Physicians have the expertise to get delivery systems right

A message to all physicians from Robert M. Wah, MD, chair of the AMA Board of Trustees.

By Robert M. Wah, MDis a reproductive endocrinologist and ob-gyn in McLean, Va. He was chair of the AMA Board of Trustees during 2011-12 and is currently AMA president-elect. Posted Aug. 15, 2011.

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In my experience, when someone says "payment reform," what physicians hear is "pay cuts." Payment reform is an important part of our new health care legislation that needs to be addressed carefully and fully, but I am not the financial expert to do that.

I am a physician. As a physician, I have more standing when I talk about delivery system reform than dollars. We all do. That's because, as physicians, we know what is best for our patients and our practices. We are in a better position to improve patient care coordination and reduce costs because the doctor-patient relationship is at the core of our profession. That's where our expertise lies.

When we get the new delivery systems right -- so they work for physicians and patients -- that's when we work on payment reform to facilitate the new delivery system while providing a sound financial foundation for physician practices. Delivery reform and payment reform are intertwined. Physicians play a key role in both increasing quality and holding down costs.

And that is why it is so important that physicians play a leadership role as our new system evolves.

A few weeks ago, I chaired my first Board of Trustees strategy session. Among other things, we examined the future of medical practice, and we took a hard look at what the profession will look like in the coming years, new delivery systems and all.

As you might imagine, there were many predictions. But throughout, there was one recurring theme: We are facing a health care system that is going to be in a constant state of change.

During that same Board of Trustees meeting as we brainstormed about the future, we also discussed current problems besetting our profession -- problems that plague physicians and take up far too much time and energy. Problems that should be dealt with before we can focus our full attention on innovation and the future.

I'm talking about things like Medicare's sustainable growth rate formula, ongoing administrative hassles and an insurance industry that gets payments wrong far too much of the time.

  • In 2010, Congress patched the SGR five different times, sometimes for as short a period as 30 days, with some of those Band-Aids coming after a missed deadline. Who can operate a practice with this kind of uncertainty? And because Congress continues to kick the can down the road, an SGR-driven 30% cut is due in January 2012. The AMA has called for Congress to scrap the SGR formula and provide a five-year period of stable payments while new physician-led delivery models and payment systems are developed.
  • Administrative hassles and frustrations are legion in every medical office. The AMA's recent National Health Insurer Report Card shows that fully 20% of insurance payments to physicians are wrong. What if a company's employees received paychecks that were wrong one time out of five? Why do we tolerate this payment malpractice? One might even consider it worthy of penalties for pain and suffering, and negligence!
  • We are fortunate that the AMA's private advocacy group is there to take the insurance industry to task and help physicians learn how to deal with issues involving the insurers. They have helped win big victories like the $350 million UnitedHealthcare settlement. Victories like this are important financially, but they also are noteworthy in providing hassle relief.

The Board of Trustees also can foresee a future with a more coherent, integrated and aligned health care system. There will be an opportunity for physician leadership in this alignment; no one else has the qualifications or the perspective -- or the levels of respect afforded to physicians. But we need to be alert to that opportunity and be proactive, because physician leadership will not be a given. We are in competition with organizations like hospital systems and insurance companies, organizations that are very well funded but that may sometimes be preoccupied with their own bottom lines.

That's why it is so important that the AMA has a place at the table in Washington. That's why the AMA actively participates in the debate on health system reform, pushed for coverage of our uninsured patients and now is working to improve and correct many of the issues in the Patient Protection and Affordable Care Act, like our stated opposition to the Independent Payment Advisory Board that would mandate pay cuts for physicians.

That's why the AMA, working with state and specialty societies, developed the My Medicare, My Choice program seeking to give seniors more choice and flexibility with their Medicare benefits. We wrote model legislation and now are supporting HR 1700 and S 1042, the Medicare Empowerment Act. Be sure to ask your members of Congress and senators to co-sponsor these important bills.

That's why AMA analysis of the health system reform law and regulations, with 400 pages devoted to accountable care organizations, is giving physicians the tools they need to understand and help navigate this complicated new world.

It's why the AMA influenced the Center for Medicare and Medicaid Innovation to assist physicians interested in ACOs.

And it is pushing the Federal Trade Commission and Dept. of Justice to make strategic changes in proposed policy so physicians in all practice sizes can develop, lead and actively participate in ACOs and other new delivery models.

That's why the AMA has organized a new Physician Payment and Delivery Reform Leadership Group to support and ensure that doctors have the information and resources we need to shape the development of these new systems of care and payment.

At the core of the leadership group is a 12-member Committee of Innovators, physicians who already have hands-on experience with new care and delivery systems. There is also a 13-member steering committee of state and specialty society representatives. This new group will allow the physician community to develop the knowledge base for the next generation of payment models. Perhaps more important, these physicians are playing a leadership role in shaping the future of our health care system.

Just like physicians before us who delivered care first and then dealt with payment in chickens and produce, today's physicians will focus on health care delivery reform first and then help design the payment systems that support those reforms. Leadership in these turbulent times demands a lot from all of us, and will continue to do so. But in this ongoing evolution of delivery models and other needed reform, America's physicians must lead.

We need to ensure that the physician-patient relationship is always protected. Physicians and our pens (and electronic medical record keyboards) can lead the way to make sure health care quality is increased and health care costs are reduced. Our patients, our country, and we as taxpayers need for us to do both well.

Robert M. Wah, MD is a reproductive endocrinologist and ob-gyn in McLean, Va. He was chair of the AMA Board of Trustees during 2011-12 and is currently AMA president-elect.

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