Chair of AMA board says farewell -- but not goodbye

AMA Leader Commentary. By D. Ted Lewers, MD. June 4, 2001.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from D. Ted Lewers, MD, chair of the AMA Board of Trustees.

There's only one way to be sure you're on the road to success: Check for construction.

This is especially true in our profession. The practice of medicine is constantly changing. So, too, is health care delivery. And organized medicine must change in response.

During the two years I have spent as chair of the AMA board, I have seen a lot of construction. But just because success is a work in progress doesn't mean we can't point to achievements -- and because this is my last column as chair, it seems a particularly good time to take stock.

Let's start with Medicare.

Thanks primarily to the work of your AMA, American physicians saw a payment update of 5.4% in 2000, followed by a 4.5% update in 2001.

How did we do it? The AMA advocated and worked hard -- successfully -- for important provisions in the 1999 Balanced Budget Refinement Act. These changes forced HCFA to correct errors in its projections that determine the sustainable growth rate -- and thus the spending targets that help determine doctor pay updates.

Next year, physicians will continue to benefit from our work. Initial estimates for 2002 indicate that the SGR will increase 6% -- the highest preliminary estimate ever provided. If enacted, such an increase would likely translate into a significant payment update for physicians in 2002.

However, it's not clear how much longer the SGR will be in place. Now that we've explained all the problems with the current system, the Medicare Payment Advisory Commission has concluded that it's true -- the SGR doesn't take into account all the factors that affect how much physician services cost, and we might just need a whole new system.

We agree with their conclusions, but we are also deeply concerned about what might replace the SGR -- and so we are keeping our ears close to the ground. Whatever comes next, you can be assured your AMA will be working to guarantee that physicians are treated -- and paid -- fairly.

In the meantime, we are taking aim at other Medicare problems by supporting important new legislation, namely the Medicare Education and Regulatory Fairness Act. We believe this legislation will help stop HCFA from criminalizing physicians for honest mistakes -- even as it requires HCFA to provide clear answers to our Medicare questions.

Already, we are seeing high levels of bipartisan support for MERFA, with 30 senators and 180 representatives co-sponsoring the bill at press time. We will be making a major push for MERFA in the 107th Congress.

We are also pushing hard for passage of a real patients' bill of rights. Last year, such legislation passed in the House by an overwhelming bipartisan majority. As you know from previous columns (Commentaries, Oct. 2, 2000; Jan. 1/8), this legislation would have curtailed some of the worst managed care abuses, primarily by making sure that physicians and patients -- not bureaucrats -- determine treatment.

This year, we continue the fight. We were heartened by President Bush's statement of principles concerning patients' rights -- and we hope that any legislation passed will be modeled on the patient protections passed in Texas during his time as governor.Our National House Call is on the road even as I write, taking our message about patients' rights from Portland, Ore., to Portland, Maine. By calling attention to the need for strong patient protections, we continue to remind members of Congress that the issue hasn't gone away -- for us, or for the voters who put them in office.

But the road to ending managed care abuse doesn't end with a patients' bill of rights.

In 2000, thanks in great part to the efforts of the AMA, the House of Representatives passed legislation that would allow physicians to negotiate collectively with health plans, without fear of antitrust reprisals. Indeed, the bill won overwhelming bipartisan support -- support that surprised many, and to our minds signaled a sea change for antitrust relief.

Although the bill did not pass in the Senate, today we are working with the specialty societies and with members of Congress from both sides of the aisle to create legislation that works for physicians -- and can get through Congress.

So stay tuned. Remember, the AMA's efforts to end abuses of managed care extend beyond Washington.

Our Private Sector Advocacy Dept. is working with the state and county medical societies to make sure physicians are paid on time -- like everyone else. They have also developed a publication about downcoding and bundling issues (http://www.ama-assn.org/ama/pub/category/4354.html) and provided physicians with much-needed guidance about contracts (http://www.ama-assn.org/ama/pub/category/2649.html).

These are just a few of the ways the AMA has been transforming itself into a more activist organization. Other issues that we are making a priority include student debt relief, tobacco control, scope of practice and patient safety -- just to name a few.

As I anticipate my last days as chairman of the board, I am proud of what we have done and continue to do -- and I am reminded of the words of the legendary relief pitcher Early Wynn. When asked about his plans to retire, he said, "Somebody will have to come and take the uniform off me, and the guy who comes after it had better bring help."

All jesting aside, although I will soon relinquish my present position on the AMA team, I won't ever surrender my AMA uniform. As long as I'm breathing, I'll be playing some part in the finest advocacy organization for physicians and patients that the world has ever seen. I hope that you'll continue to be there with me.

Tell me what you think. E-mail me.

Dr. Lewers of Easton, Md., a nephrologist and internist, was AMA board chair during 2000-01.