“We’re all in this together”

Friday, March 01, 2013 12:26 PM

Jeremy Lazarus, MD, AMA President

In recent years, “teamwork” has become the byword for the future of medicine. The idea that by working together under a physician’s leadership, a group of medical and health care professionals can treat more patients, more effectively, and hopefully at lower cost makes profound sense for the complexities of health care today.

But teamwork is nothing new to American medicine. Since 1847 physicians have understood the value of working together to achieve broad important goals. In the early days, members of the AMA joined forces to create a code of ethics and standardize medical education. Today’s focus is on assuring that legislation and regulations support physicians’ ability to serve our patients.

For as long as I can remember, the American Medical Association and the Colorado Medical Association have worked together to address problems facing physicians in Colorado and in Washington.

The AMA is working with CMS right now to protect Colorado’s medical liability laws. This effort includes fighting bills in the state legislature that would weaken or totally remove the cap on damages for medical liability cases, and other bills that would weaken the Colorado peer review statute, which outlines requirements for people who testify as expert witnesses.

We are also supporting CMS with analysis of proposed state legislation that aims to prevent deaths from unintentional abuse/misuse of prescription painkillers.

And we are collaborating in efforts to get the Colorado Legislature to repeal Chiropractic Board Rule 7c that gives chiropractors the authority to administer non-FDA approved compounds by injection.

During the past year, the AMA’s collaborations with state and specialty societies have achieved more than 70 legislative victories for medicine. These included implementing the ACA in six states, advancing medical liability reforms in nine states, defeating legislation that would have encroached upon the physician-patient relationship in seven states, demanding insurer fairness and transparency in five states and advancing public health in more than 10 states.

In these collaborations, the AMA’s Advocacy Resource Center (ARC) has been a key resource. Six state legislative attorneys and a host of AMA content specialists are the arms and legs of the ARC. They create state-of-the-art model legislation, testimony, talking points and white papers for use by medical societies across the country and provides research support and consulting wherever it is needed.

Even more important, our ARC Executive Committee includes 20 state medical association CEOs, lobbyists and general councils, including Susan Koontz of CMS. This ensures that our advocacy efforts are closely linked to local public policy realities and the needs of the state and specialty societies.

The AMA hosts its annual State Legislative Strategy Conference each January to ensure our focus is on the right topics. This conference is the only meeting in which the AMA, the American Osteopathic Association and the majority of state and national medical specialty societies get together to focus on the toughest state-level issues in health care. As part of this year’s meeting, CMS president-elect John Bender, MD, spoke on state-based delivery and payment reform, one of the issues highlighted at the meeting.

Besides legislative advocacy, the AMA’s Advocacy Resource Center also has been successful in developing strategic collaborations to influence national state policy-making organizations like the National Association of Insurance Commissioners, National Governors Association and others. We are currently assisting CMS in the National Governors Association Prescription Drug Abuse Project. We are also benefitting from this effort: CMS leadership in reaching out to the governor and key stakeholders on this issue is providing the AMA with best practices that we can share with other states confronting the nation’s drug abuse and diversion crisis.

In another related area, the Litigation Center of the AMA and state medical societies have participated in more than 250 cases since the Center was created in 1995, and in many instances have achieved precedent-setting results. In Colorado we are currently supporting the lawsuit filed late last year to stop the chiropractic rule that I mentioned above.

National advocacy

On the national level, the AMA in association with state and specialty societies helped shape what became the Affordable Care Act (ACA). As part of this effort, our advocacy efforts secured physician representation on health insurance exchanges, an area where Colorado is a leader. Colorado has not only set up a health exchange well ahead of 2014, but also applied for a $43 million grant to build the infrastructure for an Internet health insurance marketplace. I also applaud Colorado for including Mike Fallon, MD, on the board of directors of the Colorado Health Benefit Exchange.

Today we continue working to affect much that the ACA failed to address, including the broken medical liability system and the flawed Medicare physician payment formula. Even though Congress did take action to avert the 26.5 percent cut on January 1, this only extended the instability of the Medicare program for another year. That’s why the AMA, CMS and more than 100 other leading medical associations have called on Congress to not only eliminate the SGR formula but also to provide for a high-performing Medicare program. In a letter we sent lawmakers in the fall, we outlined core principles and elements that should lay the foundation for a system that is good for patients, physicians, taxpayers and the Medicare program overall.

Every February the AMA sponsors a National Advocacy Conference in Washington, DC to zero in on top issues for the medical profession. CMS President Jan Kief, MD, is scheduled to be a keynote speaker this year.

We will keep you informed as the year progresses. The AMA will be in Washington,
Colorado and elsewhere to support and incentivize better health outcomes and improve our health care system.

Long term

While we work in our public arenas to protect physicians and patients, the AMA is also playing a long game to shape a better health care future for our nation.

The AMA’s long-range strategic plan is focused on three core areas that we believe are vital to improving the future of health care in the country:

1. Improving health outcomes for patients and populations;
2. Accelerating change in medical education to meet evolving needs of the health care system; and
3. Enhancing physician satisfaction by shaping delivery and payment models.

These are ambitious goals, and achieving each one will require collaboration. However, we’re already coming together to advance important health care issues. A good example of this approach is the joint CMS-AMA-United Health Care Colorado Collaborative Quality Improvement Project.

A more recent example is the Million Hearts Initiative, a multi-medical organization effort to improve America’s cardiac health. This ambitions HHS plan seeks to prevent 1 million heart attacks and strokes over the next five years. The goal is for 30 million more
Americans to get their high cholesterol or hypertension under control and for 4 million people to quit smoking by 2017.

As part of the Million Hearts project, CMS plans to incorporate relevant performance metrics into both the Physician Quality Reporting System and electronic medical record meaningful use criteria. Additionally, community health centers are being asked to report annually on cardiovascular disease prevention measures. Health information technology grants will help nearly 100,000 primary care physicians track and improve their performance on these metrics. Other parts of the initiative directly targeting patient behavior include graphic health warnings on cigarette packs and new menu labeling requirements.

Whether we are involved in long-term projects like the Colorado Collaborative Quality Improvement Project or Million Hearts, in a legislative drive to protect Colorado’s medical liability laws, or the push in Washington to ensure all Americans have access to affordable health care coverage, we are working together to shape a better future for patients, medical students and physicians.

Together we are stronger. The AMA is looking forward to continuing our collaborative successes throughout 2013 and beyond.