It's not exactly the most relaxing setting one can imagine. Witnesses are seated in the oft-intimidating hearing room before a panel of lawmakers asking tough questions and cross-examining when they don't like the answers. Reporters are there to document every word uttered, and television cameras are frequently part of the set.
Depending on the topic and its political magnitude, there can be dozens or even hundreds of spectators. Lobbyists hover around the room, and mechanical buzzers sound loudly when it's time for a vote.
Welcome to the world of congressional testimony. Those who are familiar with it say most of getting ready for a grilling by Congress is common sense-be prepared and polite; practice answering the hard questions; don't appear flustered even when you are.
Gail Warden estimates he has testified before state and federal legislative committees more than 15 times. Warden, president emeritus of Henry Ford Health System in Detroit and former chairman of the American Hospital Association, says the best way to prepare to testify before Congress is to study and understand what you're facing.
"First, you need to know the purpose of the hearing and what the committee wants to accomplish," Warden says. "Secondly, you need to know the background of the members of the committee, their issues or hot buttons, and the profile of how they've voted on healthcare issues."
There are, however, other things-less obvious things-one can do to prepare for the hot seat. One is relationship building. No one is better prepared to deliver testimony than the witness who has talked beforehand with members of the committee and their staffers.
"You want good relationships with the staff on the committee to help place questions to support your case or cut through the noise to pin your target to the wall," says Alec Vachon, a former Senate Finance Committee aide and now president of Hamilton PPB, a Washington-based health policy shop.
Vachon and others advise people preparing for testimony to visit with staff members, discuss the testimony they plan to give and get a sense of where lawmakers' questions will take the discussion. In some cases, lawmakers themselves are unsure what they're asking, and the witness can guide the tone of the hearing simply by having a dialogue with their questioners before the event itself.
"Congressional staffers are the experts elected officials lean on to help them understand the issues, and can either make or break the testimony you're giving," says Matthew Williams, vice president of advocacy and government relations for Catholic Healthcare Partners in Cincinnati. "If you don't help lay the groundwork and context for what you're talking about, you create opportunities for failure in the dialogue time" following prepared testimony.
There are stated and unstated purposes for most hearings, says Richard Morrison, regional vice president of governmental and regulatory affairs for Adventist Health System in Orlando, Fla.
"I generally limit my testimony, both the written and the initial presentation of the spoken, to the stated question, but research what is the hidden question," Morrison says. "They never limit themselves to the question at hand."
The type of hearing can also have a lot to say about how one prepares. Some hearings, like those surrounding a proposed law, are usually scheduled in advance and very clear in the topics they will cover. Others, like the hearings last year to question CMS Actuary Richard Foster over his cost estimates for the Medicare drug bill, can be hastily arranged and featured as part of whatever political drama is engrossing Washington at the moment.
"Hearings where there's a level of inquiry on a certain issue tend to be more confrontational," says John McManus, former staff director of the House Ways and Means Committee, and now president of the McManus Group, a Washington lobbying firm.
Adventist's Morrison says he also researches what committee staff are likely to know about his organization by consulting their potential sources.
"Where are we on the Medicare program? Any major changes? I look to see if we've had any filings of EMTALA claims against us-anything that could be looked up and be potentially embarrassing," he says.
The two best sources are what you report to Medicare and your Form 990 filings with the Internal Revenue Service, Morrison says. "Every administrator ought to be very familiar with his organization's 990 over the last three years."
Using association staff and that of your own organization is the best way to prepare, Warden says, particularly to gather data about reimbursement or quality, the focus of most hearings.
The Federation of American Hospitals provides resources to help connect the dots on legislative matters, as well as a good working relationship with many committee staff members, according to federation lobbyists Jayne Hart Chambers and Jeff Cohen.
Richard Pollack, the AHA's executive vice president of advocacy and public policy, says the AHA has an infrastructure that kicks in to support hospital executives testifying on its behalf.
Association government relations teams work with committee staff to determine the key points the committee wants to explore. These lobbying pros also research members of the committee to be sure the witness understands each member's concerns and perspective.
Everything in a congressional hearing is timed, Pollack notes, and a witness needs to be crisp to get his or her points across. While extensive written testimony typically is presented to the committee before the hearing, the witness must pare down the opening statement to fit within five minutes.
"Practice helps to get the timing right so you're not cut off by the red light," Pollack says. For any type of public presentation, practice makes sense, Pollack adds, whether one is testifying before a congressional committee or doing an interview for television or making a speech.
"It sort of polishes the presentation," he says. "You don't want to be a robot, but you want to be articulate."
Warden warns against reading straight from written testimony. "You've got to sound like it's in your own words," Warden says. "I don't believe in getting up there and just reading something because you don't engage the committee as well as if you look right at them and say what you want to say."
Morrison typically passes his written testimony to legal counsel and a political adviser for review and to rehearse the best way to answer potential questions.
"Once you get to the hearing, you want to listen very carefully to the questions," Morrison warns. "Don't assume that you understand what the question is. And if you don't, ask for it to be clarified. You can, with some members, get the `When did you stop beating your wife?' question. You need to listen for the underlying assumption."
If you truly believe something, don't hesitate to say it, Morrison continues, even if it disagrees with the assumption being made.
"There is no need to compromise what you believe, but do it in a respectful way," he says. "It may be a hard thing for some administrative types to do, but put your ego aside."
Even the most thorough preparation can't fend off surprises. "Don't try to kid them that you know something you don't, because they'll nail you," Warden says. "And as hostile as they may get, you've got to keep your cool and not overreact. I've seen people get really clobbered who say, `Senator, you're just wrong.' It's fine to feel that way, but you've got to be a little diplomatic."
Most times you'll have a technical expert with you, Warden continues. "You shouldn't be afraid to say, `Excuse me, I need to consult my colleague.' "
Be straightforward, honest and firm in your convictions, Morrison adds. "Don't weasel around an issue. If you do that, it's like putting blood in the water. They smell blood and they can see fear."
If by chance your organization has done something wrong, inadvertently or otherwise, acknowledge the problem and explain how you are working to fix it, Morrison says. He recalls his own June 22 testimony before the House Ways and Means Committee's subcommittee on oversight in a hearing that examined the tax-exempt status of hospitals and also touched on charges.
"I was very candid and said there is not a whole lot of rationale for why we charge what we do," Morrison says. "This is part of a system that has evolved over 30 years, and unwinding it will be extremely complex. Don't try to defend the irrational."
As for some basics: dress conservatively, get a good night's sleep and eat breakfast, Morrison advises. Try to get over the fear that it's a congressional committee and consider it more like speaking to the Kiwanis group back home. That may be easier said than done, he concedes, because the environment is set up to intimidate.
"They are sitting in high chairs looking down at you and they have the power to cut you off," he says. "It's a little different position than normal because you aren't controlling the agenda. But there is not anything they can really do to hurt your institution directly, and keep reminding yourself that they are the folks we elect."
Whichever type of hearing it is, witnesses should know their arguments cold-as well as those of their opponents. But in the case of a hearing that is likely to be partisan and controversial, witnesses should be prepared for lawmakers to use them as political tools, or at the very least as vessels through which they get their own message across.
"Remember, this is theater," Vachon says.
And in congressional theater, things aren't always scripted. Take for instance a March 2003 hearing in the House Ways and Means' health subcommittee. The hearing focused on payment policy for renal dialysis providers and featured Glenn Hackbarth of the Medicare Payment Advisory Commission, which advises Congress on Medicare policy.
Rep. Jerry Kleczka (D-Wis.) asked Hackbarth if dialysis providers should receive annual payment adjustments the way hospitals and doctors do, hoping Hackbarth would say yes and provide ammunition for a policy change. Hackbarth, however, definitively said no-and Kleczka was forced to move on to another line of questioning.
Witnesses may not need to be overly reserved, but they should be cautious about displaying too much personality or grit. Some practiced witnesses may be able to get away with more, but most are advised to stick to their script and avoid sideshows.
"Being colorful is not necessarily a bad thing, but not many people can pull it off," Vachon says.
Elizabeth Thompson Beckley, a former Modern Healthcare reporter, is a freelance writer based in Takoma Park, Md. She can be reached at [email protected].
* Do your homework. Know the purpose of the hearing and what the committee wants to accomplish.
* Who are the chairman and members of the committee? Where do they come from? What is their background?
* Network and discuss testimony with lawmakers' staffs--on both sides of the aisle--prior to the hearing.
* Be polite, confident and always have data to support your points.
* Conduct mock hearings with friends or colleagues to prepare for various lines of questioning.
* Review transcripts of previous hearings held by the committee.
* Be able to relate your individual situation back home to the broader policy issues involved.
* Be crisp and honor the time constraints that are part of the rules of the committee.
* Do not be afraid to say you don't know the answer to a question. Offer to research it and submit an answer for the record.
* Be concise; have clear recommendations.
Source: Modern Healthcare reporting