Integrity should be guiding force in finding SGR fix

A message to all AMA members from the chair of the AMA Board of Trustees, Cecil B. Wilson, MD.

By Cecil B. Wilson, MDis an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11. Posted Aug. 7, 2006.

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Among the frustrations our profession faces on a daily basis, none is more irritating than the seeming indifference of government leaders to the fatal flaws in the Medicare physician payment process, notably the ill-named sustainable growth rate.

In my view, the frustration stems from a fundamental principle to which we all should adhere -- the principle of integrity.

Defined as firm adherence to a code, especially a moral code, integrity is easy to understand and vital to maintain. It is the honesty, the reliability, the very legitimacy of medicine. Some would even call it the soul of medicine.

Without integrity, there can be no workable patient-physician relationship, with all the negative effects a fractured relationship implies. Without integrity, we all might as well fold our tents and steal away into the night.

More to the point, integrity in the SGR discussions involves a series of honesty factors, not least of which is an honest day's pay for an honest day's work. For a decade, the AMA patiently and firmly has presented Congress and the Health and Human Services Dept. with practical, workable solutions to the SGR problem. Yet the annual payment crisis recurs with the regularity of the seasons.

Beyond the obvious moral imperative at stake, the annual threat of Medicare payment cuts casts a cloud of doubt over every planning decision a physician treating Medicare patients must make.

If 4.7% cuts are made Jan. 1, 2007, and a cumulative 37% cut is made by 2015, as required by Congress, and if practice costs continue to rise as they inevitably do, rational physicians cannot long continue to take the difference out of their own pockets.

One AMA physician poll tells it all. Asked what the effects of proposed cuts would be, nearly half (45%) of physicians said they would have to decrease the volume of, or stop accepting new, Medicare patients. Half also said they would be forced to defer buying badly needed equipment, including information technologies.

Currently, one in four Medicare patients reports trouble finding new primary care physicians.

More startlingly, 65% of the physicians in our survey said that more and more Medicare patients receive treatment in the emergency departments rather than in the physician offices of their communities.

Congress promised America's seniors care. Congress needs to back its commitment with reasonable payments. The alternative is disgraceful. An ironic coincidence can be found in the third, fourth and fifth letters of "diSGRace."

Integrity compels America's physicians to point out that a 4.7% cut in physician payments involves savings only at the margins. Physician payments will amount to just 16% of Medicare's $388 billion spending in 2007. A slice of 4.7% takes $30 billion out of physician income but amounts to just 0.8% of the total Medicare bill for the year.

Where is the integrity in that?

Integrity cannot be bought or measured with money. But it can be irretrievably lost unless protected and enhanced every day by each of us.

Not for personal gain. But to preserve our ability to care for our patients.

Integrity is integral to our profession. It is the way we do business.

Is it too much to ask Congress and the administration to do the same?

I urge you to join me in asking them.

Cecil B. Wilson, MD is an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11.

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