Executive office update: Our silent partner

Sunday, July 01, 2012 01:07 PM
Print this page E-mail this page

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

Judging by the relatively low AMA membership penetration in Colorado, the association’s substantive, ongoing contributions to the welfare of the profession and our efforts here, in particular, are largely invisible to most practicing physicians. It is as though we have a silent partner in advocacy, albeit a talented, highly-effective partnership that delivers results for us on a regular basis. I’d like to break that silence by detailing a short list of the types of regular support my colleagues at AMA bring to us and their relevance to physician and patient advocacy.

Advocacy Resource Center
Think of this as a team of health policy experts and attorneys. If you had to find this team on the street, this would be one of the top legal and consulting firms in the country. Its advisory body, on which I served for years, is comprised of state medical lobbyists, general counsels and CEOs. In other words, they are closely linked to local public policy realities and the needs of state medical societies. They see the tsunamis coming long before the practicing physician could possibly detect a problem. They have developed state-of-the-art model legislative bills, white papers and extensive research support.

You can bet that when we are preparing a regulatory or legislative initiative we start at the top, with our colleagues at the Advocacy Resource Center (ARC). The first-of-its-kind laws CMS pushed through the Colorado General Assembly had their origins with the ARC’s arsenal. Standardized contract law, physicians’ rights and standards for any health plan profiling scheme, truth in advertising, health plan merger and acquisition reform – to name more recent reform laws and efforts in Colorado – were all drawn from the resources, research and talent of the ARC.

Private Sector Advocacy
A complement to the ARC, Private Sector Advocacy (PSA) lawyers and practice management experts produce the kind of tools and national influencers that can literally change the landscape of commercial and market behavior. For example, they have built model physician contracts for health plans that every physician should read and consider. The health plan contract model is an interactive website that can take any clause or subparagraph and compare it to any state law in the country, rank it accordingly and discuss, with extensive annotation, the optimal language. And physicians can now join PSA’s “cutting edge contracting” on-line educational webinars and community for ongoing access to national managed care contracting experts.

Another of PSAs influential intellectual properties is the National Health Insurer Report Card, now in its fifth year, which produces objective metrics measuring the performance of every major plan and ranks them according to payment accuracy and timeliness, prior authorization, use of claims edits and denial rates, and the wide array of plan operations and functions relevant to the business side of medical practice. I can tell you that this kind of national exposure and transparency has transformed many of the plans’ values and orientation. Indeed, error rates for these plans’ paid medical claims fell by 19.3 percent in 2012, resulting in $8 billion in health system savings due to a reduction in unnecessary paperwork!

Litigation Center
I am serving my second term on the Litigation Center (LC), which is also comprised of state medical society CEOs and general counsels. It is the voice of the medical profession in legal proceedings across the country. Established in 1995 as part of AMA’s physician resources program, the LC provides physicians with legal expertise assistance and has participated in more than 200 cases, many with precedent-setting results. The LC has provided financial and legal resources to us on several occasions during my tenure.

Inside baseball with federal agencies
There are many examples, and here’s one where we were involved. When the FTC started weighing in with letters opposing state legislation to regulate interventional pain management techniques and in support of legislation that would abolish or loosen standards for collaborative practice agreements between physicians and advanced practice nurses or physician assistants, AMA’s federal affairs team stepped in with the ARC and PSA to mount an impressive strategy in defense of the historical role of states to protect the public through regulatory action.

Like all national trade and professional organizations, a big tent that encompasses the views and needs of an increasingly diverse medical profession is guaranteed internal disputes and tensions. Unfortunately, too many physicians walk away from the AMA rather than continue to engage and participate in an organization that has a wide-open process for resolving disputes and setting a consensus, and has steadfastly supported the Colorado Medical Society. The organization continues to make the tough choices in the public affairs arena that by definition cannot make every physician happy. Our work on behalf of Colorado physicians would be suboptimal without their resources, experience and expertise. Thank you to our partner, the AMA!


Posted in: Colorado Medicine | Initiatives | Advocacy | AMA
 

Comments

Please sign in to view or post comments.