Originally published in American City Business Journals
By Daniel E. Greenleaf
Like most Americans, my knowledge of Washington is grounded in the civics classes of my youth and watching political pundits on cable TV news.
In the last year, however, I have spent a great deal of my time in Washington, enduring a political baptism by fire as I tried to reverse the unintended consequences of a law that imperiled my employees and the patients they care for.
My political adventures began in earnest in December 2016, when Congress passed the 21st Century Cures Act. Overall, it’s a good law that promotes medical research and efforts to cure cancer.
At my company, however, it was more like a bomb exploding than a cure. It imperiled employees in the home-infusion industry and could end the treatment they give to some very sick patients, including those awaiting heart transplants.
The law cut Medicare reimbursement by more than 95 percent for many infusion drugs. The law did have a new benefit to reimburse home-infusion providers, but not until 2021 — a bureaucratic oversight that had real implications. People have lost their jobs, and vulnerable patients have suffered.
As the CEO of a company that employs people to treat these patients, I suddenly needed a crash course in the workings of Washington. Our industry needed the law changed — fast — but I knew nothing about how to get that done.
With a lot of help from others in the industry, we managed to build bipartisan support for the Medicare Home Infusion Therapy Access Act of 2017 to restore home-infusion therapy payments for patients on Medicare, effective in 2019. The legislation was passed by Congress and signed by the president on Feb. 9, representing a huge win for the industry and our patients.
Having traveled this path, I’d like to share for the benefit of other executives seven lessons I learned during this incredible journey to get this legislation passed.
1. Get help
Anyone who watches the news knows how crazy Washington is and how many important issues are vying for political attention. Hiring a great lobbying firm that knows how the city works at a molecular level is essential.
There are great lobbying firms and many mediocre outfits. Hiring a superstar lobbying firm is worth every cent. Had my firm hired a lobbyist before the 21st Century Cures Act was enacted, perhaps we could have headed off our problem.
In politics, just like health care, an ounce of prevention is worth a pound of cure.
2. Build an internal team
Navigating D.C. is a monumental task that requires help from a diligent general counsel and a hard-working communications team. Beyond that, every firm has other resources upon which to draw.
Our chairman, R. Carter Pate, for example, leveraged his Washington knowledge to write an opinion piece published in D.C., and enlisted the help of congressmen to promote our cause. Similarly, another board member, Michael Bronfein, engaged with other members on our behalf.
Ask everyone at your company who they know in Washington and network those connections. Perhaps your office manager went to college with a key staffer at a crucial congressional committee. You’ll only find out if you ask.
3. Build an industry coalition
Changing a law in Washington demands competitors working together. To build political support, we collaborated with others in the home-infusion industry as well as the National Home Infusion Association. Companies cannot expect associations to do all the political work for them.
4. Build relationships
Before needing help, executives should establish personal connections with key players in D.C. and politicians in their home states so that when something unexpected happens, they know whom to call. That involves attending dinners and making one-on-one connections. When trouble hits, you want to have the mobile numbers of some of the people who can help.
5. Be bipartisan
Winning bipartisan support is helped by making your message as simple as possible and illustrating that story with the impact on real people. Alerting politicians to how a law hurts their constituents and having them write letters to lawmakers is also helpful.
Our legislation at the U.S. Senate won truly bipartisan backing, co-sponsored by Democrat Mark Warner (Virginia), who introduced the bill with Republican Johnny Isakson (Georgia), as well as more than a dozen other senators, almost equally split red and blue.
The same was true in the House, where our legislation was sponsored by Republican Pat Tiberi (Ohio) and Democrat Eliot Engel (New York) along with a bipartisan group of co-sponsors.
6. Show up
For the last year, our team has walked the halls of Congress at least once a month, meeting with lawmakers and explaining our story. We’ve also held lunches and dinners where those lawmakers have heard personal stories from employees whose jobs are at risk, as well as from patients. That human touch made a big difference.
7. Remember the little guys
Passing a law requires a tremendous effort from the legislative staff who chop the wood and carry the water. Staff that are engaged become ambassadors for your cause, spreading the word to others on your behalf.
Similarly, understanding how institutions such as the Congressional Budget Office and the Centers for Medicare & Medicaid Services work and connecting with staff at those places helps.
After a Herculean effort over the past year, we made it across the finish line. This experience has made me a believer that our lawmakers are not as divided as they are often portrayed and that they want to do the right thing. Sometimes you can see only when you get elbow-deep in the process. It is a story worth telling, with lessons worth sharing.
Daniel E. Greenleaf is president and chief executive officer of BioScrip Inc., a provider of infusion and home health care management solutions.