Starting the new year with our priorities set realistically

The new year is upon us and brings excitement and hope for new beginnings in all of our endeavors. It is time to review our gains and losses in 2006, and to set our goals for 2007. So let's begin with an honest and critical look at the year that has just been completed.

Last year, our No. 1 legislative priority was again medical liability reform. For the 10th time in the past 10 years, our MICRA-type bill was passed by the U.S. House of Representatives, only to be stalled in the Senate. As in past years, the bill was prevented from a floor vote by the filibuster or cloture rule.

Even though it appears that we would prevail in a floor vote, such a vote has been prevented by a handful of senators. The cloture rule necessitates a supermajority vote of 60 to bring a bill to the floor for a final vote that can enact the bill with a simple majority vote of 51.

Another major setback was a ruling by the 3rd Circuit Court of Appeals in Lake Charles, La. A five-judge panel struck down the Louisiana cap on damages in a 3-2 decision. Fortunately, the written decision included some gross inaccuracies, such as a statement that there is absolutely no proof that caps are related to the lowering of medical liability premiums.

Statements such as this give us hope that this unfortunate ruling can be overturned on appeal. However, the crystal-clear lesson for us is that even our most dearly won gains are at risk as long as there are trial lawyers and judges, as long as the tort system is the method by which medical liability claims are adjudicated.

On a much more positive note, we saw continued reductions in the medical liability insurance premiums charged to physicians in Texas. This follows their tort reform efforts and the passage of Proposition 12, which amended the Texas constitution to allow for caps. It is reported that the improvement in the medical liability climate in Texas has been so remarkable that their state medical board has been swamped with applications from physicians who want to practice in the Lone Star State. This Texas experience documents the fallacy of the ruling in Louisiana.

SGR battle

Because of the stalemate of our medical liability legislation, the majority of our time this year has been spent with an all-out effort to educate the public and our legislators about the shortcomings of the Medicare sustainable growth rate used to calculate physician payments. Because of this outdated and unfair formula, we were scheduled for an across-the-board cut of 5% in 2007.

Long story short, last-minute action by the Legislature canceled the cut and instituted a freeze at 2006 levels (which by the way, were unchanged from those in effect in 2001). A new addition was a provision for a 1.5% increase starting in July 2007 for those physicians who voluntarily report performance measures. The problems associated with this little addition are obvious.

Our quandary is that we are clearly fortunate that our senators and representatives in Washington stopped the 5% cut. However, the freeze means that we fall even further behind in reimbursement, since the fixed costs of our practices increase each and every year. To make matters worse, all other sectors of health care see yearly increases of at least the amount of annual increases in the cost of living.

Further gains

In 2006, we also spent a significant amount of time developing proposals for expanding coverage of the uninsured. We have been active participants in a variety of coalitions to address this increasingly important problem. We have answers based upon facts and reality. It is imperative that physicians be at the center of these discussions.

We continued our leadership in the area of healthy lifestyles. We have targeted the shocking levels of obesity, lack of exercise, tobacco and drug abuse, and other behavioral problems that threaten the health and well-being of our patients. Beyond this are the phenomenal, unnecessary costs that these behaviors add to health care.

Although the effects of Hurricanes Rita and Katrina essentially have disappeared from the pages of our newspapers, the devastation to the physicians, other members of the health care team and their patients continues.

Health care delivery in many areas depends solely upon the ongoing heroic efforts of dedicated physicians, nurses and others. These courageous professionals epitomize the ideals for which we all stand. They need our continued support. The American Medical Association has made a long-term commitment to disaster preparedness and as a part of this effort we are expecting the launch of a major new journal dedicated to disaster preparedness in 2007.

Those are just a few of the many things that we can look back at that occurred in 2006.

Lessons learned

Certainly we have had significant victories as well as depressing losses. What is most important, however, are the lessons learned. These are what must drive our actions in the coming year. Some will dictate what we must do as an Association. Others will give us valuable insights into what we must be prepared to do as individual physicians.

Medical liability is one area in which we seem to make little progress as long as we "soldier on" and live with the terror of the tort system. There is no question that as long as we continue to allow ourselves to be subjected to the inequities of this system, we will never see meaningful change. It is clearly time that we face this undeniable fact. The day will most certainly come when we must say ENOUGH.

Since we spent a majority of our time fighting for fair reimbursement in the Medicare system last year, let's look at this first. Our very intense and expensive campaign definitely captured the interest and support of the public and the press; however, the legislative outcome was lackluster at best.

It is clear that the costs are such that legislators are not willing to face true reform of the SGR formula. Even more instructive of the realities of modern Washington is the fact that even the bill that gave us a freeze was loaded with "earmarks" (in English, that's PORK). We have heard that in spite of our entreaties, legislators are fully aware that physicians continue to provide care for their Medicare patients. This they take as proof-positive that, regardless of what we say, physicians feel they are fairly reimbursed for their services.

We have done our very best to send the message that physicians really are having trouble making their practices fiscally viable. However, this seems to fall upon deaf ears for the reason stated above.

As I travel around the country, I am seeing that more and more physicians are being forced to make the decision that they must reduce the number of Medicare patients in their practices.

The most common way that this is being done is by closing practices to "new" Medicare patients. This practice is already causing hardships for seniors in some parts of the country, and their legislators are getting the message loud and clear.

The unfortunate lesson is that this is what it takes to get the attention of our legislators, and that to date, only a very few understand.

I have deliberately omitted any reference to the 800-pound gorilla sitting in Medicine's living room: pay-for-performance. Because of its size and complexity, I plan to devote next month's column entirely to it.

Suffice for now to say that the pay-for-performance issue continued in 2006 to gain momentum and the severity of its unintended effects became more and more clear with each passing week.

Be assured that I have strong views, which I fully intend to share with you in one month.