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Serving patients and physicians in challenging times

June 14, 2008

2008 AMA Annual Meeting
Hyatt Regency Hotel
Chicago, Illinois

Michael D. Maves, MD, MBA
Executive Vice President
American Medical Association

Good afternoon. I want to welcome my friends and colleagues from across the country to Chicago and this annual meeting.

Over the next few days, you will be making decisions to help guide our organization in the weeks and months ahead. In the next few minutes, I want to lay before you what I believe are the important issues facing our organization.

I want to share the bold actions being taken to address the challenges we face. And I want to stress the even bolder thinking needed from us — the standard bearers of organized medicine — to shape a better future for the patients and physicians of America.

I stand here today extremely pleased to report that the House of Medicine is strong.

In 2007, the AMA marked its eighth consecutive year of financial growth. But financial growth alone is not the only measure of success — for our ultimate success is in the pursuit of our mission to promote the art and science of medicine and the betterment of public health.

My friends and colleagues, I am proud to provide a brief update of where we stand today — of where we are going — and how we are going to get there.

Medicine has evolved over time. The AMA has evolved over time. As you know, organizations that do not change risk falling behind.

So I promise you this — we will always be America’s health care leader. We will always be the leader our patients need and our profession demands.

Today’s political, social and health care landscape is rife with change. We’re in the midst of a presidential campaign that has enormous consequences for our nation – and for our profession.

Many of us believe that health care is the domestic issue that must drive the political decision-making. But there are other significant concerns that will compete for the candidate’s and the public’s attention: the wars in Iraq and Afghanistan; our nation’s security; the domestic food and gas prices that dominate the talk at dinner tables across the nation; and the hundreds of thousands who have lost their homes in the mortgage crisis, and the resulting impact that has rippled through our economy.

We know that health care costs that are spiraling up and out of control. And we know full well the challenge our nation faces because the nation’s 47 million uninsured Americans.

You have heard the candidates address these issues. But each issue needs its champion. We must do everything we can in the upcoming electionto ensure that health care is a priority issue – that the AMA is health care’s champion. Physicians will be looking to us to drive that debate. It is our challenge and our responsibility to fulfill that mandate.

As part of building that awareness, after the successful launch of the AMA’s Voice for the Uninsured campaign in the early primary states, the program rolled out nationally in January of this year.

Research conducted after the first few weeks of the campaign indicated a 25 percent increase in awareness of the problem of the uninsured among those surveyed. That was a significant uptick and signals the success of this effort even in its early stages.

And just to give you an idea of the type of impact we’re having — through May 31 of this year, the campaign has been seen by voters and policy makers in news stories, magazines, online and on the ground more than 180 million times. In addition, more than have 280,000 people have visited the uninsured Web site and more than 13,000 have signed a petition to Congress.

I think it is a testament to the hard work of our staff and the guidance from the House of Delegates with this campaign that has established the AMA as a leading voice and champion for the uninsured. The uninsured campaign is not only important – it is the right thing to do – and it is working.

As this year unfolds, and as we enter the next phase of the campaign, we’re going to shift from building awareness of the issue to building awareness of the AMA proposal – a proposal that our Council on Medical Service has been instrumental in shaping. It is a proposal that we will use to help shape national and local policy initiatives as we approach the upcoming election.

Here are two new commercials that will air beginning in September through the presidential election. Also see the banners around the room and hotel of the new ads that will appear in national magazines and online.

So how is 2008 shaping up? First, you will hear more from our president, Dr. Ron Davis, about the Medicare update, but I want to reiterate that we are at the table, and we are working closely with Congress.

We all know that seniors’ access to care is in jeopardy. Access to care for military families is in jeopardy. And your practices are in jeopardy.

The situation in Washington is fluid, but we are confident a solution will be found.

So while our Medicare advocacy continues, I also wanted to share some recent successes you might not have heard about. And the secret to these successes is that we didn’t do it alone. All of these were accomplished with your help, and we really could not have been accomplished any of them without your help.

Your incoming AMA President, Dr. Nancy Nielsen was a close confidant to — and worked alongside with New York Attorney General Andrew Cuomo to protect patients and physicians from unfair profiling by insurance companies.

We changed policy without passing legislation, but when legislation was necessary, we were there.

In Colorado, we helped the state medical society achieve passage of a number of bills, including health insurance merger regulation, physician profiling, rental network regulation and more.

In Indiana, Ohio, Florida and Connecticut, we worked together to enact rental network and fair contracting legislation. And I’m very pleased to report that South Carolina just became the final state in the country to pass prompt pay legislation — congratulations.

All of these major legislative advancements in managed care policy make great strides to promote fairness and transparency for patients and physicians.

That said, we know there are tough fights ahead of us.

We are standing alongside our brothers and sisters here in Illinois as they fight to protect hard-won medical liability reforms they only secured a few short years ago.

And we are still working closely with our friends in Nevada to improve managed care in the aftermath of the United/Sierra merger.

The advocacy side of the house of medicine is strong.

On the Professional Standards side of the House of Delegates, one of the initiatives that crosses over between Advocacy and Professional Standards is patient safety.

You may remember our victory in Congress getting the Patient Safety and Quality Improvement Act of 2005 passed and signed into law. The law took a few years to be implemented, but vigilance by the AMA, specialty and state medical societies helped make sure the law was not forgotten.

Now, the AMA is working with the government to make sure the law does what it was intended to do — namely, help doctors make patient care safer. And, the AMA is working on a proposal to become a Patient Safety Organization.

I’m also proud to say that the Physician Consortium for Performance Improvement continues its important work in the development, testing, and maintenance of evidence-based clinical performance measures. To date, there are more than 200 measures developed for more than 30 clinical conditions.

Performance measures created by physicians for physicians — not bureaucrats — that’s how it should be done.

Transforming medical education is another strategic initiative where the AMA is using its vast national influence to get all the major players seated at the same table. Transforming how medical students are educated, and how physicians continue their education will be key because as we all know — the leading edge of the baby boomers are now in their sixties, and caring for our elderly patients requires a different set of skills.

The AMA also wants to be sure our nation’s physicians are prepared for the demands our aging population will place on our health care system. That is why we are developing models for geriatric care – convening experts to provide recommendations for teamwork, performance measures and reimbursement.

Now let’s talk about the future of our American Medical Association. I have a question for you: Do you know who this is?

This is Andrea Jung, CEO of Avon. She took over about six years ago, which is roughly the same time I have been at the AMA.

Avon’s sales, morale, product line and stock price were in the dumps. Ms. Jung began an aggressive campaign to turn Avon around and in five years, the company had made a tremendous recovery.

She recognized that the “old” Avon, with the ladies knocking on your door was not a viable business proposition going forward, and, despite or maybe because of her success, she initiated a transformation of Avon for the future.

The new Avon is a company with different product lines, sold in what was for Avon non-traditional venues with local, regional, national and worldwide responsiveness to the customer afforded through the internet.

Now, I think this story is a metaphor for our AMA. In the past six years we have enjoyed considerable financial growth and prosperity. We have not committed the mis-steps that plagued us in the late 1990s.

In fact, the organization has been re-branded and reinvigorated. Sales of our products and services are solid and the American people hold us in high esteem. But physicians are not buying our value proposition. The AMA is seen as irrelevant to their daily lives. For many physicians, we’re simply just not worth the price.

So I think that we too, need a transformation of our organization — change that will put us in a position to be successful for the next generation of physicians. And change can be a scary proposition.

Here’s a reality check for us all. This slide shows AMA membership since 1993. Now the good news is that we actually had an uptick in members in 2007, the first in many, many years. But the bad news is that the trend continues downwards.

I can stand here and tell you that many organizations have declining memberships — and I’d be telling you the truth. I also can tell you that most organizations struggling with membership have not had the benefit of the growth, revenue and financial stability we’ve worked hard to create – and that’s true as well.

We are obviously doing everything we can to continue the positive trends, but our stagnant membership cannot continue. We need to face the situation head-on. We need to take targeted — yet aggressive — action to stabilize and improve the situation.

Now, before I go any farther, I want to directly address a question I think many of you are itching to ask: Mike, you ask, what about all the time and money that went into the McKinsey studies and the brand advertising?

The answer is that the McKinsey studies laid the foundation for our current work. It allowed us to re-invigorate our brand and taught us crucial lessons we are still applying today. But the core value proposition of our AMA is not resonating with physicians.

At the July 2007 strategic planning meeting, the Board of Trustees directed our senior management, working with the Membership Committee of the Board, to undertake an assessment of the AMA membership. The team has been actively engaged in comprehensive analysis of all aspects of the membership environment.

Our research indicates that many physicians are feeling under siege in their practices, large and small. They are preoccupied with the problems of either keeping their practice afloat or meeting their employers’ productivity standards while taking care of their patients and maintaining a decent family life. I see many of you nodding your heads in agreement.

The bottom line for the Board, senior management, and I would say for those in the House of Delegates: We need to increase the value for our members.

So you say, what do docs want so that we can fulfill their needs? Based on our research, physicians’ needs look very much like the Maslow’s Hierarchy of Needs we learned in behavioral science. At the core, physicians need tools and resources to help them in their everyday practice.

My best example is a quote we heard from a focus group from a young primary care physician: “What the AMA can do for me is to help me get through my day in an efficient and effective manner so I can get to my daughter’s dance recital.”

Until those day-to-day resource needs are better met, physicians find it difficult to focus on fundamental advocacy issues in health care. Physicians certainly want the AMA to fight the battles that are necessary to fight, but they desperately want help in their day-to-day practice.

Our efforts are targeted so the work-a-day physicians — the grassroots doc can look to the AMA and see that we are providing the right mix of resources to help them not only survive but to thrive. Once those resource needs are addressed, then physicians can focus on the fundamental advocacy issues in health care such as Medicare/Medicaid reform, tort reform, unfunded mandates and collective bargaining.

We are working intensely so physicians recognize we’re engaging in the right advocacy issues at the right time. After meeting resource and advocacy needs, physicians can turn their attention to idealism needs — concerns about being a “good doctor.”

We are investing our considerable time and energy into developing this improved offering so physicians will see that the AMA strives to — and can achieve the ideal that compelled most of us to become physicians — making the world a healthier, better place.

Now, I can hear: “Mike, are you telling me we are not going to pursue our advocacy agenda anymore?” The answer is an emphatic “No, that is not what I’m telling you.”

You may recall that I showed this slide in Hawaii. It depicts what I’m telling you, and that is that we must do both. We must change the environment in which we live and work — the “push,” or advocacy-related side; and we must change the way we work in our environment — the “pull,” or resources side.

We will always engage in advocacy for the medical profession just as we provide for the professional development of medicine. We must engage in bold, innovative action that will help us create a balance of push and pull.We must stand up for the profession — those things I highlighted at the beginning of my speech — and we must provide physicians with the tools they need to survive in today’s environment.

So how are we going to do this?

We are exploring strategies to further improve how our existing assets can be delivered to physicians, and in the months to come, we will continue to use our considerable expertise to address basic practice resources — especially in our Private Sector Advocacy and Professional Standards areas.

We will continue to look for opportunities to enhance our alliances with our partners in the state and specialty societies. We’ll do this with recognition that we need to balance our efforts. We need to preserve our existing relationships while seeking out new ones to secure our future.

This is a new value proposition that I think you will find exciting. And more importantly, because our work is market-driven and physician-focused, I think we will see a turnaround in how physicians perceive the AMA. And just as the current landscape took many years to get us to this state, it will take a concerted effort to get us where we want to be — where we need to be — an organization that is an essential part of physicians’ lives.

It will not happen overnight. There will be no “big-bang.” We will test, research and re-evaluate. We will add new solutions. We will do what is necessary to increase value for our members. That day will come, but during the process, the organization will maintain its focus on membership recruitment, retention, excellent service, and all other aspects of AMA operations that will help us succeed.

Before I close, I want to review some over-arching principles that I have shared with my senior staff and that I have promised our board of trustees. As the AMA CEO, I am committed to the following:

Speed — we need to become more nimble, efficient and effective; cut bureaucracy, cut talk, cut paperwork and implement real solutions.

Input — we need the ideas and feedback of practicing physicians in the heart of their career; we need to increase the dialogue with them and find opportunities for them to participate.

Trust — we, management, staff, elected leaders and the House of Delegates must work together toward our common goals.

Courage — we will need to challenge our basic assumptions — particularly when it comes to how we bring value to physicians — and have the courage to make the tough choices that will bring focus and clarity to our work as well as how we leverage our expertise.

I have no interest in mediocrity. I have all the faith that we are on the right path. I have confidence in our profession and our organization. I am proud to lead the AMA and serve all of you here today — and all of your colleagues back home.

Finally, I want to end with a story about how change and uncertainty can be managed.

You may think we have a lot at stake, and in our own world of organized medicine we do, but let me close with an example of a real gamble on transformation.

This is the Chevy Volt — a concept car designed by GM to solve the problem of gas mileage.

While GM is working hard to manage the company — and consider for a minute the current gas prices and pressure on car companies to design more fuel efficient vehicles.

In the face of this, GM decided to “leapfrog” the problems of miles per gallon and skyrocketing gas prices by creating a car that does not use gasoline at all. The Volt will be an all-electric car available for sale in 2010. They currently have a design, wheels, motor and chassis. What they do not have is a battery – yet.

In a lab in Detroit, there are three versions of the lithium batteries that will power the Volt. They are each being tested, evaluated and re-evaluated.

They don’t know which one will finally be put into production, but they have had the courage to stake both money and the reputation of General Motors on this vehicle. In the toughest of times, they are looking forward.

Our equivalent of GM’s gas-powered vehicles is a membership proposition that currently does not adequately power the needs of physicians. We are designing our own “AMA Volt” for the future, having the courage to leave the past behind and focus on a new future.

Just as the stakes at GM are high, the stakes for the AMA are high, too. But we are doing the necessary R and D. We are engaged in constant evaluation and re-evaluation to ensure that what we offer is what physicians want and need.

From advocacy to professional standards to communications to products and services — I am confident in our plan, secure in our direction, and energized by the challenges.

Our AMA is blessed with formidable talent and resources to help assure a solid future for our organization.

On behalf of the talented individuals and teams I’m privileged to lead, thank you.

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