Opinion

AMA's private sector advocacy efforts yield results

A message to all physicians from AMA Chair Rebecca J. Patchin, MD.

By Rebecca J. Patchin, MDis an anesthesiologist and pain management specialist in Loma Linda, Calif. She served as chair of the AMA Board of Trustees during 2009-10. Posted Oct. 5, 2009.

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As I'm writing this column, the flurry of negotiations for health system reform continue to dominate the news. Will there be bipartisan agreement? Will the provisions about x, y and z find their way into the final bill?

By the time you read this, the situation likely will have changed. Here's what you should know: Behind the scenes, our grassroots advocacy helps ensure that physicians' and medical students' interests are well-represented. Our strategic communications work helps keep you informed. Our micro Web site is constantly updated with resources, tools and information that provide you with what is necessary to get involved -- to help us reform the system for our nation (link).

Yet, even as our country debates health system reform -- even as we engage in what is likely to be one of the most historic debates in our nation's history -- there is more to the AMA's advocacy than what happens in Washington, D.C. For the practicing physician trying to navigate yet another health insurer hassle, AMA advocacy provides actionable transparency. Physicians know that collaboration often results in superior patient care. We've recently started a project using that model in innovative ways. And for the solo, small or large group practice that wants to grow and ensure they are doing what their patients want, the AMA can help there as well. Here's how:

Last year, the AMA launched our Heal the Claims Process campaign to raise attention about the ills of the claims-processing system, and more importantly, to do something about it. The campaign caught health insurers' attention across the country. To put it mildly, they weren't exactly thrilled to be graded on administrative accuracy, whether they paid their claims on time, and whether their payment rules were understandable to the average physician.

Before we had proof -- before we had hard data -- we never got very far, did we? That tide has turned. We not only put out grades, but we shared the data with the health plans. You don't believe us? Here you are. Full transparency. That first year, we heard a decent amount of grumbling, but we also earned grudging acknowledgment that there were problems; that physicians had valid reasons to be upset. To put it mildly, we know.

A few months ago, we released the second report card (link).

I'm very pleased that health insurers have made important improvements since they received their first report card. Or should I say, since we've taken steps to diagnose the strengths and weaknesses of the claims-processing systems used by seven of the nation's largest health insurers and Medicare.

There is definitely more work to do. Research shows that the inefficient and inconsistent claims process adds as much as $200 billion annually to the health care system; that 14% of physician practice revenue goes to fighting denials and other administrative headaches.

To be fair, a majority of the insurers we're scrutinizing reduced the time to respond to a physician claim, and they're getting better with accurate payments. In 2008, insurers paid the expected contract rate 62% to 87% of the time. This year, they've been accurate 72% to 93% of the time. We hope this positive trend will continue.

So while we're pleased that the health insurers are responding to our report card, we also believe that with the right approach, we can work with them to improve in other ways. In Colorado recently, we've helped lay the groundwork for the Colorado Collaborative Quality Improvement Project, which will begin next year.

We've created this project with the Colorado Medical Society and UnitedHealth Group from the ground up to help physicians compare what they do with best practices identified by state and national medical organizations. Similar to the report card, this is a data-driven project with a goal to enhance value, improve outcomes and increase the quality and affordability of health care.

Furthermore, unlike some proposals, this collaboration is voluntary. And it's physician-built, so you can be confident it meets AMA policy to enhance patient care, and it will not interfere with the patient-physician relationship.

The data also will not be used in any retributive manner. In the spirit of a true collaboration, physicians can review what they do based on what others do, and the health plan will help share data so physicians get the full picture. In other words, this is a truly collaborative approach using the best information available to help patients and physicians. In other words, what the AMA is all about.

The third project you should know about is one that will help your practices by helping you improve from your patients' point of view. Specifically, we've launched a "patient experience" pilot project in Illinois to allow patients to rate their patient experience from the time they make an appointment to when they leave the office; follow-ups, etc. I know that there are popular Internet ratings services, but that information is collected the same way a customer might rate his or her hamburger. Not useful.

Rather, the AMA pilot project will allow physicians to gather de-identified data from their patients. It will allow you to see where your office can improve; how you can enhance the value you provide. The pilot will help us refine the survey questions, improve the resource, and ultimately make it available to you. That's what we do -- help you help your patients.

One way to look at the national scope of all the AMA is that we're doing everything possible to see health system reform enacted this year. But those efforts don't stop us from providing tools, resources and advocacy needed right now. Today's physicians need an AMA that knows how to advocate nationally, and also provide what physicians need locally -- right in their own offices.

That's today's AMA.

Rebecca J. Patchin, MD is an anesthesiologist and pain management specialist in Loma Linda, Calif. She served as chair of the AMA Board of Trustees during 2009-10.

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