Bill Klaproth (Host): This is an AAOMS On The Go podcast. I'm Bill Klaproth, and I'm pleased to welcome with me today two of the lobbyists advocating on behalf of OMSs in the state houses as we talk about navigating the state capitals as these two OMS lobbyists share their stories with us. We have Josh Carpenter, Government Affairs Director with the Iowa Dental Association. Josh, welcome.

Josh Carpenter: Thank you for having me, Bill.

Host: You bet. And we also have Edie Busam, Principal and Political Affairs Consultant with Aponte & Busam who represents the Colorado Society of Oral and Maxillofacial Surgeons. Edie, welcome.

Edie Busam: Hey, it's great to be here. Thank you.

Host: You bet. Well, thank you so much for your time today. We appreciate it. And this is going to be a very interesting topic. So, Edie, let me start with you. How long have you been advocating for OMSs, and what would you say is your primary role?

Edie Busam: So, this will be our third legislative session. We started out two years ago. They brought us in to look at policy issues impacting their practices. And my primary role is actually to educate them about what happens in policy world here in Colorado, but also to educate the General Assembly about who oral and maxillofacial surgeons are and what role they play in the healthcare delivery system. And so, that's been so far so good. We're doing lots of great things.

Host: Well, we appreciate your service, and thank you for that. And Josh, how about you? How long have you been advocating for OMSs, and what would you say is your primary role?

Josh Carpenter: I started with the Iowa Dental Association back in August of 2020. So, I think from that day moving forward obviously, the OMS are an integral part of state dental associations. And for me, my primary role has been really helping develop legislation that, while would impact all dentists in the state of Iowa, we do pay special attention to the OMS and how they're impacted through the different bills that we take a look at every time during the legislative session.

Host: Got it. Well, thank you for your service as well. So, I'd like to ask each of the questions to both of you and get your perspectives from your individual state, Josh, you from Iowa, Edie, you from Colorado. So, Edie, let me start with you. From your perspective, how does the sausage get made? Or in other words, how do we go from an idea to a new law? What's that process in Colorado?

Edie Busam: Well, I think the good thing here in Colorado is the process is really accessible to citizens. If there is an idea that they have, we do have a citizen legislature that only, fortunately, meets 120 days out of the year. We are not a full time legislative body like other states where legislators are in the building all of the time. So, that is how Colorado runs. I think having the citizen legislators, allows people in the community to contact them. They do not have staff. They mingle with their constituents very easily. So, if one of our oral surgeons has something on their mind, they can easily call a legislator directly and not always have to go through a staff member. So, that makes the process easy.

Once a bill and our idea is drafted and we're moving forward, I think that the process is very similar to other states. It's heard in a committee, then it goes to one house or the other and passes, and then it goes to the other, and then it obviously heads to the governor for approval. So, that process is similar. But I think accessibility here in Colorado is much easier, and I think that's a good thing for our constituency, for the oral surgeons.

Host: Absolutely. Well, you mentioned the relationships and accessibility, so that's why we're always advocating for OMSs to get to know your state legislator because that relationship could become very important. So Josh, let me ask you, in Iowa, how do we go from an idea to a new law?

Josh Carpenter: Well, Bill, I think Iowa is very similar, sounds like, to Colorado in the fact that our legislature meets part time of the year. We do not have full time legislators up at the Capitol. And they have very limited staffing as well. So when we bring ideas to them, often times we're meeting directly with the legislators themselves and working with them to develop legislation that's going to work best here in the state of Iowa. So, a lot of the times, the legislators themselves become experts on the bills that we're working with them on. And it's very critical, I think, for a lot of our dentists and OMS across our different states to get involved in these processes, because they're going to be turning to you guys as experts in order to do so. So, a lot of the advocacy work we do from going from an idea to a new law really hinges on the experts, being you guys getting involved in that process.

Host: Yeah, that's a great message. Get involved. And Josh, being from Iowa, would it be okay if I said to you, "Go Hawks"?

Josh Carpenter: Yes. I am originally from outside of the state of Iowa, but I think I've adopted the Hawkeyes as my in-state team.

Host: Okay. Well, my wife is from Iowa. And as you keep talking about Iowa, I just keep wanting to say, "Go Hawks." So, thank you for that. But yeah, the overall message from both of you, relationships, accessibility, get involved, all of those messages are really important for an OMS. So, thank you for sharing that. We appreciate it. So, Edie, let me turn back to you. Can you share with us what has been your biggest challenge, faced on behalf of oral and maxillofacial surgery and what was the result?

Edie Busam: My biggest challenge so far has not come yet. I think that there are a lot of issues impacting the oral surgeons here in Colorado. And we haven't had a major battle just on the part of surgeon community. I think dental community or the Colorado Dental Association and dentists here are fighting some additional battles that we weigh in on for sure. But I think our battles are still yet to come.

Host: And it's good to know that you're prepared for those bigger battles when they do arise. So, thank you for that, Edie. And Josh, how about you? Have you faced a challenge on behalf of oral and maxillofacial surgeons yet? And can you share with us what was the result?

Josh Carpenter: Yep. So, we've been lucky in Iowa. We haven't had a lot of the bigger issues that I know some of our other states have had as it relates to anesthesia and whatnot. But the biggest issue I think we've faced here in Iowa has been trying to increase Medicaid rates. And I think taking a look at it through the OMS lens, we currently, as far as we're aware, don't have any OMS in the state of Iowa that accept Medicaid in their offices because the rates have been so low in the state. And so, one of the big things that we've been really fighting for has been getting an increase so we can increase access, not just for dentists across the state, but also getting our OMSs back involved in the program here in Iowa.

Host: Fighting for increased rates, Well, Josh, thank you for sharing that with us. Medicaid reimbursement certainly is an issue then. Edie, let me ask you this then. What do you see as the biggest threat to the specialty?

Edie Busam: In addition to what Josh said, I think the biggest threat to the specialty is Medicaid reimbursement, but it's also working with health plans in general. I think there is a lot of administrative burden and difficulty for small practices, especially here in Colorado to have to hire staff, additional staff, and negotiate all the things around prior authorizations, et cetera, that patients need. And so, I think that that is very, very difficult and a big threat to them.

Host: Well, that makes sense. Worrying about those health plans, having to hire additional staff because of that. That certainly is a threat. And Josh, how about you? Biggest threat that you see to the specialty?

Josh Carpenter: I think from my perspective, one of the biggest issues OMSs are going to be facing are changes to the scope of practice, so changes in the way that you might operate within your own office. I know one of the biggest ones right now, kind of as I mentioned earlier, is the anesthesia battles that may or may not be coming down for different states, and ensuring that you can continue to practice in a way that you see best serves your patients and best ensures their safety. So, making sure that we allow for you to use your expertise to the best of your ability and continue to deliver the best services possible to the patients that come through your doors.

Host: Well, anesthesia always is one of the hot points when it comes to the specialty. So, thank you for sharing that, the anesthesia battles. And you also said the scope of practice. So when we talk about state advocacy, Edie, let me ask you this. What do you wish more OMSs knew about that?

Edie Busam: It's an interesting question, because I think they need to know that they can make a difference. I think that they probably think about, "Oh, I have this great idea" or "I need to contact my legislator," and one for them, they're just so busy. They're just busy all of the time. But I think they need to understand that contacting their legislator and getting involved and even thinking about running for office if they would like to do so is really necessary to promote what they do and never think that what they say doesn't make a difference.

Host: Yeah, that's a great point, Edie. I'm so glad you said that. They need to know that they can make a difference. So, they need to know that, that their efforts will be rewarded. So as you said earlier, Edie, those relationships are important, and know that if you cultivate a relationship, it can make a difference. So great point, Edie. Thank you for pointing that out. We appreciate it. And Josh, how about you? What do you wish more OMSs knew about state advocacy?

Josh Carpenter: I kind of want to build on what Edie just said there. You guys are the experts. You guys as oral surgeons are the experts on oral surgery and legislators recognize that. I think we as lobbyists, we as advocates at our respective state capitals, we only know so much and I think legislators are very cognizant of that. However, when you have a conversation as an oral surgeon with your state legislator, they are fully aware that you are the ones that are experts on the subjects that you're talking to them about and are very respectful of that fact. So when you go and give them information that they might not otherwise have, they really do kind of take that to heart and are very willing to use that when they go back to the Capitol when they're drafting legislation and kind of making and passing laws. So, I think one of the biggest things that you can be is an expert for your own profession.

Host: Another great point, Josh. Thank you for that. The OMS is the expert, so having that conversation with the state legislator certainly carries a lot of weight, it sounds like what you're saying, and hearing from the OMS directly really is important. And then, if I could ask you, Edie, what is the single most important piece of advice you would give to OMSs based on your experience?

Edie Busam: I would say know their personal legislator. So, they live in a district, they are a constituent to a legislator, they need to develop a relationship early on, they need to pick up the phone and call their personal legislator, their House member, their Senate member, at the state level. Yes, they can develop the relationship with a congressional person maybe. But primarily, a lot of policy is done at the state level and not that we're always looking at what's happening at the national level.

And more than that, I think getting involved in those campaigns, feel free to host a fundraiser for a candidate that you like because if they get involved at that level, anytime they pick up the phone and call, that legislator will be responsive. And they want to hear, as Josh said, much more from their constituent who happens to be an oral surgeon than they want to hear from a lobbyist or a policymaker like we are.

Host: So, yeah, get to know your personal legislator, house member or Senate member at the state level, whatever that might be, and get involved. So, great thought, Edie. And Josh, how about you? What's the single most important piece of advice you would give to OMSs based on your experience?

Josh Carpenter: Well, I think Edie kind of hit that one out of the park there. I think getting involved is still the most important thing you can do, but kind of building off of that. Staying informed, know what issues are in your state and kind of where advocacy might be going for you and your profession. It's important to talk with your legislator. But if you're not aware of what the issues are and kind of how to talk about them, some of your advocacy might fall flat. So, making sure that you're as up to speed on the issues impacting you and your profession as possible, I think, would be the biggest benefit when you're having those conversations.

Host: Yep. Again, another great point. Stay informed, know the issues facing the specialty, and if there are any specific issues in the state that the specialty is facing, certainly be up on those issues. I want to thank you both for a great discussion today. One last question to each of you before we wrap up. Edie, let me start with you. Is there anything else you want to add to our conversation today.

Edie Busam: I think also is for the OMSs to join their membership organizations, and I think that that's actually what Josh was reinforcing. The way for them to know what's going on is by joining their membership organizations at the state and national level. And I think it's crucial for their involvement at that level, too.

Host: Yeah, that's a great point. Join your member organization. And Josh, as we wrap up, any final thoughts from you on navigating state capitals?

Josh Carpenter: I think the final thing I'll kind of leave us with here is we can't do this advocacy without you guys. You are still the single most important tool that we have available to us to where we can be effective advocates. So, getting involved, staying informed, it might sound somewhat cliche, but it is the most important thing that OMS and dentists across the country can do.

Host: Excellent point. Very well said, Josh. Thank you so much for wrapping that up for us. And Josh, thank you so much for your time today. We appreciate it.

Josh Carpenter: Absolutely. Thank you for having me.

Host: You bet. And Edie as well, thank you so much for your time and your thoughts today.

Edie Busam: Thank you so much.

Host: And once again, that's Josh Carpenter and Edie Busam. And to learn more about AAOMS's state advocacy efforts. And to get involved, please visit aaoms.org/advocacy or reach out to your state OMS society. And if you enjoyed this podcast, please share it on your social media and make sure you subscribe so you don't miss an episode. Thanks for listening.