A year of AMA successes helped patients and doctors

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 May 14, 2012.

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Last summer in my first American Medical News column, I shared my philosophy that during times of great change like this one, there is also great opportunity. We have only to seize it.

I believe the past 11 months have proven me correct. This is a critical time for physicians to be involved in the broader world. We’re in the implementation phase of health system reform, and we’re filling in all those “to be determined” blanks — to benefit patients and physicians. As I write this, I am returning from the World Medical Assn. council meeting. There is great interest in how the U.S. health reform process is faring, and while I was there, I was reflecting on some of our successes this year. Here are some of the highlights:

I am pleased to lead the American Medical Association Board of Trustees with our seven new members and with our new CEO and new editor of The Journal of the American Medical Association. The fresh perspectives and diverse talent serves the AMA well.

When we gathered as a group for the first time this past July for our annual strategic planning session, we established common ground quickly. Specifically, we recognized that the world is changing, and for the AMA to have maximal impact, it must change with it. Together, we developed a long-range strategic plan aimed at tackling issues that matter most to physicians.

Formed around AMA policy and informed by input from our House of Delegates, sections and councils, this plan focuses on three core areas: improving health outcomes, enhancing medical education across the physician continuum, and improving physician satisfaction by optimally shaping delivery and payment reforms. We have begun talking about the AMA equation —— the many ways the AMA connects with physicians across the U.S.: the House of Delegates, membership, medical education, practice tools and advocacy.

The AMA’s work in advocacy has been first-rate. While we have not gotten Congress to scrap the sustainable growth rate formula, I have heard more members of Congress talk about permanent elimination than ever before. When I testified before the House Ways & Means subcommittee on health, I reminded the members that while they often call it the “doctor fix,” it is not doctors, but the SGR/Medicare payment system that needs fixing. Ultimately, Congress passed a two-month patch and then extended it to the end of the year.

In the face of the SGR mess, there is promising proposed legislation based on policy created in the AMA House of Delegates. The Medicare Patient Empowerment Act, HR 1700, would create a new Medicare option allowing patients and physicians to enter into private contract arrangements without penalties for either party. In January, the AMA launched a grassroots campaign to seniors and to secure more congressional co-sponsors for this important legislation. There are currently only 30 co-sponsors.

We have engaged Federation of Medicine groups and individual physicians. Information is available online about the legislation at the AMA’s Medicare Patient Empowerment Act page, including copies of the bill, video and other resource material. Please let me know if your group is interested in receiving co-branded electronic files of this material.

A big AMA success in recent months was the role we played in pushing back the transition to ICD-10, the new World Health Organization coding system with 64,000 different items. We swung into action with a strong advocacy effort and made the case that there is a confluence of Centers for Medicare & Medicaid Services/Dept. of Health and Human Services-directed actions that are exceeding capacity in doctors’ offices. At the AMA National Advocacy Conference, acting CMS Administrator Marilyn Tavenner announced that CMS/HHS would re-examine the October 2013 deadline to convert to ICD-10. Later, CMS proposed changing the deadline to October 2014 and convening a meeting of stakeholders to examine the issues around conversion. This is a good start and a significant response to the AMA advocacy on behalf of doctors.

Our other big advocacy success was in changing the rules for accountable care organizations so as to make physician leadership more possible. It was gratifying when the first shared savings ACOs were announced to learn that physicians will lead a majority of them.

Two very rewarding events of recent months were the payout of $200 million in the case brought by the AMA against UnitedHealth Group over its flawed database —— thousands of doctors got their checks last month —— and the U.S. Supreme Court decision to invalidate Prometheus Laboratory patents, a case supported by an amicus brief from the AMA.

On a personal level, my feelings about the many great opportunities in medicine were reinforced when I had a chance to talk with two of the best and brightest students from Thomas Jefferson High School, which my daughter attends. Recently, the father of one of those students told me his son has decided to attend Harvard Medical School, where he was accepted not long after we had talked.

I am very pleased to say that AMA membership increased for the first time in a long while. We have nearly doubled the number of group practices joining the AMA, with 64 new groups in 2011. I was recently honored to be No. 10 in Modern Healthcare magazine’s 50 Most Influential Physician Executives, along with AMA Executive Vice President and CEO James L. Madara, MD. It was great to see that the majority of physicians on the list are AMA members. In 2012, I am optimistic to see another year of increasing membership.

As chair of the AMA Board of Trustees, I have sought to increase the dialogue between the board, the House of Delegates and the Federation of Medicine. I have held calls with the House of Delegates, chairs of geographic and specialty caucuses, and chairs of AMA councils, sections and special groups. I convened meetings with members on SGR elimination, medical liability reform and the Medicare Patient Empowerment Act.

It has been a pleasure to write this column each month. While the deadline seems to sneak up on me quickly each time, it has been very gratifying to hear from many members about the columns. I was recently talking about health care at a well-known computer company in Cupertino, Calif., and a doctor came up and said he had read my column. When I was in Prague for the World Medical Assn., another doctor came up and said he had seen my column as well.

We have much to be proud of and to be optimistic about. Still, though, many challenges remain. We have yet to see medical liability reform nationwide. The SGR formula has not been eliminated, and we may see another cliffhanger year-end given the pending 30% cut in Medicare payments on Jan. 1. The Supreme Court decision is due in June; health insurance exchanges are still being developed by states and the federal government for those states that don’t build their own exchanges.

Now more than ever with so many forces arrayed against medicine, physicians need to come together to defend against those forces and implement positive change where we can.

For those of you who are AMA members, thank you for your engagement and support. For those who are not members, please consider joining with your fellow physicians as we work together to improve the health system and our patients’ health and make it possible for our practices to thrive. The future of students like the two I talked with earlier this year, our patients’ future and our own futures all depend on us working together to improve and preserve the doctor-patient relationship we cherish.

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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