Influencing Federal Health Policy: Lessons from Nephrology Social Work

Background and Purpose: Social workers have been embedded in United States’ healthcare system for more than a century, providing professional assessment and intervention to patients and their families to improve the psychosocial aspects of health and illness. Health social workers commonly work on interdisciplinary teams. However, only in the medical specialty of nephrology does federal law require MSW-level social workers to be members of every dialysis and kidney transplant team. This study examined how nephrology social workers successfully lobbied the Centers for Medicare and Medicaid Services (CMS) to include a policy provision in the Conditions for Coverage Social Security Amendment Act of 1976 and 2008 that required MSW-level social workers to be members of the interprofessional nephrology treatment team.

Methods: Data were collected from 15 in-depth, semi-structured oral history interviews. Participants primarily included past presidents and other former leaders of the Council of Nephrology Social Workers (CNSW). Key stakeholders from organizations identified as instrumental to advocating for MSW-level social work services in nephrology settings were also included in our sample. Interviews were conducted from 2014 to 2019. We asked participants about their tenure as a nephrology social worker and as a CNSW leader, their advocacy efforts before and after implementation of the 1976 and 2008 Conditions for Coverage, and the lessons learned from these efforts they believe are important for all health social workers. Interviews were transcribed verbatim and coded thematically using an inductive, grounded theory approach in MAXQDA (2018) software. Data from interviews were triangulated with archival document analysis of historical CNSW documents from 1972 to 2008. These documents were analyzed using an inductive archival coding schema.

Results: The most prominent themes that emerged from the analysis included nephrology social workers’ organizing efforts and advocacy for their profession through grassroots efforts. All interviewees described that CNSW communicated with their membership continuously throughout CMS’ proposed changes to the Conditions for Coverage in both 1976 and 2008. Proximity to policy making was also a recurring theme. Specifically, having professional social workers embedded within policy-making organizations seemed to significantly contribute to the inclusion of MSW-level social workers in the 1976 and 2008 Conditions for Coverage.

Conclusions and Implications: Nephrology social workers successfully lobbied CMS in 1976 and 2008 to require by federal law that MSW-level social workers be members of the interprofessional treatment team. Health social workers in other medical specialties can learn from nephrology social workers’ successes and advocacy efforts. In an era of healthcare in the United States that is increasingly focused on being responsive to the psychosocial aspects of health and illness, social workers are well positioned to become the provider of choice in any medical setting where professional psychosocial services are needed.