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Creating a Better, Healthier Future for the Nation

Address to the House of Delegates
AMA Annual Meeting
Hyatt Regency, Chicago
June 7, 2014

Ardis D. Hoven, MD
President
American Medical Association

Mister Speaker, members of the Board of Trustees, delegates, and friends. It is an honor to address this house for the last time as your president.

Truth be told, it's also a bit surreal. It seems like just yesterday I was being sworn in. So needless to say, I've done some reflecting in recent weeks. I have reflected on the accomplishments of the AMA over the past year. I have reflected on the challenges ahead. And I have reflected on my personal experiences as president – and how those experiences fit into my larger goals as a physician.

In the course of these reflections I found myself thinking back to my childhood and a conversation I had with my father one day. I was about seven or eight years old at the time. We were sitting at the kitchen table eating supper when I proudly announced that I wanted to be a doctor. Not just any doctor. A missionary doctor. In Africa.

My father was a minister, and my favorite church services growing up were the ones that featured visiting missionaries – doctors and nurses who had worked in various African nations. I was fascinated by their stories...how they were able to save countless lives using only the most basic equipment and medications.

But when I proclaimed my intentions to my father his answer surprised me. He said, "Ardis, you can be a missionary doctor. But you don't need to go to Africa. There are too many mission fields at home you need to attend to first."

As you know, my father's words proved prophetic. I found my mission right there in my own backyard in Kentucky. Fighting for patients with HIV. Fighting against discrimination. And fighting for the rights of the uninsured.

All these years later, as I think about the AMA and why we are all here today, I can't help but turn to my father's words once again. We are here today because we have a mission: to create a better, healthier future for the people of this great nation.

During the past year the AMA has worked hard to achieve that mission. And we have had many successes.

As the government continued to roll out the Affordable Care Act, the AMA was there – addressing gaps and finding solutions to meet the needs of patients and physicians. We created six model bills to help state medical societies navigate health insurance exchanges...to ensure that the 8 million patients who have signed up receive true, meaningful access to care – not just an insurance card. And that physicians are not faced with unfair contracts or increased administrative burdens. Washington state has already enacted a law based on these bills. And three other states are working to do so.

The AMA also made significant progress on our strategic plan. Our Rand Report on physician satisfaction is shifting the conversation on delivery reform, highlighting the bureaucracy and red tape that stand between physicians and patients. Today we are working hard to ease those burdens – through dedicated practice tools, research and advocacy.

On the medical education front, the 11 schools in the AMA learning consortium have met twice to share findings. I've attended those meetings, and I can tell you the innovations they're working on – from individualized learning plans to population health – will enable the next generation of medical students to hit the ground running.

And our efforts to reduce the toll of diabetes and cardiovascular disease continue to take shape, from partnerships with the YMCA and Johns Hopkins…to pilot programs...to our new framework for identifying and effectively managing hypertension.

The AMA also scored numerous advocacy victories, both federally and at the state level. We convinced CMS to award nearly one billion dollars in grants to fund innovations in the delivery of specialty care. We secured delays on Meaningful Use requirements of electronic medical records – increasing the prospects for physicians to earn incentives, and lowering the risk of cuts when the penalty phase kicks in. We played a leading role in the national effort to help prevent death from overdoses. We helped six states pass truth in advertising legislation – so patients understand who is, and who is not, a medical doctor. And we helped four states achieve important medical liability reforms – so physicians can spend more time focusing on the patient, and less time worrying about lawsuits.

While all these victories are important, in my mind the biggest victory of the past year is one many of you probably don't see as a victory at all – our effort to repeal the sustainable growth rate formula. Now I know what you're thinking...Ardis has been traveling too much. She must be suffering from jet lag.

I'll admit there has been a day or two of jet lag in the past year. But not today.

I know many of you looked at the outcome of our SGR effort – another temporary patch – and wrote it off as a failure. But let me tell you what I saw...

I saw a House of Medicine that had been deeply divided by conflict over the Affordable Care Act, come together to fight for America's seniors.

I saw members of the SGR task force – including many of you in this room – develop a set of principles for replacing SGR. And I saw over 100 physician groups embrace those principles.

I saw an SGR repeal campaign that garnered over a million emails and 45,000 phone calls to Congress. I saw a year of intensive advocacy culminate in bicameral, bipartisan legislation to replace SGR with a system that encourages innovation. I saw an unprecedented 600 medical organizations come together to support that legislation.

I saw politicians on both sides of the aisle – in the Senate and the House – voice their approval for the legislation. I saw them look me in the eye and tell me they would get it done. And then, a few weeks later, I saw those same politicians – vote that bill down.

Colleagues, I like to think of myself as a straight shooter. And when I make a mistake, I'm the first to admit it. But when I review the facts surrounding this unprecedented opportunity to fix Medicare, I come to one conclusion: The AMA didn't fail America's physicians and America's patients. Congress failed America's physicians and America's patients.

Recall that the price tag for SGR repeal had been cut in half. Recall that the pathway for transitioning to a more effective system was there. Recall that three separate Congressional Committees devoted countless hours – and countless taxpayer dollars – to develop a solution. Recall that the AMA lobbied successfully for several crucial legislative improvements, achieving a set of Medicare payment reform policies that enjoy broad support among Congress and physicians. No matter how you look at it, in the end just one thing prevented Medicare reform from passing – politics.

So where does that leave us? If organized medicine flexed its muscle and it wasn't enough to make Congress do the right thing, what is our course of action going forward? How can we make progress not just on SGR, but on the other challenges confronting our health care system?

If I've learned anything from my days fighting HIV it's that giving up is not an option. So today I want to offer you three solutions. Number one: We need to hold politicians accountable.

Picture this. A sick patient arrives in your office. You diagnose the problem. You arrive at a treatment plan. Then at the last moment, you decide not to implement it because someone, somewhere might not approve. Can you imagine how many lawyers would descend on you with medical liability suits?

We physicians are held accountable every day. It's time Congress was held accountable too. We need to let Congress know that business as usual is unacceptable. It is unacceptable for taxpayers. It is unacceptable for physicians. And most importantly, it is unacceptable for the nation's seniors.

The wonderful thing about democracy is that each of us has a vote. We have a vote in our city. We have a vote in our state. We have a vote in our country. We need to use our votes. We need to remind our elected officials that the nation's physicians and the nation's patients matter.

Number two: We need to educate. One of the biggest surprises to me during my year as president was how many organizations don't know what the AMA does. I'm talking about businesses, civic groups, even some academic institutions. The misinformation circulating around the AMA is incredible. And it's not just the AMA, but the Affordable Care Act and some of the fundamental realities of our health care system.

I can't tell you how many people think the AMA is just a trade organization fixated on pocketbook issues. Who think death panels are part of the Affordable Care Act. Or that the reason health care costs are soaring is because doctors are charging too much.

You should see the alarm on their faces when I talk about SGR and how it spells a more than 25% cut to physician pay. How it would force many physicians to close their doors or start refusing patients. You should see how surprised they are to hear the AMA is working to reduce the toll of diabetes and cardiovascular disease. That the AMA brought national attention to the plight of the uninsured during the 2008 election cycle. That when patients and physicians were being overcharged for out-of-network services, the AMA went to court and won a $350 million dollar lawsuit on their behalf.

The more people who know about the AMA – who we are, what we are, and what we're fighting for – the stronger we will be. A moment ago I told you an unprecedented 600 organizations stood together to demand SGR repeal. Imagine if that number had been 1,200. Imagine if in addition to medical organizations, we had been joined by community associations, businesses and civic groups. Imagine a number so large it would be impossible for Congress to ignore. Even during an election cycle. When we educate people, we empower them. And when we empower them, we can make a difference.

Number three: We need to be leaders in our communities. Now I may be preaching to the choir on this one – because during this past year I have been privileged to see how many of you do lead back home. Still, it bears repeating. At the end of the day, health care is local. And if we want to improve health care in this country, it starts at home.

If we want to tackle obesity, we need to collaborate with local schools and community organizations. If we want to teach the newly insured about the importance of prevention, we need to work with community health centers. If we want to explore accountable care organizations, we need to reach out to hospitals and other potential partners to talk about collaboration.

As physicians and as leaders, we need to continue to put ourselves on the front lines – whether it's caring for our patients, collaborating with community organizations, or paying a visit to our local congressional representatives to advocate for reform. There are countless roles we can play back home as we work together to shape a better health care future. Remember: One physician can make a difference. I saw this time and time again through my travels this past year.

Now I know I've given you a lot of directives. And I can just imagine what Dr. Wah is thinking. "Gee thanks, Ardis. Any other tasks you'd like to assign before you retreat into the sunset as Immediate Past President?" And now Dr. Lazarus is rolling his eyes..."Retreat into the sunset? Was I supposed to be cycling through the mountains this past year? Didn't get that memo"

Rest assured, I hold no one more accountable to these directives than myself. And I will do everything in my power to advance them when I return to practice in Lexington. That's not to say it will be easy. With so many stakeholders involved, we are bound to encounter obstacles on our quest to improve health care. But while obstacles matter, what matters a great deal more – is our reaction to them.

Over the year you've heard about some of the trials my HIV/AIDS patients faced in the early days of the epidemic. Well today I want to share a more recent story. One of my current patients is a beautiful African American woman with HIV/AIDS. For the sake of anonymity, I'll call her Sarah.

When I met Sarah in 2003 she was in a great deal of pain. She had acquired HIV from her drug-abusing husband, and was suffering from a range of physical side effects due to her medications –headaches, fatigue, severe leg pain and depression. Sarah's husband had already died from the disease. She was alone, scared, and losing hope. She saw no way out. Nothing but pain in her future.

Fortunately, medicine's ability to treat HIV improves every day. With the right regimen of medications I was able to get Sarah's physical symptoms under control, and soon her spirits began to lift. Sarah met a man. She fell in love, got married and bought a house. Things seemed to be looking up.

But then, out of the blue, Sarah's in-laws began giving her the cold shoulder. They weren't just avoiding her…they were shunning her. Alarmed, she confronted her husband, and he revealed the ugly truth. Sarah's husband had told his family about her illness, and they reacted with utter contempt. From that day forward they spurned Sarah, refusing to even be in her company. In the end, sadly, her marriage fell apart.

Now many of us would throw in the towel at this point...a life-changing diagnosis. The death of a spouse. Divorce. But Sarah is stronger than that. Instead of succumbing to depression she grew determined to fight. She went out into the community and began speaking about prevention and treatment of HIV.

She shared her personal experiences with anyone and everyone who would listen. She addressed not only the physical, but also the social implications of the disease. Today she is a prominent spokesperson in the fight against HIV/AIDS and an inspiration to everyone she meets.

During this tumultuous period of change for America's health care system, I believe we too can draw inspiration from Sarah's story. When we encounter setbacks, we can regroup and fight back. When we encounter obstacles, we can find new ways to overcome them. Instead of retreating, we can hold politicians accountable for their actions. Instead of falling back, we can engage the public in the fight for reform.Instead of giving in, we can take matters into our own hands, leading by example in communities across the nation.

It is no small thing to be tasked with improving America's health care system. But then it is no small thing to stand over a critically ill man or woman…and find a way to save them. As physicians, achieving the impossible is something we are called to do every day.And on this day – in this Hour – our mission is clear: to create a better, healthier future for this great nation.

A year ago I stood before you and said that organized medicine stood at a crossroads. Ahead of us were two paths. One was the path of glorifying the past, lamenting the changing health care environment, and thwarting any attempt to move forward. The other was the path of action. Of collaborating, innovating, and leading the drive toward productive change.

I am happy to say the AMA took the second path. It has been my honor to walk that path alongside you as your president this past year. And it will be my honor to continue walking alongside you in the weeks, months and years ahead.

Thank you.

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AMA President Ardis Dee Hoven, MD