BRIAN KLEPPER and DAVID C. KIBBE
First Published in the Florida Times-Union
At an Orlando meeting last week, Florida Medical Association (FMA) members fumed that their parent, the AMA, isn’t adequately representing Florida’s private practice doctors. After talk of secession and forming a new group, they settled for writing a stern letter urging the AMA to straighten up.
The FMA dustup began with a resolution written by Douglas Stevens MD, a Fort Myers cosmetic surgeon – you can’t make this stuff up – complaining that the AMA’s support for recent reforms was “a severe intrusion in the patient-physician relationship and allows government control over essentially all aspects of medical care.” He wrote that it will “relegate physicians to the role of government employees…and essentially end the profession of medicine as we know it.” A St. Petersburg neurological surgeon, David McKalip, added, “Without (AMA) support, the whole thing (i.e., reform) would have died."
Well, no. We aren’t sure which reform provisions Dr. Stevens is referring to, but he might have two in mind. One uses subsidies to encourage doctors to obtain Electronic Health Record technologies, so patient information can be easily exchanged and unnecessary or redundant services can be reduced. Some data would be submitted to a federal repository, so doctors can better understand how effectively they practice compared to their peers and how to improve if needed. Of course, physicians opposed to these rules could opt to avoid patients whose care is paid for with public dollars. But we think most doctors will welcome the opportunity to modernize their care.
The second bone of contention was a well-intentioned but flawed 1997 Medicare formula, the Sustainable Growth Rate, which tied physician payments to the growth of the US economy. If Medicare physician spending exceeded the target in one year, then payment the following year would be reduced. But every year, Congress has relented from this discipline, delaying the payment reductions. Now, in 2010, the accumulated cuts would be a whopping 21.2 percent. Despite promises made to the AMA in exchange for support, and with massive costs looming for health care, the financial bailouts, two wars and other needs, Congress is reluctant to spend the additional $200 billion to forgive the cuts. American specialists, who make triple the salaries of their primary care colleagues, are bound to see smaller Medicare checks in coming years.
In the past, we’ve had many differences with the AMA, which was often more focused on physicians and their economic prosperity than on patients and theirs, especially as health insurance costs relentlessly grew four times faster than the economy. The AMA lobbied hard against Medicare and Medicaid, famously recruiting Ronald Reagan to play the “socialized medicine” scare card. Through a secretive, specialist-dominated reimbursement advisory committee, they urged Congress to pay specialists more at the expense of primary care physicians. As a result, it is not far-fetched to lay much of the current health care cost crisis at the AMA’s feet.
But recently, as it strived to reinvigorate itself and appeal to younger physicians, the AMA became more progressive. It mounted a three year campaign for universal coverage. It supported government’s efforts to facilitate and reward the meaningful use of modern computerized tools and the best medical science in clinical practice.
To its credit, the AMA has also learned that it shares influence over health policy. In the intense, 2009 health reform lobbying environment, the AMA contributed $21 million to Congress, but the pharmaceutical/health products industry alone contributed $267 million, or 13 times as much, according to the watchdog group Open Secrets.
Many groups assumed that reforms would be achieved, and the AMA knew it was not in control. So it wisely pressed points it believed were in doctors’ interests and compromised when it needed to.
While they are incredibly important to us, American physicians over the last half century have been handsomely, even often excessively, rewarded. But now, the system that has been hugely wasteful must find ways to reduce costs while improving quality, and make sure that care is accessible to everyone. These imperatives are emerging just as data and information tools are becoming more available. Health care will become more like a market than before.
Medical practice is changing profoundly, mostly for the better. In the process, doctors will still be highly valued, but many may earn less.
The FMA’s challenge to the AMA was the old guard denouncing the new. But the new way is what mainstream patients, doctors and the people who pay the bills for care desperately need. It is coming, and the FMA should get on board or out of the way.
Brian Klepper, PhD (Atlantic Beach, FL) and David C. Kibbe, MD, MBA (Chapel Hill, NC) write on health care policy, market dynamics and technology trends. Their collected essays are at www.kibbeandklepper.blogspot.com.