hall We Dance?
61st Interim Meeting
American Medical Association House of Delegates
Hawaii Convention Center
Honolulu, Hawaii
Saturday, November 10, 2007
Ronald M. Davis, MD
President
American Medical Association
Aloha, and mahalo nui loa, thank you very much. I hope you’re all enjoying our location. I know I am. The beauty of these islands is simply unsurpassed. And the people are so warm and friendly. I think I feel healthier just breathing in the air here, or smelling the flowers. I wish we could write prescriptions for that.
Another reason why I have a deep affection for Hawaii is because my very first AMA meeting was here, back in December 1979. Also, my father was stationed here during World War II, from 1942 to 1945.
Hawaii is still a crucial strategic location in the world. Did you know that this is the only place with all five U.S. armed services on one small island? Soldiers at Schofield Barracks, sailors at Pearl Harbor, airmen at Hickam Air Force Base, Marines at Kaneohe Bay, and the Coast Guard patrolling the waters as well?
Wherever they are, and whenever they served, I want to acknowledge all those who put themselves in harm's way to protect our freedom, and this country, and a way of life that embraces peace and friendship among all people. And that includes the selfless physicians here with us from the Defense Department and the Veterans Administration.
My brother returned from Iraq two months ago, and like others returning from the front lines, he’s going through a challenging transition. As physicians, we’ll be dealing for years to come with highly visible physical injuries suffered by service members returning from Iraq and Afghanistan, and also post-traumatic stress disorders and other emotional wounds that afflict our returning troops. Let’s be ready for them. They deserve it.
Getting back to my father, who passed away in 1997 … he was in the 113th Radio Intelligence Corps, just a few miles from here. And in his free time, believe it or not, he taught ballroom dancing to his fellow GI’s.
Watching a film clip a few weeks ago of him teaching dancing in Hawaii got me thinking about the dancing we do at the AMA, and the partners with whom we dance. We engage in a very special form of dancing. It’s not the Hula. It’s not Tahitian dancing. It’s not nearly as pretty, or graceful, or enjoyable to watch. Sometimes it’s more like a limbo at a luau.
Thirty years ago, a Rhodes Scholar named Eric Redman wrote about “The Dance of Legislation.”
That was actually the title of his book, about the drafting and passage of legislation to establish the National Health Service Corps. The NHSC, through scholarship and loan repayment programs, has recruited more than 27,000 health professionals to deliver primary care in underserved communities.
Many of you have no doubt read “The Dance of Legislation.” Redman published an updated version of it a few years ago.
This dance is one of both triumph and frustration, and includes some strange moves and countermoves. But most of all, it involves one hell of a lot of work. And it’s a very slow dance. Legislative change usually occurs incrementally rather than revolutionarily.
Take a look at the State Children’s Heath Insurance Program, or SCHIP. The original legislation passes 10 years ago, but with a 10-year sunset. This year, Congress passes a bill to reauthorize the program, but it’s vetoed by President Bush, and the House fails to override his veto.
So now we have a new bill, stewing in the most partisan environment I’ve ever seen. Yet it’s over something that we, the members of the House of Delegates of the AMA, had no problem with last summer. We were virtually all on board when we adopted our position. It’s clearly in the best interests of everyone.
I’ve been disappointed in hearing a lot of uninformed criticisms of the SCHIP legislation. Let’s separate fact from fiction.
*Myth No. 1 is that the SCHIP compromise is a major step toward “government-run,” “socialized” health care. In fact, SCHIP is a public-private partnership, with 77 percent of kids in the program getting their coverage through private health plans. Let me ask you this: If the SCHIP legislation is socialized medicine, why is Senator Orrin Hatch supporting it?
* Myth No. 2 is that the SCHIP compromise vastly expands program eligibility. In fact, there is no provision in the bill to expand income eligibility for children, and the compromise will limit program eligibility more than current law.
* Myth No. 3 is that the SCHIP compromise bill will cover illegal immigrants. In fact, the SCHIP bill does not change current law prohibiting coverage for illegal immigrants. Health coverage is only available for U.S. citizens and legal immigrants who have been in the United States for at least five years.
*Myth No. 4 is that the SCHIP legislation will cover adults. In fact, the bill phases out non-pregnant adults from the program.
I don’t know about you, but I can no longer stomach rollercoaster rides. So let’s get SCHIP off Washington’s rollercoaster, so children from low-income families will have secure and reliable access to health care.
* * *
The first version of the SCHIP legislation in the House included Medicare physician payment reform. Unfortunately, the Medicare provisions were not included in legislation passed by the Senate, and did not make it into subsequent compromise bills. So now it’s likely we’ll be dancing with that one all the way to December, down to the wire, once again.
Recent Congresses seem to want to wait until a crisis occurs, or until the last possible moment before it would almost assuredly occur, before taking definitive action. And this pathetic yearly tourniquet approach to the SGR cuts is a perfect example of management by crisis.
We in medicine know a lot about crises through our work in disaster preparedness. We plan for, and respond to, terrorism, tsunamis, hurricanes, and many other mass-casualty events.
The latest are the fires in southern California, which were on everyone’s minds when I was at the California Medical Association’s annual meeting in Los Angeles a few weeks ago. Our hearts go out to our colleagues and their patients who have been affected by the fires, and we’ve offered assistance through our AMA Center for Public Health Preparedness and Disaster Response.
Speaking of fires, I share a birthday with the late Red Adair. You’ll remember that he was the world-famous oil field fire fighter, who successfully battled more than 2,000 fires in oil and natural gas wells.
Adair’s well control company, which continues its work today, divides its services into three categories: prevention, response, and restoration.
Let’s apply those approaches to the looming SGR disaster.
Let’s begin with prevention. Prevention involves safety inspections. We’ve already done safety inspections, and we already see weak points in our system of care for seniors. According to the Medicare Payment Advisory Commission, or MedPAC, about a quarter of seniors seeking a new primary care physician are already having difficulty in finding one to take care to them.
Prevention also includes conducting a risk assessment. We’ve done that too. And we see huge risks if Medicare cuts go through as projected.
According to our MemberConnect survey, if the 10 percent cut goes through in January, almost a third of physicians will reduce the number of new Medicare patients they accept, and almost 30 percent will stop accepting new Medicare patients altogether. Even more disturbing is that almost a third of physicians will reduce the number of established Medicare patients in their practice, if the 2008 cut goes through. And another eight percent will stop seeing any Medicare patients in their practice.
And ladies and gentlemen, 10 days after Halloween, this is not the type of scare I want. Before the U.S. Capitol becomes a haunted house, Congress needs to listen to MedPAC, its own advisory committee, and scrap the SGR. Listen to MedPAC, and tie physician payment to the Medicare Economic Index, the government’s own index for the costs of running a physician practice.
A few years ago, the Congressional Budget Office estimated that a permanent SGR fix would cost $90 billion. Now the CBO says that deep-sixing the SGR in favor of the MEI will cost us $262 billion. As Congress continues to kick the can down the road, effective remedies become more and more costly.
But Congress seems to ignore the benefits of preventing an SGR disaster. It seems willing to rely on disaster response and restoration.
Well, we need to tell Congress that if this imminent melt-down occurs, response and restoration will be slow in repairing the damage, will be expensive, and may ultimately fail. If physicians across the country are forced out of the Medicare program, and lose trust in the program, they may become wholly resistant to any last-ditch effort by the federal government to respond to the crisis, and to restore the program to “business as usual.”
Unless Congress has a “Medicare Red Adair” to put out brush fires in every one of the 3,066 counties in the United States, a lot of seniors are going to get burned.
I’m pleased that my own senator, Debbie Stabenow, is showing leadership on this issue. You’ll recall that she spoke at our National Advocacy Conference in February, wearing her AMA purple.
Two days ago, she spoke passionately about the SGR problem on the floor of the Senate. She called on Congress to “pass legislation this year that provides physicians with two years of positive Medicare payment updates … in a way that does not add to the cost of eliminating the SGR.”
Senator Stabenow endorsed a repeal of the SGR and the establishment of “a Medicare physician payment system that will provide stable, positive payment updates to preserve Medicare beneficiaries’ access to high-quality care for the long-term.”
She said, “It defies common sense to think that payment rates that are lower today than they were six years ago will be enough to maintain the access to care that our seniors need.”
Many physicians have told me that they doubt Congress will solve this problem unless a melt-down actually occurs. Thus, some have suggested that we acquiesce to the 10 percent cut for 2008 -- just let it go through, they say -- so Congress will see that our concerns and predictions are not a poker-style bluff.
A few have even suggested to me a physician boycott of the Medicare program. Well, boycotts raise serious legal and ethical issues. But I know where those suggestions come from. Many or most physicians are mad as hell and are in no mood to take it any longer. Lest you have any doubt, there’s as much anger on this stage as there is on the floor of this House and in physician offices across this country.
So let me highlight several courses of action that are available to physicians.
First, we can do what TV news anchor Howard Beale suggested in that 1976 movie “Network” -- get up out of your chairs, go to the window, open it, and stick your head out, and yell, “I’m as mad as hell, and I’m not going to take this anymore!”
Unfortunately we don’t have any windows in this room, so you’ll have to save your best Halloween scream for later.
For our second course of action, we must continue, and intensify, our advocacy efforts, talking to our Congressmen, and our patients, and the media, about the looming melt-down.
And third, we must remind physicians, in the face of these huge cuts, that they may wish to review their Medicare participation options.
As explained in the fact sheet that’s available on the tables at the back of this room, physicians who wish to change their current Medicare participation or non-participation status for next year, must do so between November 15th and December 31st.
They have three options:
One, they may sign a PAR agreement and accept Medicare’s allowed charge as payment in full for all of their Medicare patients.
Or, two, they may elect to be a non-PAR physician, which permits them to make assignment decisions on a case-by-case basis and to bill patients 9.25 percent above the PAR-approved payment rates.
Or, three, they may become private contracting physicians, agreeing to bill patients directly and to forego any payments from Medicare to their patients or themselves.
* * *
For folks who are fatigued by these endless machinations in policy, Eric Redman explains our current reality: “… the dance of legislation never really ends, and … a law may [even] intensify rather than terminate the perpetual struggle over policy.”
At the AMA, it’s our job to continue this dance until the music stops. Fortunately, we’ve had some nice recent victories in the smaller dance contests, such as getting the Department of Education to extend eligibility for deferring repayment of student loans, so that medical student and resident debt burdens don’t get worse than they already are. Yet that, too, is a short-term fix. We still need a long-term legislative solution to that problem.
Have you seen either of the current reality television shows, “So You Think You Can Dance” or “Dancing with the Stars”? To win these competitions, you need to be more than just the best dancer. There’s song selection. There’s how well you’re trained by a randomly chosen choreographer. And there’s your popularity with the viewers, who vote off the contestants. Thus, winning the dance contest involves talent, training, and a tendency to be liked.
Well, physicians have a lot of talent. Are we’re certainly well trained. And I’d like to think we’re popular among our patients. So we must show Congress that we’re in this for the long haul. We aim to win our dance marathon, and not get voted off.
Now, to accomplish this, I believe the key is to always keep patients as our main focus, and to ensure that their access to care is the basic harmonic running through everything we do.
Which is why we’ve been pushing so hard to be the Voice for the Uninsured.
I’m very proud of our campaign. We’ve joined forces with some of the most influential groups in America. And we’ve joined forces with our patients. What we’re doing, we’ve done before, but never with as much strategic and tactical focus.
So this is probably a good time to show you one of our 30-second spots. These will go national in January. And those of you in Iowa, South Carolina, and New Hampshire have most likely already seen it.
I’d really like to thank the Medical Societies of those states for their superb partnership with us on this campaign. When I was out on the road for four days last week in Iowa, I personally heard several sad stories about the devastating impact that lack of insurance can have on people who experience serious illness or injury.
I heard something else, too. Leaders of the Iowa Medical Society and I met with Gov. Chet Culver for an hour, to talk about covering the uninsured, Medicare physician payment reform, and a few other important issues. Moments after we walked into his office, the Governor mentioned that he had seen our AMA billboards about covering the uninsured all over the place.
I’m glad the Governor saw our signs. Because for two days before our meeting with him, I was out driving our mobile billboard around the state capitol in Des Moines.
So we need to do whatever it takes to get the message out in this campaign, to important decision-makers but also to our patients and to voters, to convince them to consider this issue when they decide which presidential candidate to support.
Politicians everywhere, but especially in Congress, need to be told by us that we’re going to do our damnedest to win these contests; that we’re going to lead the charge to provide the best health care for all Americans, but especially the most vulnerable: our children, the elderly, and the uninsured.
* * *
As we work toward covering all Americans, we need to remind our patients, and all citizens, that they play a critically important role in determining how healthy they are and how long they will live. More than one-third of all deaths in this country are due to four unhealthy lifestyles: tobacco use, alcohol abuse, poor diet, and physical inactivity.
That’s why I’m very pleased that earlier this week, our AMA and the American College of Sports Medicine launched a new initiative to assist physicians in helping their patients get more physical activity. The theme of the campaign is “Exercise is Medicine,” and we encourage you to prescribe exercise for all of your patients. Please check out the campaign website at www.exerciseismedicine.org.
Incidentally, one way to get exercise is through dancing. In fact, the state of West Virginia is combating the epidemic of youth obesity by placing the videogame “Dance Dance Revolution” in all 765 public schools in the Mountain State.
* * *
I sometimes wish I had inherited my father’s dancing skills. I did not.
But when we do the “Dance of Legislation,” whether for SCHIP or Medicare or another important issue, it really doesn’t matter if we occasionally step on our partner’s toes. It might even prove a point. What matters is, when the music stops, who wins the dance?
I hope you get the chance to catch the evening show at the Hilton Hawaiian Village or out at the Polynesian Cultural Center. You’ll be amazed at all the dancing. And the climax is a dancer who juggles flaming torches. It’s like combining Red Adair with Fred Astaire.
Sometimes, we have to juggle a little fire in our dance. That just comes with the territory. And when we have partners, we’re not always going to be in sync. And we may have to switch partners when we find one who has better moves. And we may need to stay on the dance floor longer than we thought we should.
So bring your Dr. Scholl’s.
Because we need to fight for physicians everywhere.
We need to prevail for patients everywhere.
And we need to win, not to get a trophy, but because it’s the right thing to do.
There is no one in this country who has more expertise in health care than we do. So in this dance, we need to take the lead.
###
Sunday, November 25, 2007
Saturday, November 24, 2007
AMA Efforts Not Appreciated?
"Your Senators are telling us that they are not hearing from physicians about the looming Medicare physician payment cuts.
So let’s make sure they get the message: now is the time to include positive Medicare physician payment updates in the Medicare bill that is being put together!"
AMA Grassroots Legislative Alert
Dear Friends and Colleagues;
In the last few days I have read several e-mails blaming our AMA for the looming Medicare cuts and and in one of those e-mails the author even suggest that
" the AMA likes to have this issue every year as it allows them to say they did something."
Lets examine the facts before we engage in self-destructive behaviors that will prevent us from achieving our goals.
A recent AMA News article http://www.ama-assn.org/amednews/2007/11/19/gvl11119.htm reviews the current status of the Medicare physicians reimbursement battle. In this article American Medical Association Board of Trustees Chair Edward L. Langston, MD states that " Congress must step in to replace the cut with payment increases that keep up with medical practice costs. Next year's 10.1% physician payment cut is bad news for America's seniors as 60% of physicians say the cut will force them to limit the number of new Medicare patients they can treat."Dr. Langston suggested using $54 billion in what doctors view as excess payments to private Medicare health plans to offset the cut. These Medicare Advantage plans received 112% of the amount that traditional Medicare paid for each senior's care in 2006. The AMA News also published his opinion piece http://www.ama-assn.org/amednews/2007/11/05/edsa1105.htm regarding the Medicare Advantage Plans. Congress needs to level the playing field between traditional and private Medicare plans by eliminating excess payments to Medicare Advantage plans in the amount of $54 billion! This money would be MORE than enough to offset eliminating the the two-year cut in physicians reimbursement.Cuts to Medicare Advantage health plans' payment would also have lowered Medicare's regional benchmark payments to insurance companies, ended a stabilization fund used to share risks with insurance companies and eliminated indirect medical education payments to teaching hospitals.
But what are the political REALITIES we are faced with:
* In the House, an Energy and Commerce Committee staff member said leaders are sticking with the Medicare physician pay provisions adopted as part of its State Children's Health Insurance Program reauthorization bill in early August. The measure would have increased reimbursement 0.5% in 2008 and 2009 each.But the provisions were removed in the House-Senate compromise SCHIP bill in an attempt to maintain a veto-proof Senate majority.
* Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, would prefer to adopt a two-year payment fix by shifting some Medicare Advantage payments to fund physician reimbursement.But many Senate Republicans OPPOSE cutting private health plan payments therefore making it almost impossible to free additional funds to prevent the looming Medicare reimbursement cuts.
* Today, there are more than eight million seniors enrolled in the Medicare Advantage program that provides more services at a lower cost than traditional Medicare, but are often more limited in the health care providers available.An insurance industry sponsored survey revealed that more than 8 out of 10 survey respondents (84 percent) said they are happy with their healthcare coverage and 75 percent would recommend Medicare Advantage (MA) plans to their friends or family members.The survey also shows that beneficiaries believe sustained funding for the MA program is crucial, and nearly all survey respondents said it is important for Congress to work to maintain adequate funding for the program. Many worry that Medicare cuts could mean they could not afford to pay the bill for an unexpected illness (48 percent) or afford prescription drugs (45 percent). Our OPPOSITION to the MA program may backfire on us and we need to carefully navigate between reducing funding for the program and the popular support among seniors for the MA program. Any MA cuts will results in higher premiums for seniors who are already hit with a >20% premium increase for the Medicare part D program.
What can physicians do? TO SUPPORT OUR AMA in its effort to prevent the looming cuts by enrolling in the Grassroots network http://capwiz.com/ama/issues/alert/?alertid=10510101.
We need to flood the offices of senators to impress upon them that the Medicare cuts will limit access to health care services for seniors. They need to understand that those seniors will vote in the upcoming elections and their vote may be influenced by the Senates inactivity and intransigence.
PROMPT PAYMENT LAWS:
Our AMA is also vigorously lobbying for federal prompt-payment laws to close the loopholes of a system that resembles a swiss cheese.
See http://www.ama-assn.org/amednews/2007/11/05/gvsa1105.htm . Insurers have found loopholes to get around the state endorsed prompt-payment deadlines and are using federal law to slip out of state laws.
What is needed is a tough federal law penalizing insurance companies that delay payment.
One reason insurers can ignore prompt-payment laws is that they dominate the market in most communities, says Cecil B. Wilson, MD, immediate past chair of the AMA Board of Trustees. It gives them tremendous negotiating power and prevents physicians from addressing unfair payment practices. The situation, called an oligopsony, occurs when only a few buyers operate in a market with many sellers.
Another problem is that many health plans are not subject to state prompt-pay laws. The federal Employee Retirement Income Security Act exempts companies that self-insure from state insurance laws. About 55% of workers have such coverage, according to the 2007 Kaiser Family Foundation Employee Health Benefits Survey. The percentage rises with firm size: 77% of workers at businesses employing more than 200 people are in self-insured plans.
In addition, many health plans are not subject to state prompt-pay laws. The federal Employee Retirement Income Security Act exempts companies that self-insure from state insurance laws. About 55% of workers have such coverage, according to the 2007 Kaiser Family Foundation Employee Health Benefits Survey. The percentage rises with firm size: 77% of workers at businesses employing more than 200 people are in self-insured plans.
A federal law would fill the loopholes. Or very own Cecil Wilson,MD outlined the elements of a proposal when testifying to the House Small Business Committee's health panel in August:
* A strong federal standard. The AMA's policy is to support legislation that requires payment within 30 days for clean paper claims and 14 days for clean electronic claims.
* Stiffer fines than those in state laws to deter bad behavior. Interest should be assessed on the amount of payment outstanding and increase with the claim's delinquency. Physicians' attorney's fees and costs also should be provided when they win a claims dispute with an insurer.
* State law protections. Stronger state laws should be protected, and state requirements not covered by a federal standard should not be preempted.
* Application of state laws. Any federal law should clarify that state prompt-payment laws apply to all nongovernment health plans, denying insurers the argument that ERISA preempts state law.
* Time limits for notification. Federal law should set a statutorily defined time limit for insurers to notify physicians that additional information is needed to process a claim. The notice should specify all problems with the claim and give an opportunity to provide the information needed. Insurers also should be required to pay any portion of a claim that is complete and uncontested.
In these critical times it would be politically suicidal to divide organized medicine because some have "ideological differences" with AMA policies.
Political rigidity will hurt us. We need experienced leaders that can skillfully execute political decisions, are able and willing to reach reasonable compromises and achieve incremental change.
I hope that I am not alone stating that opinion and I call upon all of you to join our AMA in this struggle.
Yours
Bernd
FMA AMA Delegate
So let’s make sure they get the message: now is the time to include positive Medicare physician payment updates in the Medicare bill that is being put together!"
AMA Grassroots Legislative Alert
Dear Friends and Colleagues;
In the last few days I have read several e-mails blaming our AMA for the looming Medicare cuts and and in one of those e-mails the author even suggest that
" the AMA likes to have this issue every year as it allows them to say they did something."
Lets examine the facts before we engage in self-destructive behaviors that will prevent us from achieving our goals.
A recent AMA News article http://www.ama-assn.org/amednews/2007/11/19/gvl11119.htm reviews the current status of the Medicare physicians reimbursement battle. In this article American Medical Association Board of Trustees Chair Edward L. Langston, MD states that " Congress must step in to replace the cut with payment increases that keep up with medical practice costs. Next year's 10.1% physician payment cut is bad news for America's seniors as 60% of physicians say the cut will force them to limit the number of new Medicare patients they can treat."Dr. Langston suggested using $54 billion in what doctors view as excess payments to private Medicare health plans to offset the cut. These Medicare Advantage plans received 112% of the amount that traditional Medicare paid for each senior's care in 2006. The AMA News also published his opinion piece http://www.ama-assn.org/amednews/2007/11/05/edsa1105.htm regarding the Medicare Advantage Plans. Congress needs to level the playing field between traditional and private Medicare plans by eliminating excess payments to Medicare Advantage plans in the amount of $54 billion! This money would be MORE than enough to offset eliminating the the two-year cut in physicians reimbursement.Cuts to Medicare Advantage health plans' payment would also have lowered Medicare's regional benchmark payments to insurance companies, ended a stabilization fund used to share risks with insurance companies and eliminated indirect medical education payments to teaching hospitals.
But what are the political REALITIES we are faced with:
* In the House, an Energy and Commerce Committee staff member said leaders are sticking with the Medicare physician pay provisions adopted as part of its State Children's Health Insurance Program reauthorization bill in early August. The measure would have increased reimbursement 0.5% in 2008 and 2009 each.But the provisions were removed in the House-Senate compromise SCHIP bill in an attempt to maintain a veto-proof Senate majority.
* Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, would prefer to adopt a two-year payment fix by shifting some Medicare Advantage payments to fund physician reimbursement.But many Senate Republicans OPPOSE cutting private health plan payments therefore making it almost impossible to free additional funds to prevent the looming Medicare reimbursement cuts.
* Today, there are more than eight million seniors enrolled in the Medicare Advantage program that provides more services at a lower cost than traditional Medicare, but are often more limited in the health care providers available.An insurance industry sponsored survey revealed that more than 8 out of 10 survey respondents (84 percent) said they are happy with their healthcare coverage and 75 percent would recommend Medicare Advantage (MA) plans to their friends or family members.The survey also shows that beneficiaries believe sustained funding for the MA program is crucial, and nearly all survey respondents said it is important for Congress to work to maintain adequate funding for the program. Many worry that Medicare cuts could mean they could not afford to pay the bill for an unexpected illness (48 percent) or afford prescription drugs (45 percent). Our OPPOSITION to the MA program may backfire on us and we need to carefully navigate between reducing funding for the program and the popular support among seniors for the MA program. Any MA cuts will results in higher premiums for seniors who are already hit with a >20% premium increase for the Medicare part D program.
What can physicians do? TO SUPPORT OUR AMA in its effort to prevent the looming cuts by enrolling in the Grassroots network http://capwiz.com/ama/issues/alert/?alertid=10510101.
We need to flood the offices of senators to impress upon them that the Medicare cuts will limit access to health care services for seniors. They need to understand that those seniors will vote in the upcoming elections and their vote may be influenced by the Senates inactivity and intransigence.
PROMPT PAYMENT LAWS:
Our AMA is also vigorously lobbying for federal prompt-payment laws to close the loopholes of a system that resembles a swiss cheese.
See http://www.ama-assn.org/amednews/2007/11/05/gvsa1105.htm . Insurers have found loopholes to get around the state endorsed prompt-payment deadlines and are using federal law to slip out of state laws.
What is needed is a tough federal law penalizing insurance companies that delay payment.
One reason insurers can ignore prompt-payment laws is that they dominate the market in most communities, says Cecil B. Wilson, MD, immediate past chair of the AMA Board of Trustees. It gives them tremendous negotiating power and prevents physicians from addressing unfair payment practices. The situation, called an oligopsony, occurs when only a few buyers operate in a market with many sellers.
Another problem is that many health plans are not subject to state prompt-pay laws. The federal Employee Retirement Income Security Act exempts companies that self-insure from state insurance laws. About 55% of workers have such coverage, according to the 2007 Kaiser Family Foundation Employee Health Benefits Survey. The percentage rises with firm size: 77% of workers at businesses employing more than 200 people are in self-insured plans.
In addition, many health plans are not subject to state prompt-pay laws. The federal Employee Retirement Income Security Act exempts companies that self-insure from state insurance laws. About 55% of workers have such coverage, according to the 2007 Kaiser Family Foundation Employee Health Benefits Survey. The percentage rises with firm size: 77% of workers at businesses employing more than 200 people are in self-insured plans.
A federal law would fill the loopholes. Or very own Cecil Wilson,MD outlined the elements of a proposal when testifying to the House Small Business Committee's health panel in August:
* A strong federal standard. The AMA's policy is to support legislation that requires payment within 30 days for clean paper claims and 14 days for clean electronic claims.
* Stiffer fines than those in state laws to deter bad behavior. Interest should be assessed on the amount of payment outstanding and increase with the claim's delinquency. Physicians' attorney's fees and costs also should be provided when they win a claims dispute with an insurer.
* State law protections. Stronger state laws should be protected, and state requirements not covered by a federal standard should not be preempted.
* Application of state laws. Any federal law should clarify that state prompt-payment laws apply to all nongovernment health plans, denying insurers the argument that ERISA preempts state law.
* Time limits for notification. Federal law should set a statutorily defined time limit for insurers to notify physicians that additional information is needed to process a claim. The notice should specify all problems with the claim and give an opportunity to provide the information needed. Insurers also should be required to pay any portion of a claim that is complete and uncontested.
In these critical times it would be politically suicidal to divide organized medicine because some have "ideological differences" with AMA policies.
Political rigidity will hurt us. We need experienced leaders that can skillfully execute political decisions, are able and willing to reach reasonable compromises and achieve incremental change.
I hope that I am not alone stating that opinion and I call upon all of you to join our AMA in this struggle.
Yours
Bernd
FMA AMA Delegate
Thursday, November 22, 2007
Working Harder or WorkingSmarter?
"The healthcare system has put physicians in a bad place... the options they have for escaping it aren't good; in our fee-for-service system,
they mainly consist of performing more services, even though they may not be needed.
We need to move away from fee for service and reward doctors for more efficient, higher-quality care."
Paul Ginsburg, Center for Studying Health System Change
The latest edition of "Medical Economics" contains an exclusive survey about physicians compensation and work hours http://www.memag.com/memag/Physician+Surveys%3A+Compensation/Exclusive-Survey-Earnings-Group-practices-pay-bett/ArticleStandard/Article/detail/471128?contextCategoryId=8485
The key findings of the survey are not surprising:
* Most primary care physicians work harder to break even.
* Physician compensation in 2006 once again reflects economic forces that are eroding the cottage-industry model of medicine. If you want to earn more, join a group practice.
* While family physicians, internists, pediatricians, ob/gyns, and general practitioners as a whole earned a median of $165,000 last year, the soloists among them trailed the pack at $152,000, with doctors in two-partner practices second from last. Their peers in groups of 50 or more posted the highest earnings—$175,000.
* The percentage of internists, FPs, and pediatricians in solo practices and two-doctor groups slipped just a notch—from 37.5 percent in 1996-1997 to 35.6 percent in 2004-2005, according to the nonpartisan Center for Studying Health System Change (HSC). Those in groups of three to five also fell as a percentage, going from 10.3 percent to 7.3 percent during the same period.
* Medical and surgical specialists stand to earn far more by consolidating, and as a result, they're deserting solo and two-doctor practices at five to six times the rate in primary care.
* Suburban and rural doctors took home more than their urban and inner-city counterparts. The white coats of suburbia benefit from having the highest percentage of privately insured patients.
What can we learn from these facts:
1. The medical economic climate will remain cloudy in the foreseeable future and doctors need to adapt to the changing market place.
2. Declining reimbursement will force many doctors to work harder to keep their practices open, but working harder will cost MORE money (more staff hours, more overhead, more office utilization etc.)
3. Working SMARTER may include the following:
* Joining a group practice
* Rebalance the payer mix
* Renegotiate contracts and if necessary discontinue existing contractual relationships
* Hire midlevel providers (PA, NP
* Implement cutting -edge technologies (EHR, Electronic Prescribing etc.) to reduce the overhead, increase patient satisfaction, reduce waiting time, maximize billing options
o Comment: Many EHR systems provide quality reporting functions allowing you to demonstrate efficient, high-quality care to potential payers (employer groups, insurance companies). This puts the doctor in the position to negotiate higher reimbursement rates based on demonstrable quality care. I have had a meeting with an executive of a large employer group who offered to pay significantly MORE $$$ per visit if chronic disease management measures can be implemented that will reduce ER visits and hospitalizations. But doctors need to have tools in place to demonstrate that they can track patients adherence and disease management performance criteria. That is an untapped potential income source for doctors who are willing to take the leap into the 21st century medical practice.
The future for medicine is not that bleak if we learn to adapt to a changing market place.
Yours
Bernd
they mainly consist of performing more services, even though they may not be needed.
We need to move away from fee for service and reward doctors for more efficient, higher-quality care."
Paul Ginsburg, Center for Studying Health System Change
The latest edition of "Medical Economics" contains an exclusive survey about physicians compensation and work hours http://www.memag.com/memag/Physician+Surveys%3A+Compensation/Exclusive-Survey-Earnings-Group-practices-pay-bett/ArticleStandard/Article/detail/471128?contextCategoryId=8485
The key findings of the survey are not surprising:
* Most primary care physicians work harder to break even.
* Physician compensation in 2006 once again reflects economic forces that are eroding the cottage-industry model of medicine. If you want to earn more, join a group practice.
* While family physicians, internists, pediatricians, ob/gyns, and general practitioners as a whole earned a median of $165,000 last year, the soloists among them trailed the pack at $152,000, with doctors in two-partner practices second from last. Their peers in groups of 50 or more posted the highest earnings—$175,000.
* The percentage of internists, FPs, and pediatricians in solo practices and two-doctor groups slipped just a notch—from 37.5 percent in 1996-1997 to 35.6 percent in 2004-2005, according to the nonpartisan Center for Studying Health System Change (HSC). Those in groups of three to five also fell as a percentage, going from 10.3 percent to 7.3 percent during the same period.
* Medical and surgical specialists stand to earn far more by consolidating, and as a result, they're deserting solo and two-doctor practices at five to six times the rate in primary care.
* Suburban and rural doctors took home more than their urban and inner-city counterparts. The white coats of suburbia benefit from having the highest percentage of privately insured patients.
What can we learn from these facts:
1. The medical economic climate will remain cloudy in the foreseeable future and doctors need to adapt to the changing market place.
2. Declining reimbursement will force many doctors to work harder to keep their practices open, but working harder will cost MORE money (more staff hours, more overhead, more office utilization etc.)
3. Working SMARTER may include the following:
* Joining a group practice
* Rebalance the payer mix
* Renegotiate contracts and if necessary discontinue existing contractual relationships
* Hire midlevel providers (PA, NP
* Implement cutting -edge technologies (EHR, Electronic Prescribing etc.) to reduce the overhead, increase patient satisfaction, reduce waiting time, maximize billing options
o Comment: Many EHR systems provide quality reporting functions allowing you to demonstrate efficient, high-quality care to potential payers (employer groups, insurance companies). This puts the doctor in the position to negotiate higher reimbursement rates based on demonstrable quality care. I have had a meeting with an executive of a large employer group who offered to pay significantly MORE $$$ per visit if chronic disease management measures can be implemented that will reduce ER visits and hospitalizations. But doctors need to have tools in place to demonstrate that they can track patients adherence and disease management performance criteria. That is an untapped potential income source for doctors who are willing to take the leap into the 21st century medical practice.
The future for medicine is not that bleak if we learn to adapt to a changing market place.
Yours
Bernd
Tuesday, November 20, 2007
AMA Interim Meeting: Disappointing Results?
I have received an e-mail from a valued colleague and friend criticizing several decisions made at the recent AMA Interim meeting in Hawaii. I have offered my attached perspective:
"As an AMA delegate I would like to offer you a different perspective of the issues outlined in your e-mail and the conclusions you have drawn.Please be advised that my comments are NOT necessarily reflecting the consensus opinion of our delegation. I will try to present the issues as accurate as possible but those comments are subject to addendum, correction or deletion by others delegates.
1. Balanced Billing: Two resolution were submitted for discussion (906, 925). Resolution 906 was submitted by our delegation.The Reference Committee made the following recommendation to the HOD,
"RECOMMENDATION A:
Mr. Speaker, your Reference Committee recommends that the first resolve of Resolution 925 be amended by insertion and deletion on page 1, line 24 to read as follows:
RESOLVED, That our American Medical Association devote the necessary political and financial resources to introduce national legislation at the appropriate time to bring about implementation of Medicare balance billing by January 2009 and to end the budget neutral restrictions inherent in to the current Medicare physician payment structure that interferes with patient access to care. (Directive to Take Action)
RECOMMENDATION B:
Mr. Speaker, your Reference Committee recommends that the third resolve in Resolution 925 be deleted.
RECOMMENDATION C:
Mr. Speaker, your Reference Committee recommends that the fifth resolve in Resolution 925 be amended by insertion and deletion on page 2, line 1, to read as follows:
RESOLVED, That our AMA Board of Trustees report back to the our AMA House of Delegates, by e-mail or fax on a quarterly basis, electronically by March 15, 2008, and at other times as appropriate on their its progress toward the completion of all of these goals. (Directive to Take Action)
RECOMMENDATION D:
Mr. Speaker, your Reference Committee recommends that Resolution 925 be adopted as amended in lieu of Resolution 906.
Resolution 906 asks (1) that our American Medical Association devote the necessary political and financial resources to protect patient access to care by advocating for national legislation or litigation to unconditionally implement Medicare balance billing by January 2009 and to unconditionally end the budget neutral restrictions of the current Medicare Physician Payment structure; (2) that this national legislation or litigation be designed to pre-empt state laws that prohibit balance billing and prohibit inappropriate inclusion of balance billing bans in insurance-physician contracts; and (3) that our AMA develop model language for physicians to incorporate into any insurance contracts that attempt to restrict a physician’s right to balance bill any insured patient.
Resolution 925 asks (1) that our American Medical Association devote the necessary political and financial resources to introduce national legislation at the appropriate time to bring about implementation of Medicare balance billing by January 2009 and to end the budget neutral restrictions inherent to the current Medicare physician payment structure that interferes with patient access to care; (2) that this national legislation be designed to pre-empt state laws that prohibit balance billing and prohibit inappropriate inclusion of balance billing bans in insurance-physician contracts; (3) that our AMA work on federal legislation that would prohibit any law or regulation from interfering with the patient-doctor relationship including any and all fiduciary relationships that are deliberate and contractual; (4) that our AMA develop model language for physicians to incorporate into any insurance contracts that attempt to restrict a physician’s right to balance bill any insured patient; and (5) that our AMA Board of Trustees report back to the AMA House of Delegates, by e-mail or fax on a quarterly basis, their progress toward the completion of all of these goals.
Your Reference Committee heard strong testimony in support of Resolutions 906 and 925. Your Reference Committee appreciates and agrees with the sponsor of Resolution 925 that it is more prudent to advocate balance billing legislation at an appropriate time in contrast to a time certain, as this may hamper ongoing advocacy efforts with respect to other issues currently pending before Congress. Further, your Reference Committee believes that the third resolve in Resolution 925 is overly broad and confusing. Since Resolution 925 mirrors Resolution 906, your Reference Committee recommends adoption of Resolution 925, as amended, in lieu of Resolution 906. Comment: This does NOT imply that the AMA opposes balanced billing. At this point in time we MUST focus on THE ISSUE pending resolution: STOP THE MEDICARE CUTS. Even though, legislators may recognize the need to stop the cuts, they have done little to prevent them. Our AMA representatives including Dr. Cecil Wilson are working tiredlessly to convince House representatives and Senators to fix the SGR and to stop the Medicare once and forever. If we add balanced billing as an additional issue we may loose the battle. We all agree that balanced billing is our final goal but we need to prioritize our efforts and focus our advocacy on ONE and the MOST IMPORTANT issue now.
2. Opposing a single payor system: This resolution was introduced by the Georgia delegation and adopted as amended or substituted by the Reference Committee.
(1) Resolution 717 - Single Payer
RECOMMENDATION A:
Mr. Speaker, your Reference Committee recommends that the second resolve of Resolution 717 be amended by insertion and deletion on lines 24 -27 to read as follows:
RESOLVED, That our AMA distribute our policy positions in opposition to a single payer system on health system reform to all declared candidates for the presidency of the United States of America and formally request their public support of AMA policy positions on single payer system those positions (Directive to Take Action); and be it further
RECOMMENDATION B:
Mr. Speaker, your Reference Committee recommends that the third resolve of Resolution 717 be amended by insertion and deletion on lines 29 – 32 to read as follows.
RESOLVED, That our AMA immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the United States on health system reform, emphasizing pluralism. (Directive to Take Action)
RECOMMENDATION C:
Mr. Speaker, your Reference Committee recommends that Resolution 717 be adopted as amended.
Resolution 717 asks that our AMA (1) reaffirm AMA policy in support of pluralism, freedom of enterprise and its strong opposition to a single payer system; (2) distribute our policy positions in opposition to a single payer system to all declared candidates for the presidency of the United States of America and formally request their public support of AMA policy positions on single payer system; and (3) immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the US.
There was strong testimony in support of the sentiment expressed in the resolution, particularly the reaffirmation of policies referred to in the first resolve. However, compelling testimony cautioned against a negative campaign. Rather than criticizing the single payer approach, it was strongly suggested that the AMA should focus on clearly articulating AMA policies for health system reform to physicians and the public. There was some support for addressing AMA opposition to a single payer approach within the context of the Voice for the Uninsured Campaign.
Your Reference Committee concurs with testimony to keep the first resolve intact, and with testimony stating that any campaign should focus on a positive message promoting the AMA proposal for health system reform. There was testimony advocating linking the positive media campaign to the Voice for the Uninsured Campaign. Your Reference Committee believes that our AMA should have flexibility in implementing the two campaigns.
Comments: During the house debate the resolution was extracted from the consent calendar. Our delegation submitted additional language to be inserted after the following RESOLVED, That our AMA immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the United States on health system reform, emphasizing pluralism, creation of a marketdriven system, and continued opposition to a single payor system.(Directive to Take Action). This language was not adopted. I personally do not support a single payor system as THE only modality to reform the US healthcare system. A comprehensive system reform requires the participation of all participants in the healthcare delivery process - government (county, state, federal), insurance companies, employers etc.- . Our AMA is offering a plan to expand health insurance and we should support a PR campaign emphasizing this POSITIVE` message. We should clearly express what we stand FOR and not only what we are AGAINST. This resolution does not imply that the AMA favors a single payor system but in favor of market based approaches utilizing the brain power of potential innovative thinkers to reform our fragmented healthcare system.
3. Presidential Candidates:
(1) Resolution 603 - Presidential Candidates' Views on Health System Reform
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 603 be referred for decision.
Resolution 603 calls upon our American Medical Association (AMA) to host a US presidential candidate forum of all the candidates at the 2008 Annual Meeting.
Your Reference Committee received testimony that was uniformly positive of the resolution’s goal—making the views of presidential candidates on health reform available to physicians. There was some concern, however, about the method proposed by the resolution—using the next House meeting as the specific vehicle. Additional points raised included a potentially low fiscal note associated with this resolution, the questionable value of such a forum to presidential candidates because of a fairly small audience, the practicalities (audience questions, logistics, security concerns, etc.), and alternatives such as using our AMA web site as a way to share information with all member physicians, not just those in the House.
Your Reference Committee supports referral for decision to allow the Board to investigate the legal issues associated with an organization such as our AMA hosting a presidential candidate forum. There also would be major logistical concerns associated with using the House as a venue for a town hall meeting in June 2008. Referral will give the Board opportunity to study the feasibility of organizing the event as proposed, as well as to identify other ways to make physicians more informed voters and supporters of presidential candidates who espouse their preferred health care system. Referral for decision also will allow the Board to start planning the event, if feasible.
Comment: The recommended referral for decision was debated ad our delegation disagreed with that proposal. Nevertheless, that does NOT mean that our AMA will NOT support such a Forum but is seeking for an appropriate venue and suitable modality to maximize the desired effect of a such a forum. I trust the AMA Board to reach a decision on that matter.
I hope that the above information may help you to reach a balanced conclusion of the actions taken. Our AMA is the ONLY and MOST effective national physicians organization to represent our interest. Dissent and disagreement is inevitable but we all strive towards a compromise based on a common denominator: to represent the interests of the majority of all physicians. Your input is crucial and valuable and please continue sending me your e-mails. I am sure that other members of our delegation will provide you with their perspectives.
Please stay involved and do not drop your membership. Otherwise your voice cannot be heard!"
"As an AMA delegate I would like to offer you a different perspective of the issues outlined in your e-mail and the conclusions you have drawn.Please be advised that my comments are NOT necessarily reflecting the consensus opinion of our delegation. I will try to present the issues as accurate as possible but those comments are subject to addendum, correction or deletion by others delegates.
1. Balanced Billing: Two resolution were submitted for discussion (906, 925). Resolution 906 was submitted by our delegation.The Reference Committee made the following recommendation to the HOD,
"RECOMMENDATION A:
Mr. Speaker, your Reference Committee recommends that the first resolve of Resolution 925 be amended by insertion and deletion on page 1, line 24 to read as follows:
RESOLVED, That our American Medical Association devote the necessary political and financial resources to introduce national legislation at the appropriate time to bring about implementation of Medicare balance billing by January 2009 and to end the budget neutral restrictions inherent in to the current Medicare physician payment structure that interferes with patient access to care. (Directive to Take Action)
RECOMMENDATION B:
Mr. Speaker, your Reference Committee recommends that the third resolve in Resolution 925 be deleted.
RECOMMENDATION C:
Mr. Speaker, your Reference Committee recommends that the fifth resolve in Resolution 925 be amended by insertion and deletion on page 2, line 1, to read as follows:
RESOLVED, That our AMA Board of Trustees report back to the our AMA House of Delegates, by e-mail or fax on a quarterly basis, electronically by March 15, 2008, and at other times as appropriate on their its progress toward the completion of all of these goals. (Directive to Take Action)
RECOMMENDATION D:
Mr. Speaker, your Reference Committee recommends that Resolution 925 be adopted as amended in lieu of Resolution 906.
Resolution 906 asks (1) that our American Medical Association devote the necessary political and financial resources to protect patient access to care by advocating for national legislation or litigation to unconditionally implement Medicare balance billing by January 2009 and to unconditionally end the budget neutral restrictions of the current Medicare Physician Payment structure; (2) that this national legislation or litigation be designed to pre-empt state laws that prohibit balance billing and prohibit inappropriate inclusion of balance billing bans in insurance-physician contracts; and (3) that our AMA develop model language for physicians to incorporate into any insurance contracts that attempt to restrict a physician’s right to balance bill any insured patient.
Resolution 925 asks (1) that our American Medical Association devote the necessary political and financial resources to introduce national legislation at the appropriate time to bring about implementation of Medicare balance billing by January 2009 and to end the budget neutral restrictions inherent to the current Medicare physician payment structure that interferes with patient access to care; (2) that this national legislation be designed to pre-empt state laws that prohibit balance billing and prohibit inappropriate inclusion of balance billing bans in insurance-physician contracts; (3) that our AMA work on federal legislation that would prohibit any law or regulation from interfering with the patient-doctor relationship including any and all fiduciary relationships that are deliberate and contractual; (4) that our AMA develop model language for physicians to incorporate into any insurance contracts that attempt to restrict a physician’s right to balance bill any insured patient; and (5) that our AMA Board of Trustees report back to the AMA House of Delegates, by e-mail or fax on a quarterly basis, their progress toward the completion of all of these goals.
Your Reference Committee heard strong testimony in support of Resolutions 906 and 925. Your Reference Committee appreciates and agrees with the sponsor of Resolution 925 that it is more prudent to advocate balance billing legislation at an appropriate time in contrast to a time certain, as this may hamper ongoing advocacy efforts with respect to other issues currently pending before Congress. Further, your Reference Committee believes that the third resolve in Resolution 925 is overly broad and confusing. Since Resolution 925 mirrors Resolution 906, your Reference Committee recommends adoption of Resolution 925, as amended, in lieu of Resolution 906. Comment: This does NOT imply that the AMA opposes balanced billing. At this point in time we MUST focus on THE ISSUE pending resolution: STOP THE MEDICARE CUTS. Even though, legislators may recognize the need to stop the cuts, they have done little to prevent them. Our AMA representatives including Dr. Cecil Wilson are working tiredlessly to convince House representatives and Senators to fix the SGR and to stop the Medicare once and forever. If we add balanced billing as an additional issue we may loose the battle. We all agree that balanced billing is our final goal but we need to prioritize our efforts and focus our advocacy on ONE and the MOST IMPORTANT issue now.
2. Opposing a single payor system: This resolution was introduced by the Georgia delegation and adopted as amended or substituted by the Reference Committee.
(1) Resolution 717 - Single Payer
RECOMMENDATION A:
Mr. Speaker, your Reference Committee recommends that the second resolve of Resolution 717 be amended by insertion and deletion on lines 24 -27 to read as follows:
RESOLVED, That our AMA distribute our policy positions in opposition to a single payer system on health system reform to all declared candidates for the presidency of the United States of America and formally request their public support of AMA policy positions on single payer system those positions (Directive to Take Action); and be it further
RECOMMENDATION B:
Mr. Speaker, your Reference Committee recommends that the third resolve of Resolution 717 be amended by insertion and deletion on lines 29 – 32 to read as follows.
RESOLVED, That our AMA immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the United States on health system reform, emphasizing pluralism. (Directive to Take Action)
RECOMMENDATION C:
Mr. Speaker, your Reference Committee recommends that Resolution 717 be adopted as amended.
Resolution 717 asks that our AMA (1) reaffirm AMA policy in support of pluralism, freedom of enterprise and its strong opposition to a single payer system; (2) distribute our policy positions in opposition to a single payer system to all declared candidates for the presidency of the United States of America and formally request their public support of AMA policy positions on single payer system; and (3) immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the US.
There was strong testimony in support of the sentiment expressed in the resolution, particularly the reaffirmation of policies referred to in the first resolve. However, compelling testimony cautioned against a negative campaign. Rather than criticizing the single payer approach, it was strongly suggested that the AMA should focus on clearly articulating AMA policies for health system reform to physicians and the public. There was some support for addressing AMA opposition to a single payer approach within the context of the Voice for the Uninsured Campaign.
Your Reference Committee concurs with testimony to keep the first resolve intact, and with testimony stating that any campaign should focus on a positive message promoting the AMA proposal for health system reform. There was testimony advocating linking the positive media campaign to the Voice for the Uninsured Campaign. Your Reference Committee believes that our AMA should have flexibility in implementing the two campaigns.
Comments: During the house debate the resolution was extracted from the consent calendar. Our delegation submitted additional language to be inserted after the following RESOLVED, That our AMA immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the United States on health system reform, emphasizing pluralism, creation of a marketdriven system, and continued opposition to a single payor system.(Directive to Take Action). This language was not adopted. I personally do not support a single payor system as THE only modality to reform the US healthcare system. A comprehensive system reform requires the participation of all participants in the healthcare delivery process - government (county, state, federal), insurance companies, employers etc.- . Our AMA is offering a plan to expand health insurance and we should support a PR campaign emphasizing this POSITIVE` message. We should clearly express what we stand FOR and not only what we are AGAINST. This resolution does not imply that the AMA favors a single payor system but in favor of market based approaches utilizing the brain power of potential innovative thinkers to reform our fragmented healthcare system.
3. Presidential Candidates:
(1) Resolution 603 - Presidential Candidates' Views on Health System Reform
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 603 be referred for decision.
Resolution 603 calls upon our American Medical Association (AMA) to host a US presidential candidate forum of all the candidates at the 2008 Annual Meeting.
Your Reference Committee received testimony that was uniformly positive of the resolution’s goal—making the views of presidential candidates on health reform available to physicians. There was some concern, however, about the method proposed by the resolution—using the next House meeting as the specific vehicle. Additional points raised included a potentially low fiscal note associated with this resolution, the questionable value of such a forum to presidential candidates because of a fairly small audience, the practicalities (audience questions, logistics, security concerns, etc.), and alternatives such as using our AMA web site as a way to share information with all member physicians, not just those in the House.
Your Reference Committee supports referral for decision to allow the Board to investigate the legal issues associated with an organization such as our AMA hosting a presidential candidate forum. There also would be major logistical concerns associated with using the House as a venue for a town hall meeting in June 2008. Referral will give the Board opportunity to study the feasibility of organizing the event as proposed, as well as to identify other ways to make physicians more informed voters and supporters of presidential candidates who espouse their preferred health care system. Referral for decision also will allow the Board to start planning the event, if feasible.
Comment: The recommended referral for decision was debated ad our delegation disagreed with that proposal. Nevertheless, that does NOT mean that our AMA will NOT support such a Forum but is seeking for an appropriate venue and suitable modality to maximize the desired effect of a such a forum. I trust the AMA Board to reach a decision on that matter.
I hope that the above information may help you to reach a balanced conclusion of the actions taken. Our AMA is the ONLY and MOST effective national physicians organization to represent our interest. Dissent and disagreement is inevitable but we all strive towards a compromise based on a common denominator: to represent the interests of the majority of all physicians. Your input is crucial and valuable and please continue sending me your e-mails. I am sure that other members of our delegation will provide you with their perspectives.
Please stay involved and do not drop your membership. Otherwise your voice cannot be heard!"
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