their state association. The second thing, I would say, is to just meet your legislator. It’s that easy, especially if you're doing it from the district where you live and vote - not necessarily where your clinic is. You're the constituent. Grab two other chiropractors in your area, call your lobbyist, and have them help you set up an appointment.”

36:23 – It’s happening in your neighborhoods now. “Advocacy is not something that should happen in a crisis. It's also not in your capital, whether it state capital or Washington. It's happening in your neighborhoods and it's a daily investment for doctors to have in their profession. Those relationships are critical in helping be able to establish an open conversation because really legislators have to have so much vast knowledge into the district that they represent. They cannot be an expert in all of the areas that are going to come in front of them. They're looking for experts in those discussion points, so they're wanting to have that relationship with you.”

37:04 – Educate your legislators on chiropractic, even if they’re on the wrong committee! “You have to keep in mind if your legislator is on the right committee or is their focus on education or law and justice or something like that? That conversation's going to be different, and that tour does have to happen because then you're slowly feeding them about what you do and then letting them know that you all don't get paid very well. Don't make things up or embellish because it's enough for them to understand the real part of what chiropractors do. Just explain it and let them ask questions. Always say, ‘let me get back to you’ on things you don’t know right away and have your lobbyist follow up, because then you encourage that legislator, who's not on healthcare, to go to their healthcare counterparts and say, hey, I had this tour in a chiropractic clinic - did you hear about this bill?’ Then there's inter-legislator communication that starts to happen and that's where the mobilization shifts into their role.”

Episode Resources:

Tennessee’s Website 

Tiffany’s Email

Washington’s Website 

Lori’s Email 

Chiropractic Future Strategic Plan's Website