(From left to right) Amy Cho, MD, of the American College of Emergency Physicians (ACEP); James Ficke, MD, FAAOS, of AAOS; Purvi Parikh, MD, of the Medical State Society of New York and Allergy and Asthma Network; Carolyn McClain, MD, of ACEP; and Daniel E. Choi, MD, met with members of the House of Representatives in Washington, D.C., to discuss surprise billing legislation.
Courtesy of Daniel E. Choi, MD

AAOS Now

Published 11/1/2019
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Daniel E. Choi, MD

Instagram Chat Group Drives Surprise Billing Awareness with Viral Video

No-budget initiative records 100,000 views and inspires 8,000 emails to Congress.

The more I learned about legislation to address surprise billing, the larger the pit in my stomach grew. The name itself was a misnomer. By using “surprise billing legislation” as a cover, insurance companies were trying to further marginalize physicians’ ability to negotiate fair payment for their services. The initially proposed bills promised further damage to the economic viability of private practices (and patient access to their preferred physicians).

I read everything I could get my hands on: every blog post, every AAOS advocacy email. In July, it looked bleak. It sounded like the bills about to pass the Senate and House of Representatives were written by the insurance lobby itself—and it was going to win.

I was fuming but determined to see where I could possibly pitch in on this fight. I felt that many of my physician colleagues didn’t even know what was at stake. Many physicians I knew, and maybe some of you reading this, did not know what benchmarking meant. (It is rate-setting by insurers to set out-of-network payments as a percentage of in-network rates, which would drive down overall physician reimbursement.) I thought my best bet was to at least start by raising awareness through the easiest way I, a full-fledged millennial physician, knew: social media.

Hashtag idea quickly evolved

I created an Instagram chat group with 23 physicians from various specialties around the country who had been involved in advocacy work in the past. The initial idea was to create a hashtag campaign. They have been used effectively on Instagram and Twitter to raise awareness and coordinate collective physician responses. Recent examples include #ThisIsOurLane, in response to the National Rifle Association’s claims that physicians should stay out of gun violence debates, and #VaccinesWork, to combat antivaccine misinformation.

CNN medical producer and pediatrician Alok Patel, MD, was in my Instagram chat group. We had met previously through Instagram because of our mutual interest in advocacy. He pitched an interesting idea to the group: “Let’s do a video about surprise billing legislation. [Dr. Choi] and I will make a script, and each of you can record one line on your smartphones. Then you can send your video to me, and I’ll splice everything together and make a short video to educate our colleagues and get the word out.”

To our knowledge, this had not been attempted previously by physicians on social media—virtually combining our voices to raise awareness about a critical issue. We were flying by the seat of our pants, and I wondered whether the video would gain any traction. The idea seemed simple, though, and everyone agreed to film their part.

Dr. Alok and I got to work on the script. We wanted to educate our colleagues on the basics of surprise billing legislation without getting bogged down in confusing, esoteric details. We also wanted to include a call to action. We reached out to Out of The Middle, a coalition of specialty societies including AAOS, the American College of Emergency Physicians (ACEP), and the American Association of Neurological Surgeons (AANS), to see whether we could direct video viewers to its website. The site contained a simple form that people could complete in five minutes to send emails to their elected members of Congress.

We also had to wear our public
relations hats and fight the temptation to speak indignantly about declining physician compensation. That would have taken the focus off patients and decreased the effectiveness of our messaging. Most importantly, the hashtag itself had to be catchy but also send a powerful message. We finally found the right one: #PatientsOverProfits.

Video campaign with big results

With zero budget but armed with smartphones and social media, we produced the video, which can be viewed at www.fixsurprisebilling.com.

Everyone who participated posted the video on their own personal social media platforms. It began to get real traction when Twitter accounts like
@AAOSAdvocacy and @Neurosurgery (the AANS account) retweeted the video. Other major specialty organizations such as the American College of Obstetrics and Gynecology, American College of Radiology, and ACEP joined the movement. State medical societies from New York, Florida, Texas, California, and eight others reposted the video, too. In the physician community on Twitter, the #PatientsOverProfits video had gone viral. After just one week, it had more than 100,000 views and, more importantly, more than 8,000 combined emails generated to members of Congress.

“The power of social media lies in its ability to amplify quickly,” said Raymond Hah, MD, an orthopaedic surgeon who participated in the video. “We have seen its effectiveness in marketing and popular culture for some time, but now we are seeing important conversations highlighted by passionate people. In health care, it has become a powerful tool for education, combating misinformation, and advocating for our patients and profession.”

Watch the video at www.fixsurprisebilling.com.
(From left to right) Amy Cho, MD, of the American College of Emergency Physicians (ACEP); James Ficke, MD, FAAOS, of AAOS; Purvi Parikh, MD, of the Medical State Society of New York and Allergy and Asthma Network; Carolyn McClain, MD, of ACEP; and Daniel E. Choi, MD, met with members of the House of Representatives in Washington, D.C., to discuss surprise billing legislation.
Courtesy of Daniel E. Choi, MD

Social media can support grassroots advocacy

The #PatientsOverProfits video campaign exemplifies the power of social media in advocacy for our profession. Social media allow instant networking. If you are wondering whether anyone cares about an issue you are passionate about, I guarantee that you will be able to find at least five physicians who also care on Twitter within 24 hours. We were able to quickly network, recruit physicians, and coordinate the production of the video across the country among different specialties in less than 36 hours—only because of social media.

“We understand that practice-changing publications can take as long as 17 years to be widely accepted into practice. Yet social media has accelerated this in clinical practice and now in advocacy,” said AAOS Board Member and video participant James Ficke, MD, FAAOS. “When the flashpoint for surprise medical billing boiled over, Dr. Choi and I were able to assemble a broad specialty and diverse practice-based group of energized physicians to advocate publicly within just a few days. The #PatientsOverProfits campaign has easily touched tens of thousands of people and made this very effective.”

Twitter is a virtual battlefield of ideologies on what is best for our country. The influence of Twitter is undeniable. Some suggest that congressional staffers monitor Twitter closely to poll for public opinion. There has been a slew of misinformation regarding surprise billing legislation that has been spread online by insurer-sponsored health economists and policy “experts.” Insurer-provided data have been used by such economists to “prove” that benchmarking has improved access to care in California, when actual complaints reported to the California Department of Managed Care have increased. The insurance industry also has waged a campaign to tie physician groups to private equity “dark money” groups. This has led to press headlines smearing physicians as “greedy” and unfortunately opened another front on a war on doctors: online misinformation.

Fortunately, physicians have a robust presence on Twitter and are united through such hashtags as #OrthoTwitter and #MedTwitter, as well as accounts such as @SoMeDocs. Some physicians have been able to fight back against of the misinformation spread online. Many of us are posting counterarguments with data showing the success of New York’s surprise billing law, which should serve as a model for federal legislation. Some of us have even been able to communicate directly with reporters to refute and protest misleading headlines.

Specialty groups such as AAOS and AANS have robust social media platforms as well (e.g., @AAOSAdvocacy on Twitter), and they are doing a tremendous job speaking out for their respective groups. However, the voice of the individual physician cannot be underestimated. We are able to share powerful stories from our clinics and how legislation will actually directly impact our patients. Such stories from the front lines can effectively counter out-of-touch graphs and charts that health policy “experts” constantly refer to when they guarantee healthcare cost savings by paying physicians less.

Social media fluency for healthcare professionals

If you don’t know where to start, check out the nonprofit organization that I founded with a group of physician colleagues also active on social media: Association for Healthcare Social Media (www.ahsm.org).

Our mission is to improve social media fluency among all healthcare professionals. We want to help all our physician colleagues leverage social media to promote public health, fight health misinformation, build their practices, and educate their patients and medical trainees.

And if you want to jump on board the #PatientsOverProfits campaign, we could always use another physician in our advocacy ranks to spread the good word about how we should fix surprise bills the right way.

Check out AAOS’ Advocacy Action Center for more information on surprise billing and follow the Association on Twitter (@AAOSAdvcoacy).

Thank you to the other AAOS members who were a part of the #PatientsOverProfits video: Bunay Unal, MD; Dr. Ficke; Jonathan Kaplan, MD; and Dr. Hah.

Daniel E. Choi, MD, is a Board-certified orthopaedic spine surgeon at Long Island Spine Specialists, P.C., and an AAOS candidate member who serves as the current chair of the Young Physicians Section for the Medical State Society of New York. You can connect with him on Instagram @spinedocny or on Twitter @drdanchoi.

References 

  1. Cho AM: Congress Is About to Give Health Insurance Companies the Nuclear Weapon. Available at: https://www.highyieldscript.com/take-action-against-the-benchmark-solution/. Accessed October 9, 2019.
  2. Adler L, Duffy E, Ly B, et al: California Saw Reduction in Out-of-network Care from Affected Specialties After 2017 Surprise Billing Law. Available at: https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2019/09/26/california-saw-reduction-in-out-of-network-care-from-affected-specialties-after-2017-surprise-billing-law/. Accessed October 9, 2019.
  3. Emanuel E: No One Likes Surprise Medical Bills. So Why Does Congressional Action Seem So Unlikely? Available at: https://www.washingtonpost.com/opinions/2019/09/04/no-one-likes-surprise-medical-bills-so-why-does-congressional-action-seem-so-unlikely/. Accessed October 9, 2019.
  4. Corlette S, Hoppe O: New York’s 2014 Law to Protect Consumers from Surprise Out-of-network Bills Mostly Working as Intended: Results of a Case Study. Available at: https://georgetown.app.box.com/s/6onkj1jaiy3f1618iy7j0gpzdoew2zu9. Accessed October 9, 2019.
  5. New York State: Governor Cuomo Announces Success of New York’s Landmark Out-of-network Law Protecting Consumers from Surprise Medical Bills. Available at: https://www.governor.ny.gov/news/governor-cuomo-announces-success-new-yorks-landmark-out-network-law-protecting-consumers. Accessed October 9, 2019.