A new year but continued resolve to reform pay system

AMA Leader Commentary. By Cecil B. Wilson, MD, Jan. 1/8, 2007.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all AMA members from the chair of the AMA Board of Trustees, Cecil B. Wilson, MD.

As we begin a new year, the temptation is to jot down a list of new year's resolutions and hope that willpower will prove sufficient to bring them all to fruition. Experience has shown otherwise.

For most of us, experience shows that we never quite lose the extra weight, consistently increase physical activity, read that great book or complete all the chores we set out for ourselves.

Topic: Medicare payment

That being said, it is true, however, that January is the time to assess the past while opening the door into the future and looking at the opportunities before us.

The Romans named the month after their god of doors and gates, Janus. His image was that of a two-faced god, with one visage looking to the past and the other, to the future, at once contemplating the old year while anticipating the new.

The old year, 2006, particularly in the latter months, saw the AMA with a laser-like focus on "fixing" the problem of the sustainable growth rate formula that determines physician payments under Medicare.

This formula presages annual cuts over the coming nine years amounting in the aggregate to a 40% reduction in physician payments, not counting the impact of inflation. A 5% cut was on the books to take effect Jan. 1.

Seen only as a physician pocketbook issue, Medicare payment cuts do not capture the public's attention or concern. But as a poll of the public last year showed, once there was an understanding of the threat those cuts pose for seniors in coming years -- threats to access, threats to receiving quality care because physicians no longer can afford to accept new Medicare patients -- the issue crystallizes into calls for action.

During the months leading up to adjournment of Congress, the public spoke. We all owe a debt of gratitude to the thousands of patients and physician grassroots activists who responded to our alerts and generated more than 1 million contacts with members of Congress.

In the waning hours of the 110th Congress, lawmakers responded by placing a freeze on physician payment cuts for 2007. Our thanks go out to our friends in Congress for making that happen.

Canceling the sustainable growth rate cut was wise in the short run but, in the long run, merely underscores the AMA's long-standing call for reformation of the entire physician payment system. The fatally flawed SGR formula remains in place, and payment cuts are still on the books for 2008 and beyond.

The late management consulting guru, Peter Drucker, cautioned that any crisis can happen once. If the same crisis happens a second time, he observed, it no longer is a crisis. It is bad management. In this context, the last five years of temporary fixes speak for themselves.

The New Year is a time not only for resolutions but also for predictions. I agree with that eminent American philosopher, Yogi Berra, in saying, "I hate to make predictions, especially about the future."

But I will use journalistic license in fearlessly predicating that in 2007 our AMA will be resolved to continue its focus on working with our friends in Congress to eliminate future SGR cuts and restore sanity to the Medicare physician payment system.

As, Janus-like, we look back for wisdom and look forward to a better tomorrow, we need to apply the lessons of history for the benefit of our patients.

Then we can truly say to one another and to our patients, "Happy New Year."

Dr. Wilson an internist in private practice in Winter Park, Fla., was chair of the AMA Board of Trustees during 2006-07. Learn more about Dr. Wilson at the AMA's bio page.

The doctors are in the house
The AMA's House of Delegates is holding its Interim Meeting Nov. 7-10 in Houston, addressing issues such as health system reform and physician payment.
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