Reform of health system, Medicare pay needs AMA input

A message to all physicians from Rebecca J. Patchin, MD, chair of the AMA Board of Trustees.

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 March 15, 2010.

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The AMA's National Advocacy Conference in Washington, D.C., earlier this month gave me an opportunity to reflect on the state of health system reform -- where we have been and where we are going.

Hundreds of medical and specialty society leaders assembled in the nation's capital March 1-3 to learn more about the issues facing medicine, what the AMA is doing to address and influence them, and how to educate their elected representatives in Congress more effectively.

At the top of the meeting's agenda was repairing the broken Medicare payment system.

When we came to Washington, D.C., physicians faced a 21% cut in compensation for treating our senior and disabled patients. This was because of cuts required by a flawed formula known as the "sustainable growth rate" or SGR. And as we all know, the SGR is neither sustainable nor growing.

Congress can fix this formula. The AMA, on behalf of America's physicians and seniors, is demanding that lawmakers do so. What occurred as the Advocacy Conference was unfolding was only a stopgap measure.

The night of March 2, after a day of visits from determined physician activists mobilized by the AMA, the U.S. Senate voted yet again to put off the 21% Medicare physician payment cut for one month, until April 1. Once again, the cuts were merely delayed, not stopped and reversed.

Physicians have been rightly outraged by the Senate's failure to act to fix this problem permanently. Our patients and practices are hurt by the ongoing instability in the Medicare system.

It's bad for all Americans, as well, because this vicious cycle of short-term delays increases the size of future cuts and raises the cost of a permanent solution for American taxpayers.

The U.S. House already has passed legislation that will permanently repeal the broken payment formula and replace it with one that better reflects the increasing cost of patient care. Now it's time for the Senate to do the same.

This ongoing injustice is playing out against a backdrop of the national debate over health system reform.

Just before the AMA gathered for its National Advocacy Conference, the White House hosted its "health care summit" that included members of Congress from both parties and both chambers. Although the public discussion of the issues among both parties was welcome, it did not achieve any breakthroughs.

Later, President Obama gave both houses of Congress a few weeks to work out their differences. Then he would ask that the budget reconciliation process be used to pass the final pieces of health reform legislation.

The reconciliation process is the mechanism used by the Senate to resolve spending and revenue differences in the budget process. By law, debate in the Senate is limited to 20 hours. Legislation can be passed by a simple majority instead of the 60 votes needed to break a filibuster.

In this instance, passing the health reform package would mean that the House would pass the Senate health system reform bill, and then the Senate would use reconciliation to patch up the bill. That means enacting a handful of relatively modest changes to the Senate bill, all budget related.

Even with reconciliation, nothing is guaranteed: There are many procedural hurdles involving arcane Senate rules. There's a lack of trust among legislators, and because of the limitations of the procedure, it will leave many problems unresolved.

This sort of legislative maneuvering is exactly why the AMA's National Advocacy Conference is such an important event for physicians. In addition to getting updates on the latest developments in the health reform debate, those attending also heard from elected and appointed officials who are close to the situation.

Among them were U.S. Secretary of Health and Human Services Kathleen Sebelius; U.S. Rep. Frank Pallone (D, N.J.), chair of the health subcommittee on the House Energy and Commerce Committee; and U.S. Rep. Michael Burgess, MD (R, Texas), one of a handful of physicians serving in Congress and a strong advocate for fixing the Medicare payment system.

Throughout the entire process, the AMA has been on top of the issues, informing legislators, educating them on the impact that legislation would have on physicians and influencing the debate even before the moment President Obama unveiled his health system reform guidelines in a speech at the AMA Annual Meeting in June.

But we can't do it alone. You can help. Use the AMA grassroots hotline at 800-833-6354.

Call your senators. Tell them that Congress must keep its promise to Medicare patients and military families covered by Tricare. Tell them that short-term fixes only will make future cuts deeper. Tell them to repeal the SGR. Every phone call and e-mail is important.

The AMA is committed to this mission, to fulfill its charge from the House of Delegates to pursue health system reform that is "consistent with the principles of pluralism, freedom of choice, freedom of practice and universal access for patients."

The AMA has been out front in this debate from the beginning, and it earned the right to have a seat at the table as the specifics are negotiated. We'll remain there as long as it takes to forge a better system for physicians and patients.

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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