Health system reform is coming -- and you all helped

I began my year as chair of the AMA Board of Trustees as the nation was in the midst of a presidential primary season promising a profound impact on medicine. The AMA already was engaged with candidates of both parties. The nation was ready for major health system reform.

Signs were everywhere. More than 46 million uninsured Americans. Health care costs rising at unsustainable rates. A Medicare payment system threatening to undermine seniors' access to care. Managed care abuses threatening physician practice viability. Massive uncertainty about health information technology. Concern over the proper role for measurement and quality reporting. Defensive medicine. Those problems remain, but I am sure we are at the brink of major reform.

The past 12 months showed how leveraging the power of organized medicine -- along with grassroots collaboration -- can be enormously successful.

Last July, a small number of U.S. senators attempted to leave town without fixing the planned physician pay reduction from Medicare's sustainable growth rate formula that would have cut physician payments by 10.6%. Immediately, tens of thousands of physicians and patients -- combined with in-your-face AMA and medical society advocacy -- put the pressure to those senators. We got the job done. And in November, some of those in Congress who were not supportive received walking papers.

And then the Litigation Center of the AMA and State Medical Societies made more physician victory announcements than this column space allows. Check the AMA Web site and see how we stood tall for physicians in Florida and Arkansas; for physicians who contract with United, Aetna, WellPoint and Cigna; and for physicians everywhere who relied on the strength of the AMA to combat the abuses that threatened your autonomy and your practice's viability.

During the campaign, the AMA led massive public relations, advertising and grassroots advocacy efforts about the nation's uninsured. It is a national disgrace that 46 million of our fellow citizens live sicker and die younger simply because they cannot find or afford health insurance.

The AMA may once have been seen as a lumbering 800-pound gorilla, but now we are seen as an agile, creative, forceful voice at the White House, with the political leaders in Congress, in the ears of the key committees in the House and Senate, and at the side of America's patients.

In the past few months, AMA's leadership has been more active in our nation's halls of power than at any other point in the AMA's recent history. While our nation's capital is not the center of the universe, the decisions being made today affect every patient and physician in the United States.

That's why it's crucial that we are collaborating more closely than ever with our state and specialty society partners. That's why it's critical that we are in constant communication and negotiation with major stakeholders in medical technology, health insurance, business, labor, nursing and so many others.

To achieve reform, this teamwork is essential. It's how -- in the past 12 months -- we've been able to get the Children's Health Insurance Program reauthorized. It's how we've achieved medical student loan relief. It's why the FDA finally will be able to regulate tobacco as a drug.

That's why I am optimistic. But, hey, I'm in solo practice! That means I do not let my hopes cloud the reality.

And we must separate that reality from the rhetoric. The reality is that change is going to come, and we need to effect that change. The rhetoric that somehow we can prevent change or that the sky is falling is neither constructive nor helpful to our cause.

I understand the unsustainable SGR payment formula hanging like a guillotine over medicine and over our patients who are elderly or disabled. I get it -- despite the federal government's support to implement health information technology solutions, many practices still will be hesitant to make the investment. And that's why the AMA will release a subscription-based platform of an array of technology solutions to take the risk, fear and major investment out of including health IT within your practices.

I know that despite the AMA's successful drive to ensure that quality measurement and reporting systems are designed by physicians, many of you will be suspicious and critical. We can create great tools, but it is hard to control how others exploit them.

I understand your concerns, because in my year as chair, I have heard from you early and often. I have had terrific conversations with family docs in rural towns and specialists in large academic medical centers, with young physicians, medical students and those nearing the end of careers. And I know all too well the emotions of those of you at the height of your skills who just want to practice medicine without the hassle, without others -- who understand little -- constantly looking over your shoulders.

I have listened and I've heard you. And AMA leadership and senior management have heard you as well.

I believe we can achieve health system reform this year, while carefully avoiding unintended consequences. We must prevent inter-specialty differences from threatening our potential collective success.

Twelve months ago, I was honored to help lead this organization on a path toward health system reform while facing daunting challenges.

Because of the efforts of physicians across America, we are closer than ever before. We will not rest until we achieve our goals. Thanks for allowing me to continue to serve both you and our patients. Together we are stronger!