Transcription:
Legislation Matters

Trisha Williams: Hi, guys. Welcome to the third season of the Advanced Practice Perspectives podcast. I'm Trisha Williams.

Tobie O’Brien: And I'm Tobie O'Brien. This is a podcast created by advanced practice providers for advanced practice providers. Our goal is to provide you with education and inspiration. We will be chatting with pediatric experts on timely key topics and giving you an inside look at the various advanced practice roles at Children's Mercy.

Trisha Williams: Today, we are excited to host Connor Stangler. This is kind of a step outside of our norm again. Connor is the Manager of Government Relations here at Children's Mercy Hospital. And we are here today to talk about all things government. So welcome, Connor.

Connor Stangler, MA: Thank you. Glad to be.

Trisha Williams: Why don't you tell our listeners a little bit about yourself.

Connor Stangler, MA: Sure. I started as the manager of government relations just about six months ago here at Children's Mercy. And prior to that, I worked for the Kansas legislature in their nonpartisan research office. So, I was tasked with researching bills and helping the legislators arrive at their ideal form of their own legislative ideas and providing background research. And prior to that, I was working on my PhD in American history, and now I'm here at the hospital.

Tobie O’Brien: Well, we're so glad that you could join us today. I'm really hoping that you can give us or remind me at least a general overview of how state legislation works. You mentioned bills, so I'd love to hear a little bit more about that as well as really what your role is at the hospital.

Connor Stangler, MA: Absolutely. Each state does it a little bit differently. The hospital straddles a state border, so we have to work with both Kansas and Missouri and we have facilities in both states. So, we pay pretty close attention to both states and work with legislators in both Topeka and Jefferson City. But generally, the very brief overview is that a legislator has an idea to change the rules of the state. That's usually how I describe a bill. And they want to change the rules to better fit their vision for society.

So, it could be about APRNs, it could be about the state fair, it could be about alcohol regulation. States deal with a lot of policy. And then, they introduce that bill, they introduce that language into whatever chamber they're sitting in, so either the House or the Senate. And then, a bill has to go through both chambers. So, it has to go through a committee hearing, a public committee hearing, and then receive a vote from the full chamber of both the House and the Senate.

If there are any differences between the bills when they emerge from their respective chambers, so if the house does something that the Senate didn't, for example, they amended the bill, then they have to meet together in what's called a conference committee at the very end and talk about the differences. And then if they can all agree to those differences, then the bill is sent to the governor and the governor can choose to sign it or not. And sometimes there's a veto override if the governor vetoes the bill. But it's a very long process.

That is the very quick and dirty version of it. But there's a lot that goes on and it's a long road, but we're in it for the long run. And my department specifically, we work with legislators on both sides of the state line to advocate for the hospital and explain what issues matter most of the hospital. And then if there's a bill that would affect us, work with legislators to make sure that that language fits our own goals for Children's Mercy.

Trisha Williams: You make it sound so easy in regards to how a bill becomes a law. But I do know that there's a lot of work going into it, and I think from an advanced practice perspective, no pun intended with our podcast name, but it's difficult for us to kind of get through the smoke of it all in regards to what's important for us as advanced practice to know about what laws or what things are going to committee on the Kansas side and the Missouri side. I've been pretty active in the Missouri side, but I live in Kansas. And so, can you kind of shed some light on what are some important topics that are going to committee at this point that we need to kind of be aware of from an APRN and a physician assistant side?

Connor Stangler, MA: There's a lot of interesting stuff going on, especially in Missouri right now. That's probably where most advanced practice providers are focused right now because Missouri is one of those states that does not have full practice authority for APRNs. I mean, they've been talking about this issue on the Missouri side for decades now. And these bills will be introduced every session, and there will be a lot of deliberation, a lot of discussion. Usually, it comes down to two sides that see the issue differently. There's usually the physician side, the medical societies in either state and then, the nurses association, the APRNs representing their own side. This year, there are a couple bills on the Missouri side that have advanced a little bit. So, House Bill 271 would grant that full practice authority and then, Senate Bill 79. So, there's a house bill and there's a Senate bill, and I'm just naming two of the many on the Missouri side.

Trisha Williams: Right. There are many.

Connor Stangler, MA: Yes. And there are some that deal with only APRNs working in correctional facilities and then CRNAs and a whole host of other categories within this topic. But Senate Bill 79 and House Bill 271, if people were looking to really zero in on two bills, I would keep my eye on those. We've heard that there might be some action coming up here soon. But it could also very well be a replay of past years where there's a lot of discussion and they punt this to next session.

On the Kansas side, they did get this done last session. So, House Bill 2279 was passed, which did give full practice authority last session. But that was pretty controversial just because of the way it passed, not necessarily the content of the bill. It was the usual discussion between the physicians and the APRNs, but there was some deliberation even in the rules and regulations stage after the bill passed where they were negotiating over some of the language for what that would look like in practice. And those rules and regulations finally got published. So, it is official in Kansas, but it's the kind of thing where the legislative process is confusing and muddled and nobody really knows what's going on. And then even after it's "resolved," there are still many things left to do. So, Kansas is in a bit of a holding pattern right now because they did pass that bill. So, I imagine they won't be working on anything for a while related to this issue. But Missouri is the one to keep your eye on.

Trisha Williams: Connor, are there any bills or discussion on things that directly impact child's health overall, like mandatory COVID vaccines or any other type of health topics that we should be aware of?

Connor Stangler, MA: Yes, many. The legislatures in both states, especially since COVID-19 and 2020, there has been a renewed focus on, vaccine requirements, especially as you said what's the best way to figure out who's making decisions about children's health, the dividing lines between the medical profession and families and patients, for example. There's a lot of that discussion. Obviously at Children's Mercy Hospital, we are concerned about any bill that might limit vaccine requirements in the state. So, for example, there are numerous bills in both Missouri and Kansas that would make it easier for someone to be granted an exemption to a vaccine requirement or completely roll back vaccine requirements, even ones that were established prior to COVID-19, so some of those usual daycare and school requirements that we've been used to for decades now. There are certain factions within the legislature who would like to roll those back.

But beyond that, there is always a bill relating to Medicaid and making it easier, for example, for kids to stay enrolled continuously in Medicaid. There are even some bills that would expand continuous enrollment and eligibility to something like six or plus years for a child on Medicaid, so they wouldn't have to be redetermined for their eligibility again and again. So really, every session, there's something that affects us when it comes to children's health, but that also leaves a whole host of bills relating to finances and hospital administration and hiring practices and workforce that really affect us. So, any day here in government relations, we're talking to 10 or more different departments of the hospital about bills that concern them or bills that might be interesting. We just heard about a bill that would prohibit the sale of novelty lighters in the state, which is a big issue for our burn clinic folks. And I had no idea what a novelty lighter was before yesterday, but now I know a lot more about the issue, because it's something that is near and dear to our hearts and our burn victims. So, yeah, it's an endless pursuit of improving children's health in both states.

Tobie O’Brien: Wow, you stay really busy, it sounds like.

Connor Stangler, MA: Yeah, it's busy. I don't think I'm any busier and I'm probably far less busy than our actual providers and our clinicians. I'm always a tad embarrassed when I talk about working at Children's Mercy to people outside the hospital because they think I do things that deserve acknowledgement and recognition, but it's mostly just working with politicians and other lobbyists and things like that. But it is, especially during this time of year, working with both states when they're in session debating bills, we can have some late nights.

Tobie O’Brien: Well, we really appreciate having something like that. That was actually going to be my next question is, I'm wondering if you could kind of help us to understand what would be our fastest way to understand any issues besides just coming to you that involve APRNs or specific health policy possible changes. Do you have any recommendations for providers if they have interest in that on an easy access way?

Connor Stangler, MA: Yeah. There are a couple different sources and this is probably familiar to most advanced practice providers. I would say your main advocacy associations, so whatever professional organizations you're a member of, whether that's NAPNAP or the State Nurses Association. They usually have a full-time lobbyist or they are contracting with a lobbyist in the state capitals and even on the federal level sometimes.

I know they have conferences out in DC and we do federal work as well. They are usually fantastic resources for the very specific issues relevant to APRNs and others because they're on the ground talking about those issues all day long. We in government relations, since we are the lobbyists for the hospital as a whole, there's several issues like we discussed sort of pulling us in different directions.

But if we have an APRN at Children's Mercy, for example, who is on the Missouri side and wondering what's the latest status of HB 271 or SB 79, is this something that could get passed this year? I would really tap into your professional associations because they have the best access to information when it comes to those bills. I mean, there are some times that we hear something, but usually it's along with 10 or 12 other items that we're keeping an eye on.

Beyond that, if you're just a concerned citizen and you want to know, you know, not only am I a professional here in healthcare, but I also have kids of my own and I'm worried about that as well, the websites of the legislatures themselves they can be helpful And they publish policy reports sometimes and things like that. So, I would go professional association first and then self-navigation of those websites and, of course, government relations. We're happy to answer any question about any policy.

Trisha Williams: I do also think that through Children's Mercy anyway, our podcast does go international. But at Children's Mercy in Kansas City, we do have, I think, on our internal website, on our advanced practice page, some links to some government relation-type topics, somewhere to find information. And so, look at that and if you guys have any questions, I think you can reach out to our director of advanced practice.

So, Connor, I wasn't aware about, you said, the novelty lighters. And I think some of us get very focused on full practice authority since that's kind of at the forefront right now. But it's very interesting to hear that you guys have a finger on the pulse of even those little things that myself would think, "Oh, that's not going to have a big impact on pediatric patient outcomes." But something like that could have a huge impact on pediatric outcomes. So, I think, you know, when you said that, "Oh, I don't work as hard," your work is very important because you're keeping us all abreast about what is and what could potentially happen. So if you have the ability to make an impact and help to navigate these laws to become a reality or these bills to become a reality, the impact that could happen within our state for our patients is huge. So, don't underestimate your work there, sir.

Connor Stangler, MA: I appreciate the kind words. I still think my work pales in comparison to what happens in the hospital on a daily basis, but I think you're right that so much goes on at the hospital. I just started six months ago, and I'm still and will still continue to hear about the amazing things every department does and every provider. And even those who are nonclinical staff and the amazing things they do. Our payer relations department, who we work with a lot to make sure that Medicaid, for example, is providing supportive reimbursement for our providers and things like that. But even we hear about bills and legislation that come up because of a conversation a legislator had with a provider. And I think that's what providers and clinical staff underestimate sometimes is the power of their own work and the stories they tell about their own work to legislators and politicians.

Our lawmakers really love to hear not from the lobbyists, not from government relations, we talk to them regularly about the technical details of governance, but they want to hear from our doctors and they want to hear the stories of what's challenging and what's innovative and what's exciting on the frontiers of healthcare. That novelty lighter bill, for example, came out of a conversation that a legislator had with someone in our burn unit. And it just happened to be a random occurrence and they mentioned the threat of novelty lighters. And this sparked an idea within the legislator's head, and they took that and led the campaign on that bill. And we hear about these things all the time where, "Oh, yes, you know, I met a nurse or a doctor at your hospital and it really inspired me to look more into this issue." And so, I introduced legislation to that end. Those things are the kinds of conversations, the kind of activity that actually get things done. It's really encouraging to hear that our providers, of course, they are saving lives and providing good healthcare, but they're the ones who are changing the laws of our country and our state as well. It's really encouraging to work here.

Trisha Williams: It's the power of communication, right? You know, I have been told that they want to hear testimony of our experiences and the ways that we impact patient outcomes and access to care. And those testimonies are very important. So, how do we do it in an appropriate way that follows Children's Mercy's guidelines and respects the rules and regulations that our institution has in place.

Connor Stangler, MA: Absolutely. That's probably the most common question we get in government relations from various departments, is how do I get involved and how do I do it the right way? We do have to abide by lots of actual laws and guidelines, both on the federal and state level when it comes to lobbying or any sort of political activity, advocating for a specific bill, for example, or how to make changes to that bill. If you are a provider who works at Children's Mercy, because we are a nonprofit hospital, you are heavily regulated when it comes to what you can do and say to a legislator in your capacity as an employee of Children's Mercy.

However, a lot of our providers do excellent work through those advocacy and professional organizations like NAPNAP, where they can attend Advocacy Day at the Capitol and they can have a conversation as an APRN, as a nurse, as a healthcare provider, without any sort of connection to the institution itself and say, "As a provider, I've seen this over years. And my concern about whatever issue, vaccine requirements, or full practice authority, this is something I'm concerned about. I would love to have a conversation with you, Senator X, about this issue." And that's fine, and we do encourage that. And I'm happy to meet with providers and talk about the best ways to testify in front of a committee, or things that we need to look out for, if we're having conversations on the side about other issues, for example. But I would say if you would like to get involved in advocacy as an employee of Children's Mercy, then come talk to us first, ask us questions. We often will call upon providers to provide testimony, to give us expert information and evidence on a topic that we admittedly know nothing about. And so, we can find ways to get you involved. But if you're looking for a way to get involved that is more in the weeds and more active when it comes to an issue you care about, I think those advocacy organizations are the place to start for those sorts of activities.

Trisha Williams: That's great information. I didn't know that we were allowed to work on behalf of Children's Mercy on certain topics, and working in conjunction with you in government relations. But I think it's also important to really know that we, as a human and as a professional, have a right to advocate for things that we feel strongly about. We just have to do it as an advanced practice provider and not be specifically affiliated with our institution. And so for people probably outside of Children's Mercy, they would need to find out exactly what their rules and regulations are within their institution and how they can safely advocate to get their testimony and to fight for what they believe in.

Connor Stangler, MA: Absolutely. And if anybody has questions, if they work at Children's Mercy, of course government relations is happy to help, but each hospital has some version of our department where they can answer questions about what's the best way to get involved, just so we're not running a foul of any IRS or state or other federal guidelines that say, "Here's how you can be involved in legislative process and here's what you should avoid."

Tobie O’Brien: I love it. I think it's great information. I think sometimes we don't get to spend enough time thinking about advocacy. We hear about it, but we just get so busy and it's really important to take time to reflect on this whole process. So, we appreciate you coming on and talking about it.

Connor Stangler, MA: Yeah. Thank you for inviting me. I love talking about advocacy. I love talking about Children's Mercy. And this has been a wonderful conversation, so thank you.

Tobie O’Brien: In each podcast, we ask our guests the same question. So this season, we will ask you this question, it is: in what way do you love to encourage your colleagues?

Connor Stangler, MA: Well, in government relations, we can get pretty nervous and anxious about the future of laws in our state and our country and our locality. And I think something we do as a department and we're a pretty small department. There are four of us total in government relations. We just have to be really mindful of reminding each other about how long the process of government and law-making takes. And so, we have to think about, "Okay, if this bill has come up many times before, and even if we make a mistake right now or even if we feel like we lost the battle on this one, there's going to be another chance coming down the road." So, we have to take the really long-term view on things.

And then related to that, we also have to remind ourself that we are doing this so that providers can do their job and that the hospital has the resources to do its job for kids in the area. And that's the sort of grounding that I think helps us day to day, is reminding ourselves why we do this in the first place. And even when we're in speaking in Jeff City and it's hard to see the forest for the trees, you know, hearing the stories, the inspiring stories about what our providers do is the kind of thing that we can commiserate over within our department and use as fuel and motivation to get back out there and have those hopefully productive conversations.

Trisha Williams: Connor, it was a true honor to spend today with you. Your advice to your colleagues, I had to take a pause because it was really great. I really think legislations like research. For the providers out there that do research, remember research is a marathon, not a sprint. And I think that that's what legislation is as well, maybe two or three marathons tied back to back maybe. But it's fantastic to have you today on our podcast. We thank you.

Connor Stangler, MA: Thank you again. I love the conversation and I really appreciate you inviting me on.

Trisha Williams: You bet. If you have a topic that you would like to hear about or you are interested in being a guest, you can email us at tdobrien@cmh.edu or twilliams@cmh.edu. Once again, thanks so much for listening to the Advanced Practice Perspectives Podcast.