AMA: A look at the facts on health reform

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

AMA: A look at the facts on health reformAs members of Congress return to their districts this month, it should be a time for thoughtful dialogue on health system reform so that when lawmakers return to Washington they can complete their work. Physicians nationwide are engaged and passionate about the health reform debate. After all, physicians are forced to navigate a dysfunctional system to provide patients with the highest-quality care. As you talk with your patients, colleagues, and lawmakers, here are some questions you may be thinking about.

Why do we need health system reform this year?

Currently 47 million Americans don’t have health insurance . Patients that suffer from disease or disability are subject to coverage denials for pre-existing condition limitations. Physicians and patients have to fight through insurer red tape to get payment for necessary care. We need to remove regulatory barriers and empower physicians with better information at the point of service to improve the quality of care.

What is the AMA working for?

The AMA is committed to keeping medical decisions in the hands of patients and their physicians and preserving that sacred relationship. Insurance needs to be affordable and available to all patients though a choice of plans regardless of job or health status. The flawed Medicare payment formula must be fixed. Medical liability reforms must be adopted. We need a system that promotes quality, incentivizes care coordination and emphasizes prevention and wellness initiatives.

Why has the AMA been engaged in the health system reform debate?

As physicians, we see first hand the devastating effects of our broken health care system. The uninsured live sicker and die younger. Individuals, small business and those suffering a serious disease are disadvantaged in the current health insurance market. Dedicated physicians are driven from the profession by the burdens of bureaucracy and payments in public programs that fail to cover physician practice costs. We take our position at the center of the health reform debate as responsibility and we are committed to achieving affordable, portable coverage for all.

What does the House bill mean to the health reform debate?

The bill expands coverage, offers a choice of plans, eliminates denials based on pre-existing conditions and repeals the broken Medicare physician payment system. It is a starting point for the health reform debate and the AMA is committed to staying engaged to improve the final legislation. Already, the House Energy and Commerce committee passed important AMA-supported revisions to the House bill that will allow physicians to negotiate payment rates in the public plan option and guarantee voluntary physician participation. The committee also voted to add modest medical liability reforms to the bill.

Why is it so important to have Medicare physician payment reform as part of comprehensive health system reform?

Reform of the broken Medicare physician payment formula is necessary to assure access to care for seniors. Without congressional action, Medicare cuts will total about 40 percent over the next five years. The gap between payments and costs will make it very difficult for physicians to keep their doors open to all Medicare patients and make quality improvement to their practices that benefit all patients.

What’s next for the AMA?

America’s patients and physicians deserve better than the status quo. There is significant common ground on a number of important issues. Issues such as financing and whether or not a public plan is offered must be resolved. The AMA will be at the table to improve the final legislation, and we urge all physicians to join us in our quest to pass health reform this year that better serves patients and empowers the dedicated physicians who care for them.

The AMA is reaching out to patients and physicians with information on how all Americans will benefit from improvements to our current health care system. Information is readily available on the AMA Web site, and this month we’ll continue a series of conference calls with physicians across the country and participate in health reform events to build support for the right reforms and to secure enactment of needed health system reform this year.

For more information from the AMA on health reform, please visit www.ama-assn.org/go/hsr.

J. James Rohack is President of the American Medical Association.

Comments for this AMA post are now open. A reminder that comments must remain civil, respectful, and relevant to the post at hand. I reserve the right to delete any comment for any reason at any time.

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  • T.R. Eckler

    Providing physicians with the ability to negotiate their fees is a good step forward for the public plan, and the overall issue of the barriers to physicians negotiating fair rates for services is one that I think needs more attention in this debate. In addition, I wonder what medical students think about the plans for the reform of their futures in the practice of medicine?

  • http://drwes.blogspot.com Dr Wes

    Heh. Couldn’t help but cluckle at the html link: “ama-ass.org/go/hsr”. I think it’s supposed to be: http://www.ama-assn.org/go/hrs

    Freudian slip?

  • http://drwes.blogspot.com Dr Wes

    Er. Make that correct link as http://www.ama-assn.org/go/hsr

    You know what I mean….

    • http://www.kevinmd.com Kevin

      Thanks for the catch Wes. I made the correction.

      Kevin

  • Primary Care Internist

    Thanks for your evident support of physicians and patients, Dr. Rohack, but a couple of concerns I have about the AMA:

    1- As doctors, we need an organization working primarily for US. Of course it’s nice to be concerned about the uninsured and the public health at large etc., but there are many, many organizations both within and outside the healthcare industry already advocating for these latter concerns. I think the AMA has largely lost membership, and probably not encouraged new membership, because of the perception that it’s not looking out particularly for the interests of doctors.

    2- I am quite dismayed by Mr. Obama’s uninformed comments on pediatricians & tonsillectomies, and on his analogy of auto repair when referring to hospital readmissions. Isn’t it possible to respond strongly to these comments while still maintaining constructive dialogue and civility? Whether true or not, the AMA is seen by many laypeople as the voice of doctors, and I would’ve thought a public response to such comments would come quickly.

    Thanks,
    Kumud B. Jindal, MD, MPH

  • Doc99

    Dr. Rohack
    Thank you for allowing comment. I have two questions -
    First, you mentioned negotiation. Would that be collective negotiation, eg the AMA negotiating fees on behalf of its members?

    Second, you mentioned modest tort reform. Which reforms, exactly were incorporated into the bill?

    Thanks in advance for your answers.

    Second

  • Dr. Steve

    I’m glad the AMA has continued to take a constructive approach to the health reform discussion. I’m, also, very appreciative of the fellow physicians above for their posts which are even-headed, sincere, and sensitive to the seriousness of this topic.

    There is so much misinformation, so much partisanship, so much passion over-running the national HSR dialogue that we face the real risk as a nation of marching doggedly forward to catastrophe because we refuse to admit as a nation that:

    1) we must take responsibility for our own lifestyle choices (i.e. diet, exercise, tobacco/alcohol use, etc…),
    2) that many more of us can have what we NEED if we aren’t forced by a broken liability system and to provide what everyone WANTS,
    3) that for-profit private health insurers require reform of their industry to better serve patients without crushing hard-working physicians,
    4) that death is a natural and inevitable element in the cycle of life and a civilized society should address death with dignity and respect, and
    5) that it helps no one to vilify and attack personally people with whom we have a difference of opinion

    Of course HR 3200 is flawed. Of course politicians are going to misstate things either due to an honest error or intentionally to create sensation. That’s politics and it’s not unique to HSR in any way.

    No matter what happens in 2009 the work will not stop and future years will bring many more challenges and opportunities for further reform and refinements. As a middle-of-the-road physician early in my career I am proud to be an AMA member and proud to see the AMA take both the high road and a long-term view in these very serious discussions on very serious problems.

    Thank you, Kevin, for facilitating this forum. Thank you, AMA, for demonstrating leadership and refusing to stoop to public mud-slinging even in the face of so much fear and concern.

  • Anon

    Doc99, there is no federal tort reform without single payer. Otherwise it’s a state issue and there’s little the Feds can do. It is thrown in there because every smart lobbyist knows that merely saying the words are red meat to the lions even though it has little benefit to physicians, and if you offer them that they’ll lose focus on everything else.

    As to payment “reform” the AMA has apparently defined reform as trying to get the payments under the current system increased, rather than actually changing the way you are reimbursed. I would say that’s not really a meaningful reform at all.

  • Matt

    I’m unsure why this post is titled the way it is. It’s really more of am AMA mission statement than a factual analysis of the bills at issue. The facts are that if you like dealing with Medicare then the current bills will give you more of that. Of you don’t think Medicare for all is the way to go, then you’ll want to start working hard to defeat the current healthcare “reform”.

  • Informed Patient

    As a patient who continually seeks out good information on health care, I found this post and the AMA website material on healthcare reform decidedly unhelpful. Lots of generic bullet points that everyone but Betsy McCaughey could agree upon.

    Physicians can be a key part of the solution to provide more efficient and effective care and eliminate the myriad pressures that make using and working within our healthcare system like shopping in a Walmart.

    I haven’t seen evidence that the AMA is doing that, although there is encouraging news coming out of many practice centers throughout the country: http://www.nytimes.com/2009/08/13/opinion/13gawande.html?pagewanted=1&_r=1&hp

  • Matt

    Here’s an interesting fact on health care reform:

    http://www.washingtonpost.com/wp-dyn/content/article/2009/08/13/AR2009081301914.html

    “Separately, a coalition of groups backing Obama’s proposals launched a $12 million TV ad campaign Thursday, pitching health insurance reform in states where centrist Democratic House members or senators are under pressure on the issue. The campaign is intended to serve as a counterweight to critics who have shouted down Democratic lawmakers at town hall meetings, encounters that have received heavy news coverage.

    The coalition distributing the ads, Americans for Stable Quality Care, is funded largely by the pharmaceutical industry and includes the American Medical Association; Families USA; the Federation of American Hospitals; the Pharmaceutical Research and Manufacturers of America, known as PhRMA; and the Service Employees International Union. PhRMA has promised to contribute as much as $150 million for advertising and grass-roots activity to help pass Obama’s health-care reform package.”

  • Gary

    Any new health care plan(s) must include negotiated rates and not dictated/assigned fees. Medicare is broke in many ways, but some specialties are severely penalized with the ridiculously low reimbursement rates, that keep getting lower.

  • Matt

    How does one “negotiate” with an entity that does not have to worry about profit, and has a limitless supply of money? Short answer: you don’t. The idea that there will be any “negotiation” is a foolish one.

  • http://www.kevinmd.com Kevin

    The following responses were forward to me from the American Medical Association.

    Response to questions from “Doc99″
    – An AMA-supported provision of the House bill passed by the Energy and Commerce committee says that physicians can negotiate payment rates in the public option, but the bill does not address whether negotiations would be collective or individual. Participation is also voluntary for physicians.

    – New medical liability provisions in the bill encourage the states to explore alternatives to the costly liability system through reforms that ensure court cases have merit and that allow providers to quickly compensate patients without litigation (i.e. certificate of merit and early offer).

    Response to question from “Primary Care Internist”
    - The AMA contacted White House staff this week to again express strong concerns with some recent medical treatment examples used by President Obama. We’ve made it clear that physicians are extremely dedicated and focused—first, foremost and always—on providing care that best serves their patients.

    We agree with President Obama on the importance of prevention. However, a recent example used to illustrate his important point was misleading. Surgeons are not paid $30,000 to $50,000 to amputate a diabetic’s foot. Medicare pays a surgeon, on average, from $541.72 to $708.71 for one of two procedures involving a foot amputation. It is possible that the total bill, hospital stay, rehabilitation, prosthesis, etc. may approach the larger amount mentioned.

    In the case of tonsillectomies, a patient is referred to a surgeon after medication therapy has proven to be ineffective. Actually, the medical profession itself recognized questions about utilization and appropriateness of tonsillectomies and took action by developing clinical guidelines, which has resulted in a sharp decline in the rate of tonsillectomies.

    These types of examples create the impression that physicians are motivated by payment levels rather than what is best for patients. The AMA will continue to stress to our elected leaders that physicians are dedicated to putting patients first and optimizing health care quality.

    You can learn more about the AMA’s advocacy for physicians by signing up to directly receive the AMA’s Health System Reform Bulletin at http://www.ama-assn.org

  • Primary Care Internist

    Thanks for the responses, Kevin & AMA speechwriters. But these kinds of wishy-washy nonresponses are exactly what I’m talking about. How hard is it for someone with a pulpit (ie. Dr. Rohack) to go on CNN and say “President Obama, your recent statements were wrong and frankly insulting to the professionalism of hard-working doctors, and here is why…”

    In fact, Rohack WAS on cnn recently, talking health reform with other non-practicing celebrity physicians Sanjay Gupta, Michael Roizen “chief wellness officer”, and politician Bill Frist – hardly a collection of doctors representative of those dealing with real patient care issues – how disappointing.

    Thanks,
    Kumud B. Jindal, MD, MPH

  • Matt

    Why would the AMA say that when it backs the President’s position. Along with the pharmaceutical industry.

  • Robert Ricketson

    Just thought I’d post this. I “copy and pasted” this directly from the Committe on Appropriations. Summary:American Recovery and Reinvestment website.
    “Lower Healthcare Costs: To save not only jobs, but money and lives, we will update and computerize our healthcare system to cut red tape, prevent medical mistakes, and help reduce healthcare costs by billions of dollars each year.

    $19 billion for health information technology to prevent medical mistakes, provide better care to patients and introduce cost-saving efficiencies.

    $2 billion to provide for preventative care and to evaluate the most effective healthcare treatments.”
    The bulk of the Health Care package, in reality, is designed to reduce payouts by increasing “healthcare technology” to the tune of 19 billion dollars. Note the 2 billion dollars to “evaluate the most effective healthcare treatments”. What is the patient reponds to something else and not the “most effecive treatment”? Will that be paid for?
    Food for thought. In the State of Texas, there is movement to change the word complication to “medical error”. Good for tort. No payment if a “medical error” occurs. Some listed examples are: UTI after foley catheter placement (no kidding); PE after hip replacement (50% of post op patients scanned have some evidence of DVT), wound infection (any) following TKA, CABG; the list went on.
    Library of Congess, American Recovery and Reinvestment Act of 2009.
    Do use this link: http://thomas.loc.gov/cgi-bin/query/D?c111:8:./temp/~c1113hQwkS::
    Sorry this was long winded. This way you can read what most of our elected officials failed to do.

  • Doctor’s Spouse

    I applaud “Primary Care Internist” points. I have thought the same thing – how can the President get away with making such misleading statements about physicians? He portrays them as money grubbing people.
    Obama also used the example that two different doctors will order the same set of tests for a specific patient because they don’t share records. That is also untrue. Even without access to electronic medical records, doctors share test results – ESPECIALLY when the patient speaks up and says, “I’ve already had that test.”
    I agree that health insurance reform is needed. And I’d love to see everyone have health insurance. But there are lots of ideas for sensible reform that are not reflected in HR 3200. The AMA says that they want to achieve reform by protecting the sacred physician-patient relationship without interference by insurance companies or the government. I don’t see how HR 3200 supports that objective.
    Currently, my husband, who is a physician has the freedom to choose which insurance plans he accepts (including Medicare). If HR 3200 is approved – looking 5 steps down the road – my prediction is that that freedom will no longer be there.

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