Interim Meeting shows physician activism in action

A message to all physicians from the chair of the AMA Board of Trustees, Duane M. Cady, MD.

By Duane M. Cady, MDis a general surgeon who was in private practice for 35 years in Syracuse, N.Y. He served as chair of the AMA Board of Trustees during 2005-06. Posted Dec. 5, 2005.

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The threat to Medicare payments, physician activism, public health and the medical community's response to Hurricane Katrina were among the hot issues at the AMA's Interim Meeting Nov. 5-8 in Dallas.

At Saturday's opening session, AMA President J. Edward Hill, MD, said the looming Medicare physician payment cuts were a policy blunder that America could ill afford.

"I'm urging you to use your imagination and influence to come up with as many new ways as possible to tell our policy-makers that this [issue] is not about doctors," Dr. Hill said. "This is about patients."

Congress has only days left to prevent cuts of Medicare physician payments by 4.4% on Jan. 1, 2006. These cuts will be a disaster for patient access to care.

Fully 38% of physicians say they will accept fewer new Medicare patients if the first cut goes through. That 4.4% cut alone would make the average Medicare physician payment rate next year less than it was in 2001.

Thousands of physicians and patients have contacted Congress in recent weeks to urge that the physician payment cuts be stopped and replaced with an increase that reflects the true cost of practicing medicine.

At the AMA Interim Meeting, it was delegates' and alternates' turn to step to the plate.

As Dr. Hill said, the need for physician activism has never been more urgent -- and physicians responded. By the time Monday's general session of the house concluded, delegates had made more than 1,700 phone calls to their representatives and senators to demand action.

The response to the "Make the Calls" effort was so overwhelming that the hotel had to rush in more telephones for delegates to call the AMA grassroots hotline. Even before lunch, many delegations had 100% participation.

On another issue that involved Medicare, the AMA also voted to support only those Medicare pay-for-performance initiatives that meet our AMA's Principles and Guidelines for Pay-for-Performance.

The House of Delegates reiterated the AMA's position that pay-for-performance measures must be focused on quality; foster the patient/physician relationship; and be patient-centered, fair and ethical.

But the Medicare issue wasn't the only instance of physician activism on display at the Interim Meeting.

One example came in response to the 5,400 AMA members who took part in a recent online AMA Member Connect Survey on resolutions to be considered by the house.

In the survey, 79% of respondents wanted the AMA to pursue federal legislation banning smoking in all places where food or drink is sold to the public and consumed on premises.

The house agreed, adopting a resolution calling for the AMA to support a ban on smoking in all workplaces, not just food establishments.

Another resolution was adopted with an amendment asking the Council on Ethical and Judicial Affairs to establish boundaries of ethical practice for physicians participating in the interrogation of prisoners and detainees. The resolution recommends input be sought from all relevant AMA stakeholders as part of the process.

And in another example of physicians working for public health, Dr. Hill in his Saturday address hit an emotional chord as he recalled working with other volunteer physicians and nurses in Mississippi's Tupelo Coliseum in the wake of Hurricane Katrina.

He described the gratitude shown by patients as a reflection of the "soul of medicine." So was a stirring video that depicted volunteer physicians in the relief effort shown at the start of the session.

The hurricanes and their aftermaths sparked a debate over public health disaster preparedness, and the AMA House of Delegates emerged with several recommendations.

The house resolved to urge all state and local public health jurisdictions to create a comprehensive public health disaster plan and voted to publicize more actively the AMA's disaster training courses.

The AMA will work with the Federation of State Medical Boards; its member boards; and state, district and territorial governments to set up a clearinghouse to speed up the licensure review process for physician volunteers working in disaster areas.

The AMA also will support national legislation giving qualified physician volunteers automatic medical liability immunity in the event of declared national disasters or federal emergencies. The AMA already has helped secure immunity for physician volunteers specifically for the Katrina disaster.

At Sunday's educational session, Donald Palmisano, MD, a New Orleans native and AMA past president, helped define what health care has learned from the devastation wrought by Hurricanes Katrina and Rita.

"A lot of lessons learned are ones learned a long time ago," Dr. Palmisano said. He recalled volunteering after a hurricane devastated Florida in 1965. After that experience, he said, it was clear that better communication and stronger government leadership were needed. It's a lesson as true now as it was 40 years ago, he said.

Many physicians, including Floyd Buras, MD, a New Orleans-area pediatrician and president of the Louisiana State Medical Society, lost their entire practices.

Dr. Buras was part of an eight-member panel that featured physicians who lived through the hurricanes and helped in recovery efforts. He said all of his medical records had been destroyed by flooding, and most of his patients had been scattered to other parts of the country.

Such observations led AMA Trustee Robert M. Wah, MD, to point out that hurricane recovery efforts may lead to wider adoption of health information technology.

"As long as you're going to have to rebuild, you might as well rebuild digitally," Dr. Wah said. "Medical information on paper is very difficult to deal with."

The AMA Foundation continues to seek contributions for its Health Care Recovery Fund, which offers grants of up to $2,500 to help physicians from hurricane-ravaged areas rebuild their practices. Attendees at the AMAInterim Meeting donated more than $37,500 to the recovery fund in just four days.

Dr. Buras is among those who got help from such support. "It gives me hope that I will be OK," he said.

Duane M. Cady, MD is a general surgeon who was in private practice for 35 years in Syracuse, N.Y. He served as chair of the AMA Board of Trustees during 2005-06.

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