Wilson Blog http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page Mon, 20 Jun 2011 20:32:00 GMT The set of the sails tells us the way we go http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a48e0fb40-d060-41c7-a667-7020f18ceb87&plckScript=blogScript&plckElementId=blogDest Mon, 20 Jun 2011 20:32:00 GMT This is my final blog post as AMA president before my good friend Peter Carmel, MD, takes the reins tomorrow evening during installation ceremonies here in Chicago during the Annual Meeting of the AMA House of Delegates. I wish Peter well as our leader for the coming year—and as “AMA Blogger-in-Chief.”<br /><br />In approaching what I would include in these final remarks, I faced dual challenges: to avoid reciting all the things I did not say in the past 12 months and saying goodbye in something less than a maudlin way.<br /><br />My father, the preacher, always said that most sermons could be well-served by having just three points. He said that a long time ago, but I suspect he also would have applied that advice to blog writing. So, here goes—on blogging, my speech to the AMA House of Delegates and my favorite poem.<br /><br />J. James Rohack, MD, immediate past president of the AMA, <a href="http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-rohack.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=21ae8cdf-e382-40c9-87cf-32c8561d0531&plckPostId=Blog%3a21ae8cdf-e382-40c9-87cf-32c8561d0531Post%3a423a4e98-e94c-4b06-9e17-a796383442e4&">started writing</a> the president’s blogs during his year of exemplary leadership for our association. When the AMA’s staff advised me that I should follow suit, I confess I approached it with some misgivings. I had concerns that it might take too much time and that finding subjects about which to write would be problematic. <br /><br />In fact, neither has been the case. The myriad of things the AMA is involved in, as well as my travels as a spokesperson for the AMA, have provided fodder for more than enough to write about. And once a subject has been selected, the time required to put pen to paper (sorry—enter on the computer screen) has not been prohibitive. An added benefit is that it encourages me to think about subjects and organize my thoughts in a way that hopefully becomes clear, coherent and helpful.<br /><br />And, I must add that my AMA “blog team” (Kevin O’Neil, Randy Liss, Kathlene Maughmer and Susan Kirkpatrick) has provided invaluable assistance in editing and fact-checking to be sure I do not go down a path I would find not helpful.<br /><br />In my speech to the AMA House of Delegates on Saturday, which is available on the AMA Annual Meeting <a href="http://www.ama-assn.org/go/annual2011">website</a>, I set three goals for my remarks.<br /><br />1.    To say thank you<br />2.    To say where we, the AMA—the physicians of this country—go from here<br />3.    To describe how we get there<br /><br />At the conclusion, I summarized the speech in six words: Thank you, lets move forward, together.<br /><br />Many of my talks during the year have drawn on my love of sailing—the theme of boats and the sea—and lessons learned from those experiences. My alltime favorite poem illustrating that motif is one by Ella Wilcox titled, “Tis The Set of The Sails.” I share it with you as my goodbye.<br /><br />“But to every mind there openeth<br />A way, and way, and away,<br />A high soul climbs the highway,<br />And the low soul gropes the low,<br /><br />Editor's note: To comment on this post, send us an e-mail.<br />And in between on the misty flats,<br />The rest drift to and fro.<br /><br />But to every man there openeth,<br />A high way and a low,<br />And every mind decideth,<br />The way his soul shall go.<br /><br />One ship sails East,<br />And another West,<br />By the self-same winds that blow,<br />‘Tis the set of the sails<br />And not the gales,<br />That tells us the way we go.<br /><br />Like the winds of the sea<br />Are the ways of fate,<br />As we voyage along through life,<br />‘Tis the set of the soul,<br />That decides its goal,<br />And not the calm or the strife.”<br /><br />Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=The%20set%20of%20the%20sails%20tells%20us%20the%20way%20we%20go-06-20-2011">email</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:48e0fb40-d060-41c7-a667-7020f18ceb87 More graduate medical education funding would help solve the nation’s physician shortage http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a2f712d57-6893-439a-a16f-98e6260454e8&plckScript=blogScript&plckElementId=blogDest Fri, 17 Jun 2011 19:27:00 GMT <p>One year after taking office as president of the AMA, I am back in Chicago, where physicians from all over the country are gathering for the <a href="http://www.ama-assn.org/go/annual2011" target="_blank">2011 Annual Meeting of the AMA House of Delegates</a>. The House is the policy-setting arm of the AMA, and delegates represent the leadership of the profession of medicine.</p><p>As I greet old friends arriving in town, I am reminded that we have a shortage of physicians in this country. In fact, during the past 10 years, at least 28 states and 18 medical specialties have reported physician work force shortages, and an additional five states and five medical specialties predict coming shortages. A recent <a rel="nofollow" href="https://www.aamc.org/download/100598/data/recentworkforcestudiesnov09.pdf" target="_blank">report</a> by the Association of American Medical Colleges summarizes various studies about the physician shortage at the state, specialty and national levels.</p><p>We know that these shortages will be exacerbated by the increased demands of an aging population, higher levels of chronic disease and the 32 million individuals who will have insurance as a result of the Affordable Care Act (ACA) passed last year.</p><p>The good news is that medical schools across the country are increasing class sizes, and new medical schools are coming online. The resulting increase in medical school graduates is helpful, although not yet enough to meet the need.</p><p>The major bottleneck is the inadequate number of graduate medical education (GME) positions. Funded primarily by Medicare, the number of these positions has been capped since the <a rel="nofollow" href="http://www.gpo.gov/fdsys/pkg/PLAW-105publ33/pdf/PLAW-105publ33.pdf" target="_blank">Balanced Budget Act of 1997</a> took effect.</p><p>The ACA took minimal steps to expand GME by redistributing some unused positions. In addition, the law authorized a <a rel="nofollow" href="http://www.gao.gov/about/hcac/nat_hcwc.html" target="_blank">National Health Care Workforce Commission</a> tasked with making recommendations to Congress on health care work force needs. Congress needs to fund this commission and increase GME slots by 15 percent to respond to the problem. </p><p>In addition, the AMA Center for Transforming Medical Education and the <a href="http://www.ama-assn.org/go/arc" target="_blank">AMA Advocacy Resource Center</a> published a <a href="http://www.ama-assn.org/resources/doc/med-ed-products/graduate-medical-education-funding.pdf" target="_blank">report</a> calling for increased GME funding. The report recommends various strategies that state and regional stakeholders could embrace to effectively promote GME funding, such as:</p><p>• Collecting meaningful data that shows the need to expand GME to meet state and regional work force needs.<br />• Identifying current and potential sources of expanded funding for GME.<br />• Identifying successful methods to distribute GME funds to meet state and regional needs.<br />• Supporting funding for training in non-hospital sites.</p><p>The AMA also recently held a webinar that looks at these and other innovative ways to expand GME funding. I invite you to listen to a recording of the webinar, which is available <a rel="nofollow" href="http://eo2.commpartners.com/users/ama/session.php?id=6500" target="_blank">online</a>.</p><p>The road to successful health system reform, including implementation of the ACA, will be long and winding and fraught with challenges. Critical to the success of this effort is paving that road with an adequate physician work force. I look forward to that.</p><p>And I also am looking forward to the AMA meeting.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=More%20graduate%20medical%20education%20funding%20would%20help%20solve%20the%20nation%E2%80%99s%20physician%20shortage-06-17-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:2f712d57-6893-439a-a16f-98e6260454e8 Looking back on a year at the AMA’s helm http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a2b25d8cb-8197-4818-9d5b-0838aed16682&plckScript=blogScript&plckElementId=blogDest Wed, 15 Jun 2011 14:22:00 GMT <p>One of the things I love most about sailing—and I love nearly everything about being in a boat on the open water—is being part of a crew of like-minded individuals, all working together to get us where we’re going.</p><p>The people with whom I have sailed are veteran sailors, but we all have our own strengths, which we each contribute to the journey.</p><p>On many days the sun shines, the seas are calm and the wind is constant. Those trips are easy, more of a “hanging out” on the water than any test of skills. Other days, wind, weather and even our vessel’s idiosyncrasies can offer challenges that raise the tension and bring into play every bit of experience our years of seagoing can muster.</p><p>Those are the days when those individual strengths come into play. The crew acknowledges someone’s greater expertise and works together to get us safely out of harm’s way and to our destination.</p><p>I have come back from those voyages a bit wiser, better equipped for the next time—and always ready to set out again.</p><p>For me, these sailing trips are not unlike my experiences of the past 12 months as president of the AMA. While I have been involved in medicine for many years and the politics of medicine for almost as long, these past months have called upon all the skills and learning I can muster. And they reminded me of the value of sailing these particular waters—not alone, but as part of a like-minded crew.</p><p>Medicare’s sustainable growth rate formula, the Affordable Care Act, medical liability reform, medical education reform, the growing physician shortage, natural disasters in the United States and abroad—our seas have not been smooth. Yet on every one of these issues, I see progress. Legislation submitted, dollars appropriated for pilot projects, steps taken, understandings achieved. Our journey toward building a better health care system is far from over, but I believe it is well under way.</p><p>William Arthur Ward, a 20th century writer who must have been a sailor himself, said, “The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.”</p><p>At the AMA, we’ve done all that. Complained about the wind. Expected it to change. But in the long run, we’ve adjusted the sails and moved on—together. </p><p>For me, that word “together” always has been the AMA’s biggest appeal—and its greatest strength. And so long as the medical community continues to work together for the good of our profession and our patients, I believe no seas will be so high or winds so strong that we can’t prevail. </p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Looking%20back%20on%20a%20year%20at%20the%20AMA%E2%80%99s%20helm-06-15-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:2b25d8cb-8197-4818-9d5b-0838aed16682 Legislation a key element of true physician payment reform http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a91f211a2-87d9-49fe-aed1-0dc9d6f60ac5&plckScript=blogScript&plckElementId=blogDest Fri, 10 Jun 2011 20:29:00 GMT In a webinar earlier this week, I shared the AMA’s work in support of legislation that would give seniors and physicians a new, additional option to allow them to freely contract “…without penalty to either party, for a fee that differs from the Medicare payment schedule,” as supported by <a href="https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fDIR%2fD-380.997.HTM">AMA policy</a>.<br /><br />This legislation, the <a href="http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/practice-management/medicare-patient-empowerment-act.page">Medicare Patient Empowerment Act</a>, was introduced in the U.S. House (H.R. 1700) by Rep. Tom Price, R-Ga., in early May. Sen. Lisa Murkowski, R-Alaska, introduced it in the Senate (S. 1042) a few weeks later. <br /><br />The <a href="http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/practice-management/medicare-patient-empowerment-act.page">Medicare Patient Empowerment Act</a> would give patients, particularly those who already are experiencing difficulty finding a physician who still is accepting Medicare patients, an option that enables them to see any doctor they choose. And it would give physicians some relief from onerous price controls of the Medicare physician payment system and help them regain some measure of professional autonomy over fee setting.<br /><br />We believe this payment option would improve the Medicare program both for physicians and patients. You can learn more about the legislation by listening to a <a rel="nofollow" href="http://eo2.commpartners.com/users/ama/session.php?id=6966" target="_blank">recording</a> of the webinar.<br /><br />Among the AMA’s major priorities are continuing efforts to demand that Congress preserve the integrity of the Medicare program. Medicare represents a promise to seniors of reliable health care and is a program to which they have contributed throughout their working lives.<br /><br />Unfortunately, during the past 10 years, a lack of adequate payments for physician services has threatened the program’s integrity. Because of the horribly flawed Medicare physician payment formula, the sustainable growth rate (SGR), payments have not kept up with the cost of care—and are essentially the same as they were in 2001.<br /><br />There is clear agreement in Congress and the White House that the SGR needs to be eliminated. However, there is a clear lack of agreement on how to do it.<br /><br />In a hearing by the House Energy and Commerce Health Subcommittee in May, I <a href="http://www.ama-assn.org/ama/pub/news/news/ama-president-testifies-medicare-payment.page">presented</a> the AMA’s three-pronged plan for fixing the Medicare physician payment system. That plan consists of:<br /><ol><li>Repealing the SGR this year.</li><li>Implementing a five-year period of stable Medicare physician payments that keep pace with the growth in medical practice costs.</li><li>During the five-year period, designing, testing and implementing a variety of new payment models intended to enhance care coordination, quality, appropriateness and reduce costs.</li></ol>So, we need a reformed Medicare physician payment system and a new option for patients and physicians spelled out in the Medicare Patient Empowerment Act. We look forward to working with Congress to make both happen.<br /><br />Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Legislation%20a%20key%20element%20of%20true%20physician%20payment%20reform-06-10-2011">email</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:91f211a2-87d9-49fe-aed1-0dc9d6f60ac5 Ethics helps us keep the faith—and our focus http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a049e413c-8d63-4fb4-834a-f6057081e9fb&plckScript=blogScript&plckElementId=blogDest Wed, 08 Jun 2011 13:59:00 GMT <p>When I stop to think about it, I don’t imagine it was any easier to be a physician in ancient Greece or early days America than it is today¬—just different.  </p><p>But I do know that in these days of political wrangling, changing U.S. demographics, fast-advancing technologies and the stifling effect from the nation’s ever-growing need for more physicians, members of our profession can get so caught up in simply getting through the day that it’s possible to lose sight of what’s most important about being a physician: our one-on-one relationship with patients.</p><p>Yet building those relationships is increasingly difficult in our society. Today’s patient visits bring with them myriad issues relating to everything from age to gender to ethnicity to insurance boundaries (although hopefully, this last issue will improve as insurance market reforms are adopted).</p><p>I don’t know about you, but while I learned about patient confidentiality, my medical training never warned about Facebook—of course “way” back then there was no such thing as Facebook. </p><p>Or made me aware that the increasingly rich diversity of culture and ethnicity in our country calls for differences in responses and sensitivity as we see patients. </p><p>Or taught me how to be a responsible steward of health care resources for patients and for the community.</p><p>So where do we go to find this kind of help?</p><p>Because the issues of ethics and stewardship have been front and center for the AMA since its founding in 1847, physicians always have been able to turn to the AMA for guidance when questions arise. And that is still the case today.</p><p>The original <a href="http://www.ama-assn.org/resources/doc/ethics/1847code.pdf" target="_blank">AMA <em>Code of Medical Ethics</em></a> was written in 1847 as part of the AMA’s founding documents. And the <em><a href="http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page" target="_blank">Code</a></em> has been evolving ever since, providing guidance to help physicians tackle new challenges raised by developments in science and medicine. </p><p>As we work our way through the dilemmas that come with practicing medicine, it is reassuring that there are resources available to help find a way through a quagmire of conflicting issues and demands.</p><p>Besides the Code of Medical Ethics, two other resources in particular are handy tools for those practicing in this quickly changing America. One is <em><a href="http://virtualmentor.ama-assn.org/" target="_blank">Virtual Mentor</a></em>, the AMA’s online ethics journal. Driven by medical students and residents, Virtual Mentor offers short discussions on timely subjects (and links to more information). The June issue, for example, examines physician responses to the wide use—by more than one-third of patients—of alternative therapies and products.</p><p>And because communication is often at the crux of the patient-physician relationship, the AMA, through its multi-stakeholder <a href="http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/the-ethical-force-program.page" target="_blank">Ethical Force Program</a>® has developed the <a href="http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/the-ethical-force-program/patient-centered-communication/organizational-assessment-resources.page" target="_blank">Communication Climate Assessment Toolkit</a>, or C-CAT, a new resource for physician practices and hospitals to help measure how well they communicate with an increasingly diverse patient population. </p><p>None of these resources will give anyone a turnkey answer to a knotty situation, but all will help open the way to making the right decision. And they will help in keeping our patients at the center of what our profession is all about.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Ethics%20helps%20us%20keep%20the%20faith%E2%80%94and%20our%20focus-06-08-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:049e413c-8d63-4fb4-834a-f6057081e9fb Weekend at oncology meeting was inspiring and impressive http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a6889d717-3dfe-4277-ad5e-ce3e624d7854&plckScript=blogScript&plckElementId=blogDest Mon, 06 Jun 2011 16:04:00 GMT <p>It was my privilege this weekend to attend the annual meeting of the <a href="http://www.asco.org/" target="_blank" rel="nofollow">American Society of Clinical Oncology</a> in Chicago (ASCO). I participated in an educational session titled “Post Healthcare Reform - Facing the New Reality.” </p><p>The focus was on the implications of the Affordable Care Act (ACA), especially as they relate to new payment and delivery reforms and the impact on physician practices. I was again encouraged and impressed to see physicians interested in playing a leadership role in this area.</p><p>What also impressed me was to see the magnitude of this meeting, with about 30,000 professionals from around the world gathered together to learn and share information about the latest in science tackling the problem of cancer – a disease that still kills half a million in this country every year.</p><p>A profession is variously defined as a calling, an occupation, a career requiring specialized knowledge and often long and intensive academic preparation. Classically, medicine, divinity and law were the only three professions. Implicit and sometimes explicit in the definition of a profession is an obligation for self regulation and lifelong learning. The ASCO meeting - with a 400-plus-page booklet of course offerings - was a refreshing reminder that physicians are committed to that principle. </p><p>I was also impressed to hear <a href="http://www.cancer.gov/aboutnci/director" target="_blank" rel="nofollow">Harold Varmus, MD</a>, director of the National Cancer Institute (NCI), talking about the opportunity to accelerate progress in cancer research, the importance of spending the budget of NCI wisely and the promise of bringing genomics to clinical practice. He also gave a grim reminder that 20 percent of cancer in this country is related to obesity.</p><p>George Sledge, MD, president of ASCO, was equally inspiring in discussing the enormous changes and progress in treating cancer, the resulting lower death rates and the promise of the “<a href="http://www.genome.gov/27540667" target="_blank" rel="nofollow">$1,000 genome</a>” for changing the way we treat cancer. Dr. Sledge also reminded the group that the demographics of our aging population with concomitant increases in cancer will reverse the trend toward decreased mortality. </p><p>Dr. Sledge pointed out the significant challenges faced by this nation related to workforce shortages and increased costs. He described both the challenge and opportunity for the future as the “tsunami of scientific knowledge bearing down on us today.”</p><p>My take-away message of the weekend was a pride in seeing so many physicians dedicated to the highest standards in what they do to care for their patients. My belief is that the American people should be reassured that their physicians put providing the best of care for them at the top of their agenda.</p><p>It truly was an inspiring weekend – and at least very familiar weather-wise. The hot Chicago temperatures were very similar to those at my home in Winter Park, Fla.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Weekend at oncology meeting was inspiring and impressive-06-06-2011" target="_blank" rel="nofollow">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:6889d717-3dfe-4277-ad5e-ce3e624d7854 Final “Office Hours” call like the rest—richly rewarding http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ac204923f-6102-4a32-ab54-cfd9dd23176a&plckScript=blogScript&plckElementId=blogDest Fri, 03 Jun 2011 19:02:00 GMT <p>Earlier this week (June 1) I held my final “<a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours</a>” call with AMA members. As many of you know, this was an initiative we started after I began my term as president last June to provide AMA members the opportunity to call in on a regular basis and ask questions and share their observations and concerns with me.</p><p>For me, this has been an enjoyable and richly rewarding experience. My hope is that those who participated have found it likewise. AMA President-elect <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/board-trustees/our-members/peter-carmel.page" target="_blank">Peter Carmel, MD</a>, who will be taking over as president in a couple of weeks, has indicated he will continue this outreach effort.</p><p>As has been the case on past calls, questions on this last call covered a broad array of issues. I received questions about:</p><p>• How senior physicians can share their experience in ways that enrich and educate their communities.<br />• The work of the AMA in influencing the Centers for Medicare & Medicaid Services’ (CMS) <a href="https://www.cms.gov/sharedsavingsprogram/" target="_blank" rel="nofollow">proposed regulations</a> on accountable care organizations and educating physicians to take a leadership role if they want to be involved; the AMA submitted <a href="http://www.ama-assn.org/ama/pub/news/news/ama-calls-on-cms-to-revise-aco-proposal.page" target="_blank">comments</a> on the proposed rule today.<br />• The change in the mix of physician payment—fee-for-service vs. salary, bundled payments or savings incentives—that appears to be a part of changes in delivery and payment for services envisioned by the Affordable Care Act (ACA).<br />• AMA activities in response to legislation pending in several states that would limit what pediatricians can ask parents about gun safety in the home, a subject I <a href="http://www.ama-assn.org/ama/pub/ama-president-blog.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a77892a0c-f7d5-4c75-9a50-945c93fb9617&plckScript=blog" target="_blank">wrote about</a> recently.<br />• How the AMA and state and specialty societies can cooperate to have a more cohesive message to physicians about how federal health system reform affects physician working conditions.</p><p>In addition, callers wanted information about the status of the individual responsibility provision  that is part of the ACA and whether it will be upheld by the U.S. Supreme Court—their guess is as good as mine. Considerable interest continues about the AMA’s <a href="http://www.ama-assn.org/ama/pub/news/news/ama-president-testifies-medicare-payment.page" target="_blank">strategy</a> to secure a permanent fix for the Medicare physician payment system, including repeal of the sustainable growth rate, and what the future holds for Medicare viability in the context of current debates on the nation’s budget and burgeoning debt.</p><p>One member who has been using electronic health records for in excess of 30 years recounted the risk, even with long experience, of errors and electronic malfunction that can jeopardize health care. That’s just part of the challenge of converting to health information technology.</p><p>As has been the case with previous calls, I will respond personally to those who pre-submitted questions not answered on the call.</p><p>Yoga Berra famously said, “It’s tough to make predictions, especially about the future.” He could also have said, “It’s tough to make generalizations, especially about what is happening.” That admonition not withstanding, if I had to make generalizations based on the range of questions I have received during the Office Hours calls, and as I have spoken to physician groups during the past year, it would be this:</p><p>As the year has gone on, the tenor of questions and debate has shifted from one primarily colored by strong passions and concerns about the ACA and changes to physician practice to what I find to be an encouraging and a positive omen for the future. That is, physicians and physician organizations across the country appear focused on how they can participate in shaping the changes that are under way in our health care system—how they can address issues left out of the ACA, how they can tackle provisions in the law that need to be changed and how they can influence the development of regulations that will govern how the ACA is implemented.</p><p>I find this to be a positive sign. And I continue to be proud of the constructive role the AMA and the nation’s physicians we represent are playing in health system reform—a role that bodes well for the future.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Final “Office Hours” call like the rest—richly rewarding-06-03-2011" target="_blank" rel="nofollow">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:c204923f-6102-4a32-ab54-cfd9dd23176a AMPAC celebrates a half-century of political support, education http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a0526d2e7-db46-4db3-8f50-2767282f5203&plckScript=blogScript&plckElementId=blogDest Wed, 01 Jun 2011 13:45:00 GMT <p>I hear there’s going to be a party at this year’s <a href="http://www.ama-assn.org/go/annual2011" target="_blank">Annual Meeting of the House of Delegates</a>. </p><p>Fifty years ago, in the roiling ’60s, the AMA wanted to find a way to use voluntary donations to support political candidates who understood the needs of patients and physicians. They looked around and saw how labor unions were benefitting from their political action committees, or PACs. And so the House of Delegates voted in 1961 to form AMPAC, the <a rel="nofollow" href="http://www.ampaconline.org/" target="_blank">American Medical Association Political Action Committee</a>.</p><p>Now, after five decades of success in supporting federal candidates and providing political education, it’s time to celebrate AMPAC—which we’ll be doing at the Annual Meeting. And 50 years of AMPAC is something well worth celebrating.</p><p>As it turned out, the AMA was the first non-union organization to form a PAC. We set an example; today, more than 4,000 PACs are involved in American politics.</p><p>Over the years, AMPAC saw a need for more than financial support for candidates and began holding political education seminars and candidate workshops.  </p><p>During the last election cycle in 2010, 90 percent of the candidates AMPAC supported for the U.S. House of Representatives and 96 percent of those supported for the Senate were elected. </p><p>Even before the AMA was formed, America’s physicians saw the need to immerse themselves in politics. Two physicians signed the Declaration of Independence. More have been appointed to government jobs, or served as governors, state legislators and members of Congress. Right now there are 20 physicians serving in Congress. Countless more have supported American politics on the ground as medical officers in our armed forces, a role I proudly played in the U.S. Navy.</p><p>Martha Gellhorn, a World War II correspondent and writer, put it this way:</p><blockquote><p>“We all know someone who says, ‘I’m not interested in politics.’ But those same people might as well say, ‘I’m not interested in my standard of being, my health, my job, my rights, my freedom … or my future. If we meant to keep any control of our world and lives, we must be interested in politics.’” </p></blockquote><p>I and my fellow AMA members share Ms. Gellhorn’s sentiments on some level, or we would not be part of the AMA. Especially now, when the future of American medicine is being debated daily in our statehouses and in Washington, D.C., it is important that physicians play a role in that debate. AMPAC is a part of making our voices heard.</p><p>If you will be at this year’s Annual Meeting, visit AMPAC’s booth to find out more about AMPAC and its political education programs.</p><p>To help us celebrate AMPAC’s golden anniversary, there will be rock ‘n’ roll, a chance to mingle with Marilyn Monroe, Elvis, Joe DiMaggio and JFK, as well as a new book, “Physicians as Public Servants.”</p><p>Be assured that I will be part of the Annual Meeting’s AMPAC party</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Celebrating%20a%20half-century%20of%20political%20support,%20education-06-01-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:0526d2e7-db46-4db3-8f50-2767282f5203 The AMA’s job is hard – all the more reason to embrace it http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad5c4d78f-615b-4161-ae12-665d92fd1413&plckScript=blogScript&plckElementId=blogDest Fri, 27 May 2011 15:20:00 GMT <p>In my journeys this past year as AMA president, I have heard a recurring theme that can be summarized as this:</p><p>If something is hard it is not fun and not worth doing. </p><p>Nothing could be further from the truth. Let me cite a couple of examples.</p><p>As I travel about the country people frequently ask me how things are going and if I am enjoying my year as AMA president. My response always is that I am having a wonderful time, thoroughly enjoying what I do. </p><p>Not uncommonly, those to whom I am talking look slightly askance and ask – “really?” The implication of course is that they wonder how speaking for the AMA could be so much fun in view of the conflict that has characterized the health care debate and the slings and arrows that from time to time come our way. </p><p>The reality is that at least for me the challenges -- and yes even the conflict in a perverse sort of way -- add to the sense of importance I feel in the work I am doing and the enjoyment I get from doing it  – work for a worthwhile, even noble cause.</p><p>In conversations with AMA members, talking about <a href="http://www.ama-assn.org/ama/pub/advocacy/our-advocacy-work.page" target="_blank">goals the AMA has particularly in the advocacy arena</a> in Washington, I often include in my remarks a realistic assessment about the likelihood of success in the short or long term. And I find that if that assessment includes an observation that the work will be hard, the almost immediate response is: “Does that mean then that the AMA will not work to make it happen?”</p><p>My response: the reality is that if it were easy, there would be no need for the AMA. All this work is difficult, as are the challenges related to our health care system that the AMA is called on to embrace in support of the profession and the patients we are privileged to serve.</p><p>In 1776 Thomas Paine expressed these sentiments well in his book “The Crisis.” </p><blockquote><p>“These are the times that try men’s souls.</p><p>“The summer soldier and the sunshine patriot will in this crisis shrink from the service of their country but he that stands by it now, deserves the love and thanks of men and women.</p><p>“Tyranny, like hell, is not easily conquered, yet we have this consolation with us, that the harder the conflict, the more glorious the triumph.</p><p>“What we obtain too cheap we esteem too lightly.</p><p>“It is dearness only that gives every thing its value.”</p></blockquote><p>George Washington was so taken with Paine’s work that he required it be read to all of his revolutionary war troops. And, Thomas Paine became the voice for the American Revolution.</p><p>More recently (relatively speaking), in a speech at Houston’s Rice University on Sept. 12, 1962, then President John F. Kennedy also aptly said:</p><blockquote><p>“We choose to go to the moon in this decade and to do other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”</p></blockquote><p>So – is the job difficult? Is the path long and winding? Is the likelihood of success not assured? Along with Paine and Kennedy, I say all the more reason to embrace it.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=The AMA’s job is hard – all the more reason to embrace it-05-27-2011" target="_blank" rel="nofollow">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d5c4d78f-615b-4161-ae12-665d92fd1413 SGR repeal would be just one step toward improving the Affordable Care Act http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a846d8d38-4f49-4c71-b453-13df54f3166c&plckScript=blogScript&plckElementId=blogDest Wed, 25 May 2011 13:52:00 GMT <p>"<em>The SGR is a failed formula, and the longer we wait to cast it aside, the deeper the hole we dig. It is past time to replace the SGR with a policy that preserves access, promotes quality and increases efficiency</em>."</p><p>That was the gist of my <a href="http://www.ama-assn.org/ama/pub/news/news/ama-president-testifies-medicare-payment.page" target="_blank">testimony</a> when I told members of a U.S. House subcommittee recently that, after years of flat payments and increasing costs, along with the looming increase in the senior population, it is time to repeal the sustainable growth rate (SGR), Medicare’s deeply flawed physician payment formula.</p><p>However, I also said that, in addition to repeal of the SGR, there should be a five-year window of stable payments to test pilot programs and transition to new payment systems, and that these systems should include alternatives that address the different needs of practicing physicians. In addition, I outlined several examples of what those alternatives could be: things like accountable medical homes, models focused on Medicare shared savings, gain-sharing, payment bundling and a penalty-free new option for patients to contract independently with physicians. </p><p>The idea of alternative delivery and payment systems, of course, is not new. The ideas I brought up in my testimony have been developed over time by groups that began to look years ago at ways to replace the SGR, as well as in the private sector.</p><p>Right now, the AMA is working with specialty and state medical societies to form a new Physician Payment Reform and Delivery Leadership Group to further the process of testing and evaluating some of those payment models and to develop resources to help physicians participate in them successfully. </p><p>What also is not new is the AMA’s work to <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/aca-advocating-for-improvements.pdf" target="_blank">improve the Affordable Care Act</a> (ACA) and our health system in general. Repealing the SGR and reforming Medicare’s physician payment system is only one part of that effort. </p><p>Here are a few other places where the AMA has been involved:</p><p>At the state level, the AMA is representing physician and patient interests on issues like <a href="http://www.ama-assn.org/ama/pub/health-system-reform/resources/insight/april-2011/22apr2011.shtml" target="_blank">medical-loss ratio provisions</a> for insurance companies. In this and <a href="http://www.ama-assn.org/ama/pub/health-system-reform/resources/insight/may-2011/05may2011.shtml" target="_blank">other areas</a> we are working with the National Association of Insurance Commissioners, as it is state insurance commissioners who have taken the lead on many key ACA projects. </p><p>We also have worked hard on Capitol Hill for medical liability reform. Early this year, AMA Board Chair Ardis D. Hoven, MD, <a href="http://www.ama-assn.org/ama/pub/news/news/hoven-medical-liability-system.page" target="_blank">testified</a> before the House Judiciary Committee on this subject. And the AMA ran supportive <a href="http://www.ama-assn.org/ama/pub/news/news/ama-urges-congress-pass-health-act.page" target="_blank">print ads</a> in Washington, D.C., when liability reform legislation was debated and subsequently approved by the House Energy and Commerce Committee. </p><p>The AMA also has been actively engaged in developing Stage 1 measures for meeting meaningful use criteria for electronic health records (EHR). And we, along with 37 specialty societies, have responded to the proposed criteria for Stages 2 and 3, writing a <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/comments-hitpc-proposed-measures-25feb2011.pdf" target="_blank">letter</a> recommending greater flexibility in meaningful use requirements that would help accelerate wider use of EHRs by physician practices.</p><p>I encourage you to stay on top of what the AMA is doing in regard to health system reform and the ACA by signing up for <em><a href="http://www.ama-assn.org/go/insight" target="_blank"><em>HSR Insight</em></a></em>, the AMA’s bi-weekly e-newsletter.</p><p>Finally, because Memorial Day is just around the corner, I would like to remind readers that this holiday is a time for remembering the country’s war dead. The holiday was first officially proclaimed shortly after the Civil War when flowers were placed on both Union and Confederate soldiers’ graves at Arlington National Cemetery.</p><p>As a former U.S. Navy flight surgeon, I am particularly aware of those serving our country. And at this time, with military actions in so many places, I once more offer my thanks to colleagues who sacrificed their lives for this country.</p><p><strong>I want to hear what you think.</strong> Join me for my final <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time Wednesday, June 1. <a rel="nofollow" href="https://cc.readytalk.com/r/mk84cb89qm6c" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=SGR repeal would be just one step toward improving the Affordable Care Act-05-25-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:846d8d38-4f49-4c71-b453-13df54f3166c Federal employees on U.S. delegation to World Health Assembly do nation proud http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad39b8bed-682f-4394-866c-c515479d8c6a&plckScript=blogScript&plckElementId=blogDest Mon, 23 May 2011 16:01:00 GMT <p>“Never pass an opinion on someone you have never met.” Those words are from Brendan Nelson, MD, Australia’s ambassador to Luxembourg and the European Union and that country’s representative to the United Nations and the World Health Organization. He said them last month during a speech he gave on leadership to the World Medical Association Council meeting in Sydney, Australia.</p><p>I think it is good advice that is sorely lacking in much of the public discourse, particularly in the way some describe U.S. government employees.</p><p>Some believe the United States government is incapable of doing much of anything well. That opinion has found strong, even vitriolic, expression in much of the debate about health system reform during the past two years. It tends to be particularly pronounced when there is disagreement with policies that are being promulgated—and it often includes disparaging those who serve the public and the work they do.</p><p>I have a different opinion of those who work in government. </p><p>As part of the U.S. delegation to the <a rel="nofollow" href="http://www.who.int/mediacentre/events/2011/wha64/en/index.html" target="_blank">World Health Assembly</a> in Geneva last week, I worked with a team of professionals, public servants all, who are employed by our federal government. They were notable for their expertise, good judgment and excellent work ethic. I found them to be conscientious, dedicated and fiercely protective of the nation’s interests.</p><p>What I found truly impressive was the skill and comprehension they displayed when participating  in the sometimes arcane process that characterizes work in the international arena. And their proficiency was clearly respected by others involved in the process. They are public servants of whom we can be justifiably proud.</p><p>It is clearly inappropriate to gloss over incompetence, whether it is in the public or private sector. But it is equally inappropriate to paint with a broad brush that assumes that just because someone works in the public sector (or the private, for that matter) that he or she is incompetent.</p><p>Dr. Nelson said it well: “Never pass an opinion on someone you have never met.”</p><p>I agree. That is advice that could serve us well and do wonders for our public discourse.</p><p><strong>I want to hear what you think.</strong> Join me for my final <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time on Wednesday, June 1. <a rel="nofollow" href="https://cc.readytalk.com/r/mk84cb89qm6c" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an email.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d39b8bed-682f-4394-866c-c515479d8c6a Assembly hears inspirational words from two amazing people http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ab9bf3ae7-50e6-4f24-bef7-def066e85ada&plckScript=blogScript&plckElementId=blogDest Fri, 20 May 2011 15:17:00 GMT <p>Two highlights of the <a rel="nofollow" href="http://www.who.int/mediacentre/events/2011/wha64/en/index.html" target="_blank">World Health Assembly</a> I attended this week in Geneva were speeches by Bill Gates of the Bill and Linda Gates Foundation and Sheikh Hasina, prime minister of Bangladesh. I was struck not only by what they said but by the different routes their lives have taken to the world stage—both with a mission to help people by improving their health.</p><p>Bill Gates grew up in America, founded Microsoft, became remarkably wealthy and has decided, along with his wife, Linda, to devote the rest of his life and resources to improving the health of people around the world.</p><p>He <a rel="nofollow" href="http://www.who.int/mediacentre/events/2011/wha64/bill_gates_speech_20110517/en/index.html" target="_blank">called for the assembly to make this the “Decade of Vaccines,”</a> with a goal of producing vaccines faster and less expensively so that they will be available to people in developing countries—and to save 10 million lives by 2020. He announced that, starting in 2012, the Gates Foundation will bestow an annual award on the person or organization that has made the most uniquely innovative contribution to the “Decade of Vaccines” in the area of science, delivery or funding of vaccines.</p><p>Sheikh Hasina served as prime minister of Bangladesh from 1996 to 2001 and most recently since 2008. Her father, known as the father of the nation, was martyred along with 18 members of her family in 1975. She and a sister escaped because they were studying in West Germany at the time. Hasina lived in exile for years before returning to Bangladesh, entering politics and becoming the leader of her country.</p><p>During her speech, the prime minister <a rel="nofollow" href="http://www.who.int/mediacentre/events/2011/wha64/sheikh_hasina_speech_20110517/en/index.html" target="_blank">talked about strides being made in improving health</a>—decreasing diarrheal diseases and pneumonia, improving life expectancy and providing resources for family planning. She also related the health of a nation’s economy to the health of its people. And she expressed the hope that some day “population will be seen as an asset instead of a burden.”</p><p>Two different people from different cultures, with different life pathways and experiences, sharing a concern for their fellow human beings. Inspiring.</p><p><strong>I want to hear what you think.</strong> Join me for my final <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time on Wednesday, June 1. <a rel="nofollow" href="https://cc.readytalk.com/r/mk84cb89qm6c" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Assembly%20hears%20inspirational%20words%20from%20two%20amazing%20people-05-20-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:b9bf3ae7-50e6-4f24-bef7-def066e85ada Preventable disease a key health concern—not just in U.S., but worldwide http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a9c419e2c-8fdf-4feb-804e-35ebd825e23d&plckScript=blogScript&plckElementId=blogDest Thu, 19 May 2011 14:36:00 GMT <p>One of the features of the <a rel="nofollow" href="http://www.who.int/mediacentre/events/2011/wha64/en/index.html" target="_blank">World Health Assembly</a> in Geneva is an opportunity for health ministers of member nations, of which there are 197, to speak at the plenary sessions on issues of importance to their country. And most of them do.</p><p>As I listened to those speeches Monday and Tuesday, I was struck by the uniformity of the major health challenges facing countries all over the world. While communicable diseases still are a scourge of developing countries, the biggest challenge now—whether the country is developed or not—is noncommunicable diseases.</p><p>These include diseases based on lifestyle and health behavior—conditions such as diabetes, cardiovascular disease, cancer and chronic lung disease. They are preventable largely by addressing obesity, sedentary lifestyles, tobacco use and alcohol abuse. In the United States they account for 75 percent of health care costs, and tackling them will be essential for addressing the rising cost of care. And, as noted above, we are not unique in this regard.</p><p>Recognizing the importance of this problem has led to countries all over the world focusing their attention on it. At home, the Obama administration has made it a major emphasis in association with implementing aspects of the Affordable Care Act. Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, highlighted the United States’ efforts in her remarks to the assembly.</p><p>Of note, there will be a special session of the United Nations in New York in September on noncommunicable diseases, moving this issue from just the agenda of health ministers of countries to the agenda of leaders of countries.</p><p>During her remarks to the World Health Assembly, Director-general Margaret Chan, MD, said in characterizing health care’s status as a priority of member nations, “Health speaks with a loud voice but still carries a small stick.”</p><p>Hopefully efforts around the world and sessions such as that planned at the UN in September will forecast a bigger stick for health.</p><p><strong>I want to hear what you think.</strong> Join me for my final <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time on Wednesday, June 1. <a rel="nofollow" href="https://cc.readytalk.com/r/mk84cb89qm6c" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Preventable%20disease%20a%20key%20health%20concern%E2%80%94not%20just%20in%20U.S.,%20but%20worldwide-05-19-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:9c419e2c-8fdf-4feb-804e-35ebd825e23d Not only good health, but also a good economy http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a08427fcb-3d24-49d1-b33a-2db5460cef44&plckScript=blogScript&plckElementId=blogDest Wed, 18 May 2011 14:04:00 GMT <p>A lot of the talk these days is about jobs—who has them, how to get them, where they are and how to create more. That’s not generally a topic associated with physicians, at least not until recently, and it should be.</p><p>A recent <a href="http://www.ama-assn.org/go/eis" target="_blank">study</a> by the AMA showed that the nation’s office-based physicians support about 4 million jobs nationwide. In addition to that, those same physicians contributed $1.4 trillion in output—or sales revenue—and $63 billion in state and local taxes in 2009.</p><p>All of us—probably physicians as much as the general population—think of physicians as being significant contributors to the health of our patients. In fact, the study shows that office-based physicians also are important contributors to the national economy and the economic health of our communities.</p><p>Conducted under the auspices of the <a href="http://www.ama-assn.org/go/arc" target="_blank">AMA Advocacy Resource Center</a>, the state legislative arm of the AMA, in cooperation with state medical associations, the study looked at the number of jobs supported by office-based physicians in each state, wages and benefits supported by physician offices, state and local tax dollars and sales economic output, or sales revenue. The study breaks down the data by state.</p><p>As an example, in Florida, where I live in Winter Park, office-based physicians in 2009 generated more than 230,000 jobs—5.9 per physician—and contribute $64.5 billion, or 8.6 percent of the state’s total gross domestic product (and almost $2.3 billion in state and local tax revenues).</p><p>Of course, Florida is a large state, but the study also found that the median state supported $10.3 billion in economic activity and supported more than 46,400 jobs. Even in Wyoming, the state with the smallest numbers, those 896 office-based physicians contribute $1 billion in sales revenue and are responsible for 4,996 jobs. </p><p><a href="http://www.ama-assn.org/ama1/pub/upload/mm/363/prp200803.pdf" target="_blank">From elsewhere</a> we learn that physicians nationwide also provided an estimated $24.4 billion in charity care nationwide in 2008. This is no small economic contribution.</p><p>Physicians have an impact on people’s lives. We all know that. That’s the reason most of us went to medical school. But I, for one, was quite surprised and pleased to find out how much of an impact we have on the U.S. economy. It is a significant, if not staggering, contribution to the nation’s well being.</p><p>The study also found that office-based physicians almost always contribute more to state economies than higher education, the legal profession, nursing homes, home health or hospitals. Speaking from experience, I know we make that contribution the hard way: one day at a time.  </p><p>At a time when state and federal budgets are driving the national debate, it is important that our lawmakers understand this other aspect of the American health care picture. Thanks to the Advocacy Resource Center study, we are in a good position to tell our state legislators and our representatives in Congress.</p><p>And at a time when many people believe that American health care is under siege, this data should be an eye-opener to those who seek to limit our ability to provide jobs and support the economy.</p><p><strong>I want to hear what you think.</strong> Join me for my final <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time on Wednesday, June 1. <a rel="nofollow" href="https://cc.readytalk.com/r/mk84cb89qm6c" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Not%20only%20good%20health,%20but%20also%20a%20good%20economy-05-18-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:08427fcb-3d24-49d1-b33a-2db5460cef44 Geneva the personification of our collective desire to work together http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ae09e9e69-aeb2-4818-8dd5-3edb3a00ac08&plckScript=blogScript&plckElementId=blogDest Mon, 16 May 2011 14:48:00 GMT <p>The <a rel="nofollow" href="http://www.who.int/mediacentre/events/2011/wha64/en/index.html" target="_blank">64th World Health Assembly</a> of the World Health Organization (WHO) will open today with speeches by Margaret Chan, MD, director-general of WHO, and Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services. Then the committee work will begin, culminating over the next 10 days in action by the assembly on items of importance to world health.</p><p>Prior to the meeting, I have had the opportunity to take city and boat tours of the environs of Geneva. And I have been reminded that although we tend to record our history in the dates of armed conflicts, there is in a real sense a desire by people everywhere to live in peace, working in cooperation with each other.</p><p>Switzerland in general and Geneva in particular epitomize this desire for a better, more peaceful world. This is evidenced by the myriad of organizations headquartered here whose purpose is to promote things like humanitarian aid, trade, human rights, peace-keeping and security, nuclear research, health telecommunications and labor.</p><p>A partial list of these organizations, followed by the year they established their respective headquarters in Switzerland, illustrates the point:</p><p>• International Red Cross—1863<br />• International Telecommunication Union—1868<br />• Universal Postal Union—1874<br />• International Olympic Committee—1915<br />• League of Nations—1919<br />• International Labour Organization—1919<br />• United Nations—1945<br />• World Meteorological Organization—1945</p><p>The International Air Transport Association, the International Organization for Standardization, the World Anti-Doping Agency and the World Conservation Union also call Switzerland home. In addition, 250 non-governmental organizations have their seat in Geneva, including the World Council of Churches, the Lutheran World Federation and many others, and 166 foreign states have a permanent mission in Geneva.</p><p>So, the point is, while conflict is inevitable, the innate desire for peace we as humans have should inspire us to continue to try to work around our differences and find those things that unite.</p><p><strong>I want to hear what you think.</strong> Join me for my final <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time on Wednesday, June 1. <a rel="nofollow" href="https://cc.readytalk.com/r/mk84cb89qm6c" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Geneva%20the%20personification%20of%20our%20collective%20desire%20to%20work%20together-05-16-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:e09e9e69-aeb2-4818-8dd5-3edb3a00ac08 Key health issues to be considered during World Health Assembly http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a668ba6e5-ec58-4f14-8669-43e3352230fc&plckScript=blogScript&plckElementId=blogDest Fri, 13 May 2011 18:31:00 GMT <p>This morning Betty Jane and I arrived in Geneva, where after overcoming a significant case of jet lag I will attend the <a rel="nofollow" href="http://www.who.int/mediacentre/events/2011/wha64/en/index.html" target="_blank">64th World Health Assembly</a>. I will participate as a private sector advisor to the United States delegation, which is headed up by Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services.</p><p>Others in the same role include Jo Boufford, MD, president of the New York Academy of Medicine; Karen Daley, president of the American Nurses Association; and Sister Carol Keehan, president and CEO of the Catholic Health Association.</p><p>Some of the major health issues of importance to be discussed during the assembly are pandemic preparedness, smallpox eradication, prevention and control of noncommunicable diseases, and safe drinking water.</p><p>Noncommunicable diseases are of major concern to the U.S. government and the AMA. In fact, the AMA delegation to the World Medical Association submitted a paper (which the WMA council approved last month in Sydney, Australia) titled, “World Medical Association Statement on the Global Burden of Chronic Disease.”</p><p>The paper documents the fact that chronic diseases, including cardiovascular and circulatory diseases, diabetes, cancer and chronic lung disease, are the leading causes of death and disability in both the developed and developing world. They are not replacing existing causes of disease and disability (infectious disease and trauma) but are adding to the disease burden.</p><p>Possible solutions are in the areas of disease prevention, increased access to primary care, more socially accountable medical education systems and strengthening the health care infrastructure.</p><p>Success will depend on active involvement by world governments, national medical associations, medical schools and individual physicians.</p><p>In subsequent blog posts I will share observations about the workings of the World Health Assembly.</p><p><strong>I want to hear what you think.</strong> Join me for my final <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time on Wednesday, June 1. <a rel="nofollow" href="https://cc.readytalk.com/r/mk84cb89qm6c" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=Key%20health%20issues%20to%20be%20considered%20during%20World%20Health%20Assembly-05-13-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:668ba6e5-ec58-4f14-8669-43e3352230fc A heartfelt reflection on women’s health http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a54724fc7-2ffe-45de-a76f-f03bca19493b&plckScript=blogScript&plckElementId=blogDest Wed, 11 May 2011 13:40:00 GMT <p>I have committed a handful of days each year to memory. You can find them marked on my calendar, programmed in my BlackBerry and written on a sticky note inside my desk drawer. Be it birthdays, anniversaries, special holidays, we all have them. </p><p>Having a wife, two sons, a daughter and three grandchildren, Mother’s Day is definitely one of those days for me. I won’t—and can’t—forget it. And in honor of all the mothers this past weekend, I’m writing today about a very important topic that’s linked directly to women: their health and their hearts.</p><p>Contrary to popular belief, <a rel="nofollow" href="http://www.nhlbi.nih.gov/educational/hearttruth/lower-risk/what-is-heart-disease.htm" target="_blank">heart disease</a> is not just a “man’s” affliction. It’s a serious issue for women, too. Not only is it the No. 1 one cause of death for women, it’s also the third-leading cause of death among women 25 to 44 years old. And high cholesterol, high blood pressure, diabetes, smoking, poor diet, physical inactivity and alcohol use all are contributing factors. </p><p>The good news is that women actually can <a rel="nofollow" href="http://www.nhlbi.nih.gov/educational/hearttruth/lower-risk/index.htm" target="_blank">lower their risk of heart disease</a> by as much as 82 percent just by adopting a healthy lifestyle. Empowering women to make their health a top priority is the theme of this week—<a rel="nofollow" href="http://www.womenshealth.gov/whw/index.cfm" target="_blank">National Women’s Health Week</a>—as well as taking the right steps now to improve their physical and mental health and lower risks for certain diseases.</p><p>That’s what the <a href="http://www.ama-assn.org/go/healthierlifesteps" target="_blank">AMA Healthier Life Steps</a>™ program is all about. It aims to help patients identify and choose healthier behaviors. And it’s based on the premise that even small changes can have dramatic results. For example, just a 5 percent to 7 percent reduction in body weight will help someone lower his or her risk of type 2 diabetes and reduce his or her blood pressure. These are the kinds of changes that will help people live longer, happier lives.</p><p>Also, as part of the Affordable Care Act, health plans and insurers are now required to waive co-pays and deductibles for many <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-preventive-services.page" target="_blank">preventive services</a> for patients. The AMA offers a <a href="http://www.ama-assn.org/resources/doc/public-health/cpt-preventive-services-card.pdf" target="_blank">CPT® code pocket guide</a> that lists codes for certain preventive services.</p><p>In addition, Medicare patients will have access to additional preventive services under the new law without a co-pay or deductible, including an annual wellness exam, nutrition counseling, a diabetes screening and flu immunization. An <a href="http://www.ama-assn.org/resources/doc/public-health/cpt-medicare-ps.pdf" target="_blank">AMA brochure</a> can help physicians and their team members assist patients in navigating Medicare coverage for these services.</p><p>As the Buddhist teacher Nichiren once said: “More valuable than treasures in a storehouse are treasures of the body, and the treasures of the heart are the most valuable of all.” Those are words we all should heed, because it’s never too early to take action to prevent heart disease.</p><p>Pay attention to your health—and your heart—this week and all year. That goes for women just as much as men.</p><p><strong>I want to hear what you think.</strong> Join me for my final <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time on Wednesday, June 1. <a rel="nofollow" href="https://cc.readytalk.com/r/mk84cb89qm6c" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a rel="nofollow" href="mailto:amaprezblog@ama-assn.org?subject=A%20heartfelt%20reflection%20on%20women%E2%80%99s%20health-05-11-2011" target="_blank">email</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:54724fc7-2ffe-45de-a76f-f03bca19493b Society of Hospital Medicine a valued partner in caring for hospitalized patients http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad77623c1-1f0a-4070-8aff-ffb55ff79c12&plckScript=blogScript&plckElementId=blogDest Mon, 09 May 2011 18:26:00 GMT <p>One of the realities of medical practice over the past several decades is the proliferation of specialties and subspecialties in response to the geometric expansion of science and technology providing ever-increasing ways to treat the sick. In addition, there has been an increase in the different modes of practice—for example, emergency physicians, intensive care physicians and, more recently, hospitalists.</p><p>The <a href="http://www.hospitalmedicine.org/" target="_blank" rel="nofollow">Society of Hospital Medicine</a> (SHM) was <a href="http://www.hospitalmedicine.org/Content/NavigationMenu/AboutSHM/GeneralInformation/General_Information.htm" target="_blank" rel="nofollow">formed in 1998</a> as the National Association of Inpatient Physicians. It has grown from the founding few to an association of about 10,000 members. By specialty training its ranks include physicians trained in internal medicine (85 percent), family medicine (9 percent) and pediatrics (6 percent). </p><p>SHM’s stated <a href="http://www.hospitalmedicine.org/AM/Template.cfm?Section=General_Information&Template=/CM/HTMLDisplay.cfm&ContentID=14047" target="_blank" rel="nofollow">mission</a> is to promote both the highest quality care for all hospitalized patients and excellence in the practice of hospital medicine through education, advocacy and research.</p><p>In 2010, SHM was admitted to the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates/the-delegates.page" target="_blank">AMA House of Delegates</a>. I will fly to Dallas tomorrow to attend the SHM’s <a href="http://www.hospitalmedicine2011.org/" target="_blank" rel="nofollow">annual meeting</a> and bring an AMA update to its members. I will speak to the plenary session and hold a roundtable discussion over lunch.</p><p>I will share primarily the work of the AMA in particular around the Affordable Care Act, focusing on <a href="http://www.ama-assn.org/resources/doc/washington/aca-advocating-for-improvements.pdf" target="_blank">important things</a> that were left out (Medicare physician payment and medical liability), things that need to be corrected (the Independent Payment Advisory Board), regulations needed for implementation and additional challenges such as work force shortages that will impact access to care.</p><p>Also, I will bring a reminder that we cannot go back to where we were. Medicine is vastly different than it was just a few decades ago. We cannot stay where we are with a health care system that does not provide coverage to everyone and that costs too much. </p><p>Moving forward is the right choice.</p><p>Critical to moving forward is the team approach to medical care. The complexity of caring for patients requires a skilled team of medical professionals led by a physician—providing coordination and continuity of care—and with all members of the team practicing to their fullest based on their training and experience.</p><p>For tomorrow, moving forward to Dallas is my right choice. I am looking forward to it.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Society of Hospital Medicine a valued partner in caring for hospitalized patients-05-09-2011" target="_blank" rel="nofollow">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d77623c1-1f0a-4070-8aff-ffb55ff79c12 Physicians play an important role in child safety http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a77892a0c-f7d5-4c75-9a50-945c93fb9617&plckScript=blogScript&plckElementId=blogDest Fri, 06 May 2011 17:07:00 GMT <p>Unintentional injuries are, according to the Centers for Disease Control and Prevention, the leading cause of morbidity and mortality among children in the United States. Each year, among those age 19 and younger, more than 12,000 die from unintentional injuries and more than 9.2 million are treated in emergency departments for nonfatal injuries. Forty-five percent of these injuries occur in and around the home.</p><p>There are multiple causes of injuries, including fire and burns, suffocation, drowning, firearms, falls, choking and poisoning. For each of these dangers, there are specific things parents can do to make their homes injury proof and protect their children.</p><p>Clearly, an important part of the responsibility of pediatricians and other physicians who care for children is to advise parents on making the home a safer place.</p><p>And that is why legislation that has been filed in four states this year is so troubling. The bills vary in specifics, but all are aimed at making it illegal, even a criminal offense, for a pediatrician to ask parents about the presence of guns in the home.</p><p>Specifically in relation to firearms, the AMA has <a href="https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-145.990.HTM" target="_blank">policy</a> that encourages its members to:</p><p>• Inquire as to the presence of household firearms as a part of child-proofing the home<br />• Educate parents on the dangers of firearms to children<br />• Encourage patients to educate their children and neighbors on the dangers of firearms <br />• Routinely remind patients to obtain firearm safety locks, to store firearms under lock and key and to store ammunition separately from firearms</p><p>In addition, the AMA encourages state medical societies to work with other organizations to increase public education about firearm safety and to recommend programs for teaching firearm safety to children.</p><p>The legislation pending in state legislatures potentially criminalizing the practice of medicine and interfering in the patient-physician relationship by prescribing what type of conversations can take place is misguided and dangerous to the health and safety of children. </p><p>It seeks to remedy a problem for which there is no evidence that it exists. It will have a chilling effect on physicians’ ability to seek information from parents about how best to protect their children—and it is an unwarranted intrusion of government on the rights of free speech.</p><p>I urge thoughtful legislators everywhere to reject going down this road. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Physicians play an important role in child safety-05-06-2011" target="_blank" rel="nofollow">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:77892a0c-f7d5-4c75-9a50-945c93fb9617 Onerous federal regulations hamper patient care http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a741cbcfa-3dc9-4d86-bf76-4895e3fe52fa&plckScript=blogScript&plckElementId=blogDest Wed, 04 May 2011 15:56:00 GMT <p>Physicians do not spend upwards of 12 years of their lives in school and training to jump through administrative hoops. But unfortunately, at times, they have been forced to do so.</p><p>We endured the education and preparation for our passion, for fulfillment of an innate, irreplaceable desire to help people, and for the patients we treat.  </p><p>Unfunded federal mandates, a ban on billing consultations and misaligned incentive programs—these are all federal requirements that sometimes get in the way and negatively impact physician practices the most.</p><p>That’s what thousands of physicians and many state and medical specialty societies told the AMA in a survey conducted earlier this year. The survey, <a href="http://www.ama-assn.org/ama/pub/news/news/ama-shares-concerns-on-burdensome-federal-regulations.page" target="_blank">announced last month</a>, also includes recommendations on how to improve these requirements. I’ve seen it happen—physicians and their staffs spending countless hours and resources in order to meet certain federal rules and regulations. And patients get the short end of the stick.</p><p>The survey came on the heels of a Jan. 18 executive order from President Obama asking all government agencies to complete an analysis of federal rules and regulations that may be ineffective, insufficient or excessively burdensome. </p><p>We wanted to make sure your top concerns were heard. And we did—with your help—by collecting a laundry list and sending them in a <a href="http://www.ama-assn.org/resources/doc/washington/regulatory-burden-reduction-letter-13april2011.pdf" target="_blank">letter</a> to the Centers for Medicare & Medicaid Services (CMS). </p><p>I don’t believe you or I have the time to run through the entire gamut of issues, but I will highlight a few. Let’s take a look at unfunded mandates and the Medicare Economic Index (MEI), for example, an issue physicians deal with daily.</p><p>The MEI’s job is to track how much more costly it is for physicians to provide care. The reality is that the formula doesn’t do that. Instead, it significantly understates the true cost of medical practice. Between 2000 and 2006, it registered cost increases of just 18 percent. But AMA survey data indicates a growth of 79 percent. The solution is that CMS needs to modernize and increase the MEI to reflect 21st century medicine.</p><p>Physicians also were concerned with Medicare’s decision to ban consultation codes and force physicians to bill for services with lower-valued visit codes. The reality is that Medicare is now at odds with the policies of most private payers, creating confusion and administrative complications. And this has caused some real problems for practices, such as inadequate implementation times. The solution is reinstated payments for consultations. Audits of new patient visits should be suspended until this is addressed.</p><p>The list continues, covering federal incentive programs, inconsistent audit policies, administration simplification provisions, the Medicare enrollment process and Physician Quality Reporting System feedback reports.</p><p>But the important thing is progress. And what we have given CMS is a road map so strategic changes and advancements can be made that benefit the entire Medicare system and our patients—the whole reason we joined this altruistic profession from the start. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Onerous federal regulations hamper patient care-05-04-2011" target="_blank" rel="nofollow">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:741cbcfa-3dc9-4d86-bf76-4895e3fe52fa Providing excellence in health care http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ac8e28771-48ff-4f20-8114-daf705d4eaec&plckScript=blogScript&plckElementId=blogDest Mon, 02 May 2011 15:43:00 GMT <p>Last week was another one of those trips that reminded me of growing up. As the son of a Methodist minister, we frequently moved from place to place—anywhere that was a part of the itinerant ministry associated with the Methodist church. </p><p>On Tuesday, my wife Betty Jane and I visited, in order, the New Hanover-Pender County Medical Society in Wilmington, N.C., the Florence County Medical Society in Florence, S.C., and the annual meeting of the South Carolina Medical Society in Greenville, S.C.</p><p>I will share some additional memories of the trip in other blog posts, but today I would like to focus on Florence where, in addition to speaking to the medical society, I also had the opportunity to visit the <a href="http://www.mcleodhealth.org/MRMC/" target="_blank">McLeod Regional Medical Center</a>. </p><p>It is noteworthy that in a small town boasting a population of 38,000 this medical facility was the <a href="http://www.mcleodhealth.org/News/article.cfm?NewsID=745" target="_blank">winner</a> of the American Hospital Association-McKesson 2010 <a href="http://www.aha.org/aha/news-center/awards/quest-for-quality/index.html" target="_blank">Quest for Quality Prize</a>. This honor is awarded to one hospital in the country that best exemplifies the Institute of Medicine’s six quality aims for patient care—safety, effectiveness, patient-centered care, timeliness, efficiency and equity.</p><p>It is significant and I believe related to being recognized with this award that the mission of McLeod Health is to improve the overall health and well-being of people living within South Carolina and eastern North Carolina by providing excellence in health care based on four values: the value of caring, the value of the person, the value of quality and the value of integrity.</p><p>In my short visit, I was impressed by the dedicated professionals who provide that care at McLeod and the outstanding facilities in which it is provided.</p><p>As I have traveled the country this year I have been reassured about the future of health care in our nation by seeing physicians and hospitals working together to provide the highest quality of care for their patients. The McLeod Medical Center in Florence is a shining example of that—and what makes medical care in this country so outstanding.</p><p>It is also a reminder of our hope that, through the Affordable Care Act enacted last year, we are successful in extending access to that care to everyone in America.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Providing excellence in health care-05-02-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:c8e28771-48ff-4f20-8114-daf705d4eaec Patient gains require personal responsibility http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3afd939ef8-4011-457b-8de0-1bc2519169e7&plckScript=blogScript&plckElementId=blogDest Wed, 27 Apr 2011 15:11:00 GMT <p>It was one of those news stories so unusual it captures one’s attention—at least for a day. A small community had a volunteer fire department to which everyone paid a monthly fee for expenses and protection if their house caught on fire. </p><p>Occasionally some homeowners would be months delinquent in payments, or they would refuse to pay at all. The house belonging to one owner who refused to participate caught on fire. And since the fire department did not respond, it burned down. The owner was incensed, saying he should have been able to pay the monthly fee while the house was burning and receive service.</p><p>Now, very few of us would wait until our house is burning down before buying or even thinking about homeowners insurance.</p><p>However, the concept is comparable to patients and health insurance. Some patients, particularly in the 25-to-34 age range, do not buy health insurance—and they end up going to the emergency room for care when they are sick or some health catastrophe happens. And since they cannot afford to pay, society (we, the taxpayers) picks up the cost; hence, the notion of “individual responsibility” for health insurance coverage.</p><p>The AMA has <a href="https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-165.848.HTM" target="_blank">long-standing policy</a> supporting individual responsibility to purchase health insurance for those who can afford it, and tax credits or other subsidies for those who cannot. It was established in 2006 and most recently reaffirmed in June 2010. </p><p>Such a policy addresses the problem of individuals “free-riding” on the backs of the insured, as well as all taxpayers. Here are a few key elements that make it work:</p><p>• The AMA policy does not specify what type of health insurance needs to be purchased, nor from whom it must be purchased.<br />• It only advocates that the health insurance purchased must contain, at a minimum, coverage for catastrophic care and preventive services.  <br />• For those with incomes below 500 percent of the federal poverty level (500 percent of the federal poverty level in 2011 is $54,450 for individuals and $111,750 for a family of four), the policy is only applicable if they are provided with subsidies to help purchase the health insurance.</p><p>The Affordable Care Act (ACA) includes a provision similar to AMA policy on individual responsibility. That provision is scheduled to take effect in 2014. My take on individual responsibility is this: It’s a classic case of patients having “skin in the game” and taking ownership of their potential health care needs and those of their dependents. And it’s a way to prevent patients from running to the emergency room every time they need medical care and to keep their health care expenses from burdening the rest of society.</p><p>The Congressional Budget Office projects that the coverage provisions in the ACA, including an individual responsibility provision, will expand coverage to 32 million more Americans by 2016.</p><p>However, this part of the ACA is controversial and has been the subject of a number of constitutional challenges. Earlier this year, five district court judges ruled on the constitutionality of it—three in support and two in opposition. It is likely that the U.S. Supreme Court will rule on this issue sometime in 2012.</p><p>Here’s the economic reality: You can’t achieve the patient gains in the ACA without some form of personal responsibility. Expansion of coverage and getting rid of pre-existing condition provisions and lifetime caps is not economically viable unless everyone contributes by buying health insurance. </p><p>While some recent opinion polls suggest the individual responsibility provision is not very popular among the public, most Americans do like the historic patient gains in the law. It makes sense with increased health care coverage, the elimination of pre-existing condition denials and the removal of lifetime caps.</p><p>I like these gains, too. Anytime we can ensure health care coverage for all patients and make sure patients get the right treatment at the right time, I call that a plus. Individual responsibility plays an important role in making these gains possible as we look forward to the future of patient care and medicine. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Patient%20gains%20require%20personal%20responsibility-04-27-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:fd939ef8-4011-457b-8de0-1bc2519169e7 Proposed rule on ACOs a starting point for discussion http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad05fc6cb-ebb2-4d4d-9403-23c935b32942&plckScript=blogScript&plckElementId=blogDest Mon, 25 Apr 2011 15:54:00 GMT <p>Last week I led an AMA webinar to discuss the Centers for Medicare & Medicaid Services’ (CMS) <a href="https://www.cms.gov/sharedsavingsprogram/" target="_blank">proposed rule </a>on the Medicare Shared Savings program, announced March 31. (View the <a href="http://www.ama-assn.org/resources/doc/washington/ama-summary-medicare-shared-savings.pdf" target="_blank">AMA summary</a> of the proposed rule.)</p><p>The program also is referred to as the Medicare accountable care organization (ACO) program and was authorized in the Affordable Care Act (ACA). It is a measure of the complexity of the subject that the proposed rule was published three months after the initially expected date of Dec. 31. </p><p>The purpose of the webinar, for which 208 people signed up, was to describe key elements of the proposed rule and make comments on our initial observations. A <a href="http://eo2.commpartners.com/users/ama/session.php?id=6659" target="_blank">recording</a> of the webinar is available online. AMA members and state and specialty society staff can listen to it for free; nonmembers can access it for $39.</p><p>This is a voluntary program to further develop and test the ACO concept for Medicare beneficiaries. Physicians and hospitals are not required to be a Medicare ACO as a condition of participating in Medicare.</p><p>Efforts in the private market also are occurring—on a parallel track, if you will—in developing ACOs and moving forward at a rapid pace. </p><p>The AMA is encouraged that the proposed rule provides for flexibility in ACOs (no one-size-fits all). It also requires a governing body that represents all participants, must include physicians in leadership roles and precludes hospitals from forming ACOs without significant physician partnerships. There is an insistence on evidence-based care, patient engagement, reporting and care coordination. And there are provisions for providing data to physicians on their patients’ claims.</p><p>In addition, the proposed rule provides for anti-kickback waivers in implementing the Shared Savings Program. And a concurrently released draft statement from the Federal Trade Commission and the Department of Justice provides for safety zone protections from antitrust enforcement if ACOs use Medicare criteria in their development.</p><p>However, approaches outlined in the proposed rule may serve to limit its feasibility and attractiveness for many physicians. The estimate of up-front costs for ACOs is $1.8 million. The payment of shared savings on the back end, with recovery limited to about half of the savings generated, raises questions about whether physicians will be able to recover their costs.</p><p>In addition, the proposed rule provides for a two-sided risk payment model, meaning that ACOs will receive a bonus if money is saved but also will pay Medicare if cost increases exceed a certain threshold.</p><p>There also are concerns about a provision for retrospective assignment of patients as well as quality measurement and health IT requirements so broad that they may make it difficult, if not impossible, for the majority of physicians to successfully comply. </p><p>CMS has emphasized that the proposed rule is just that, a proposed rule, not final, and is encouraging comments until June 6. The AMA will solicit comments from state and specialty societies as it drafts its response.</p><p>It is important to note that there is no assurance that anything in the proposed rule (good or bad) will be included in the final rule.</p><p>And there is no assurance that new things (good and bad) will not be added to the final rule that were not in the proposed rule.</p><p>With that in mind, comments from the AMA (and hopefully from others) will focus not only on changing those elements that we do not think will work well but also on preserving those that we like.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Proposed rule on ACOs a starting point for discussion-04-25-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d05fc6cb-ebb2-4d4d-9403-23c935b32942 Physicians have unique perspective in new patient safety initiative http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a4980953c-1b60-4666-b100-06398a1598ec&plckScript=blogScript&plckElementId=blogDest Fri, 22 Apr 2011 16:00:00 GMT <p>Last week I represented the AMA in joining U.S. Department of Health and Human Services Secretary Kathleen Sebelius, Centers for Medicare & Medicaid Services Administrator Donald Berwick, MD, and other health care leaders at the National Press Club in Washington, D.C., for the rollout of <a href="http://www.healthcare.gov/news/factsheets/partnership04122011a.html" target="_blank">Partnership for Patients</a>, a new initiative to make hospital care safer.</p><p>Achieving the partnership’s goals will involve many key stakeholders across the health care system—physicians, nurses, hospitals, health plans, employers, unions, patients and their advocates, as well as the federal and state governments.</p><p>The goals of the partnership are twofold. The initiative aims to keep hospital patients from getting injured or sicker by decreasing preventable hospital-acquired conditions 40 percent by 2013. It also seeks to help patients heal by reducing preventable complications during a transition from one care setting to another so that hospital readmissions would be reduced 20 percent by 2013.</p><p>HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help patients transition safely between settings of care. Another $500 million from the Center for Medicare and Medicaid Innovation will be used to test different models of improving patient care, patient engagement and collaboration to reduce hospital-acquired conditions and improve care transitions nationwide.</p><p>Improving the quality and safety of health care has been a guiding principle of the AMA since its founding in 1847. The AMA chose to join the Partnership for Patients in the tradition of seeking excellence in medicine on behalf of patients.</p><p>Physicians see up close and personal, on a daily basis, both the complexity of the human condition and the diseases that afflict it. And we experience the uncertainties of outcomes even under the best of circumstances.</p><p>It is important to remind ourselves that we need to do everything we can to avoid preventable patient injuries or sickness while working to ensure that patients are able to heal without preventable complications.</p><p>It also is important to point out in the context of this new initiative that what we are talking about is not blame, but better systems to improve the quality of care by avoiding errors and reducing preventable complications.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Physicians%20have%20unique%20perspective%20in%20new%20patient%20safety%20initiative-04-22-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:4980953c-1b60-4666-b100-06398a1598ec Leading new models of patient care http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a6dee97ac-91af-4cd5-988d-f1d722208180&plckScript=blogScript&plckElementId=blogDest Wed, 20 Apr 2011 12:14:00 GMT <p>“What are ACOs?” </p><p>“How will they work?” </p><p>“How will they affect physicians?”</p><p>These are just some of the inquiries I have encountered during my travels, my “Office Hours” conference calls and in emails and on phone calls from physicians nationwide. And they are the focus of the AMA’s intent exploration after the Centers for Medicare & Medicaid Services (CMS) released its long-awaited <a href="http://www.ama-assn.org/resources/doc/washington/ama-summary-medicare-shared-savings.pdf" target="_blank">proposed rule</a> March 31 on its ACO, or accountable care organization, program. </p><p>It’s important to note that this is a proposed—not a final—rule. In addition, the program is voluntary. Despite the intense interest in this alternative delivery system, physicians do not have to rush headlong into signing up with an ACO. Physician groups are not required to become a Medicare ACO, and individual physicians are not required to join one. This is just one federal model among numerous reform models that are being considered in health system reform, such as the patient-centered medical home and bundled payment systems. There will be more to come.</p><p>However, even as Medicare has been developing the rule for ACOs, formation of ACOs in the private sector by health plans continues to move ahead. Therefore, it is important that while physicians should not rush in to commitments, they should be involved in the process at whatever level it is occurring in their community in order to be able to provide leadership and help shape the outcome. </p><p>The AMA has until June 6 to comment on the draft regulations, which, once final, will be used to implement the voluntary Medicare Shared Savings/ACO program, authorized in the Affordable Care Act. This program will further develop and help test the ACO model of delivery reform over the next three years.</p><p>There are four parts to the rule:</p><p>• The first part covers the governance, quality and payment structure of the ACO program<br />• The second element, from CMS and the Office of the Inspector General, includes a joint solicitation of comments on proposed waivers for Medicare ACOs from the self-referral, anti-kickback and civil monetary penalties statutes<br />• The third component, from the Department of Justice and the Federal Trade Commission, encompasses a proposed policy statement on antitrust enforcement and ACOs<br />• The final piece, from the Internal Revenue Service, consists of a proposal on the tax treatment of ACOs</p><p>The hope for ACOs is that they improve care coordination and quality while reducing cost. Physicians and hospitals working together to provide better care and lower costs will be able to share in the savings they produce for the Medicare program. This won’t be “easy,” per se. It will involve significant investments up-front and complex arrangements to integrate and coordinate care.</p><p>For ACOs to be effective, they must—first and foremost—be physician-led. Structure requirements need to be more flexible, and physicians will need more transitional steps for ACO formation as well as increased access to loans and grants for small practices, easing of antitrust restrictions and timely access to quality data. In response to AMA advocacy, the government will waive certain legal provisions for ACOs to help them succeed. </p><p>The AMA will fully review the proposed rule and statement of policy and provide comments, working closely with state and specialty medical societies to collect feedback. We will make recommendations to reshape those areas that need it while supporting those that are in alignment with AMA policy. </p><p>The AMA has developed several <a href="http://www.ama-assn.org/go/paymentpathways" target="_blank">resources</a> to educate physicians about ACOs and other payment models. I’m hosting a <a href="http://eo2.commpartners.com/users/ama/session.php?id=6659" target="_blank">webinar</a> tonight which will outline the content of the proposed regulations, help answer some of your questions and obtain any feedback physicians have. A recording of the program will be available online on Thursday.</p><p>And remember to watch <em><a href="http://www.ama-assn.org/go/amawire" target="_blank"><em>AMA Wire</em></a></em>, <em><a href="http://www.ama-assn.org/go/insight" target="_blank"><em>Health System Reform Insight</em></a></em>, the <a href="http://www.ama-assn.org/" target="_blank">AMA website</a> and other AMA communication vehicles for updates in this time of change. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Leading%20new%20models%20of%20patient%20care-04-20-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:6dee97ac-91af-4cd5-988d-f1d722208180 “Office Hours” sparks discussion on ACOs, medical liability reform, other topics http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a7bb9c975-846f-4335-bda3-7b20965aa1ee&plckScript=blogScript&plckElementId=blogDest Mon, 18 Apr 2011 13:51:00 GMT <p>I hosted my second-to-last “<a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a>” conference call last week. These calls are an opportunity for AMA members to dial in and ask questions of importance to them. They are also an occasion for having interchanges about issues. </p><p>I introduced this communication format last June and have found it especially helpful for me in attempting to stay in touch with the concerns AMA members have. The questions have been excellent, and this time was no exception.</p><p>I began the session with a discussion of the proposed regulations on <a href="http://www.ama-assn.org/go/paymentpathways" target="_blank">accountable care organizations</a> (ACOs), issued March 31, by the Centers for Medicare & Medicaid Services. The AMA currently <a href="http://www.ama-assn.org/ama/pub/news/news/proposed-medicare-aco-rule.page" target="_blank">is reviewing</a> the <a href="http://www.ama-assn.org/resources/doc/washington/ama-summary-medicare-shared-savings.pdf" target="_blank">proposed rule</a>. I also provided an update on H.R. 969, the “Medical Practice Freedom Act of 2011,” introduced by Rep. Tom Price, MD, R-Ga., and supported by the AMA.</p><p>Questions from callers covered a wide range of topics, including the Employee Retirement Income Security Act (ERISA), tort reform, <a href="http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/practice-management/medical-liability-reform/state-legislative-activities.page" target="_blank">state medical liability reform</a> legislation, the potential for international medical licensing (there is none), facility payments for physicians not part of a hospital system, support for the private practice of medicine, <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page" target="_blank">CPT® codes</a>, palliative care training, the differences between ACOs and HMOs (not clear yet), the AMA’s strategy to replace Medicare’s <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare.page" target="_blank">flawed sustainable growth rate (SGR) formula</a>, Medicaid reform, and <a href="http://www.ama-assn.org/ama/priv/advocacy/centers-engaged-advocacy/advocacy-resource-center/state-advocacy-campaigns/scope-practice.page" target="_blank">scope-of-practice issues</a> particularly related to transparency of professional qualifications.</p><p>Other questions were related to misuse of pain medications, <a href="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education.page" target="_blank">graduate medical education</a>, achieving <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-issues/health-care-costs.page" target="_blank">cost savings in health care</a>, AMA membership, AMA goals for health system reform, work force shortages and ERISA restrictions on medical liability.</p><p>Learn about ACOs this Wednesday. At 7 p.m. Eastern time Wednesday, April 20. I will host a webinar to outline in further detail the content of the proposed regulations on Medicare’s ACO program. The event is free to AMA members and to state and specialty society staff. <a href="http://eo2.commpartners.com/users/ama/session.php?id=6659" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=“Office Hours” sparks discussion on ACOs, medical liability reform, other topics-04-18-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:7bb9c975-846f-4335-bda3-7b20965aa1ee Our nation’s great “doers” improve the health of America http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a4a18e11f-22b6-40b5-9431-ead7f15ce905&plckScript=blogScript&plckElementId=blogDest Fri, 15 Apr 2011 18:28:00 GMT <p>This past week has been another one of those times that has given  me the feeling of constant travel. I returned home Sunday evening from the World Medical Association meeting in Australia, and then traveled to Washington, D.C., on Monday and  Chicago on Wednesday, where I am now attending the April meeting of the AMA Board of Trustees. </p><p>It reminds me of that TV series from the 1950’s, titled “Have Gun—Will Travel,” starring Richard Boone as the gunslinger, Paladin. In my case, of course, it’s “have the AMA tablets (to mix a metaphor)—will travel.”</p><p>One of the highlights of this week was the opportunity to give the opening remarks at the 10th Annual Leadership Awards Dinner during the <a href="http://www.nmqf.org/" target="_blank">National Minority Quality Forum</a> in Washington, D.C., on Tuesday.</p><p>The abolitionist Frederick Douglass once said, “Man’s greatness consists in his ability to do and the proper application of his powers to things needed to be done.” The awards dinner was an opportunity to recognize some of our nation’s great “doers.” They included:</p><p>• David Sutherland, MD, a renowned transplant surgeon who has trained more than half of the surgeons performing pancreas transplants worldwide<br />• Elizabeth Ofili, MD, professor of medicine and cardiology at Morehouse School of Medicine, known for her expertise in the field of cardiovascular medicine and health disparities<br />• Dorothy Ouchida, director of patient advocacy and professional relations at Boehringer-Ingelheim, who has more than 38 years of experience in biomedical research, patient advocacy and patient health education</p><p>In addition, Rep. Nancy Pelosi, Democratic leader in the House of Representatives, and Sen. Harry Reid, majority leader in the Senate, received lifetime achievement awards.</p><p>It can fairly be said of this group of distinguished individuals that, by their accomplishments, they have changed the lives of countless minority patients.</p><p>Where there was little hope of a cure, they created it.</p><p>Where education was lacking, they filled the void.</p><p>And where existing legislation failed to support those in need, they rewrote it.</p><p>They are an inspiration to us all—proof that what “needs to be done” can and will be done—so long as individuals, such as them, are leading the way.</p><p>My congratulations to each of the awardees and to the National Minority Quality Forum for its important work in helping improve the health and quality of the lives of the American people.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Our nation’s great “doers” improve the health of America-04-15-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:4a18e11f-22b6-40b5-9431-ead7f15ce905 Realistic, attainable criteria needed for EHR incentive programs http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3afbc41d58-eab5-4821-a7a1-e322e18aea6f&plckScript=blogScript&plckElementId=blogDest Wed, 13 Apr 2011 15:13:00 GMT <p>Information is the lifeblood of medicine, and health information technology has the potential to be the circulatory system for that information.</p><p>The 2009 economic stimulus law included billions of dollars to aid hospitals and physicians as they incorporate electronic health records (EHR) into their practices to improve quality of care delivery, enhance patient safety and support practice efficiencies. And with that, the federal government’s <a href="http://www.ama-assn.org/ama/pub/physician-resources/health-information-technology/incentive-programs/medicare-medicaid-incentive-programs.page" target="_blank">Medicare and Medicaid meaningful use EHR incentive programs</a> were born. <br /><br />The Centers for Medicare & Medicaid Services will reimburse physicians who demonstrate meaningful use of qualified EHRs starting this year. Payments can be as high as $44,000 over five years with Medicare or $63,750 over six years with Medicaid. The agency announced last month that it’s paid out more than $37 million this year alone.<br /><br /><a href="http://www.ama-assn.org/go/hit" target="_blank">Technology</a> has the capability to become the hallmark of efficiency for physician practices around the globe. Once it’s interoperable, patients will be able to seamlessly move between various physician offices and specialists and instantly have their updated records follow them. Physicians will be able to prescribe, bill and even obtain patient feedback in real time. </p><p>With Stage 1 under way and as we begin to discuss requirements for Stages 2 and 3, physicians are working to adopt EHRs into their practices. But unrealistic requirements for becoming a meaningful user have overly burdened physicians and hampered adoption—especially for those in a small group or solo physician practice.</p><p>Greater flexibility and possible solutions to barriers that already exist—even under Stage 1—are needed. Moving forward to Stages 2 and 3, we need reasonable exclusions so physicians can opt out of a measure if it has little relevance to their practice. We need to avoid objectives that can’t be met because of the lack of health information exchange. A future where EHRs are interconnected will not be possible until infrastructure and standards are fully in place, and the requirements to receive incentives must take this into account.</p><p>And just like for Stage 1, the AMA has been in front of the issue. On multiple occasions over the past year, we have taken the opportunity to comment on the government’s federal rulemaking process with respect to meaningful use of EHRs. Recently, we wrote a <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/comments-hitpc-proposed-measures-25feb2011.pdf" target="_blank">letter</a> to the Office of the National Coordinator, with support from 37 medical societies, detailing our recommendations to proposed criteria for Stages 2 and 3 in an environment that is still not largely interconnected. </p><p>David Blumenthal, the former national coordinator for health information technology, made the following statement during the AMA’s National Advocacy Conference in February: “The era of meaningful use is a time when we have created a process through the meaningful use paradigm of coming to a collective census on what information, at a minimum, we should store to give patients the best care possible.” </p><p>If I had invented a new cell phone and wanted it to be successful, the goal would be to make it simple, even intuitive, to use—and a lot of fun. I would call it an iPhone, and millions would buy it. </p><p>Unless technology will help physicians practice more efficiently, adoption will lag. As we continue to refine current Stage 1 meaningful use requirements and move to Stages 2 and 3, my hope is that we will keep simple, intuitive and easy to use in mind. Lacking that, the challenges to widespread use will continue to be formidable.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Realistic,%20attainable%20criteria%20needed%20for%20EHR%20incentive%20program-04-12-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:fbc41d58-eab5-4821-a7a1-e322e18aea6f Australia plans bold new initiatives to reduce smoking rate http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3adbd62a85-e3c1-4774-b617-b3cbdd832434&plckScript=blogScript&plckElementId=blogDest Fri, 08 Apr 2011 16:39:00 GMT Tobacco smoking continues to be the major cause of preventable illness and death worldwide. <br /><br />In an address during the opening session of the World Medical Association Council meeting in Sydney on Thursday, we heard Nicola Roxon, Minister of Health and Ageing for Australia, announce the government’s intention to file the world’s first-ever plain packaging law on tobacco advertising.<br /><br />This is part of a plan to tackle the problem of preventable disease, which accounts for greater than 30 percent of morbidity and mortality in Australia. Tobacco is by far the largest cause, even though the smoking rate has decreased from 30 percent of the population in 1998 to 16 percent in 2010. It is a greater problem among the disadvantaged, where the smoking rate is 30 to 40 percent.<br /><br />The overall decreased smoking rate comes as a result over the years of increases in excise taxes on tobacco products and restrictions on Internet advertising.<br /><br />The goal for the new program scheduled to go into effect Jan. 1, 2012—pending passage by the parliament—is to decrease smoking to 10 percent by 2018. Cigarette packages will be required to be a dark olive/brown color—a color that has been determined to be the least attractive to people. The front (90 percent) and back (70 percent) of cigarette packs will be devoted to warnings about the ill effects of smoking. The size of the brand name will be prescribed.<br /><br />Australia is not alone in its efforts. England is considering a <a href="http://www.bbc.co.uk/news/health-12680815" target="_blank">similar plain-packaging measure</a>, as well as a proposal to ban tobacco displays in shops.<br /><br />Minister Roxon indicated that the government expects vigorous opposition from the tobacco industry—no surprise there. She also said: “We might be breaking ground, but we are on firm ground.” <br /><br />I wish Australia well in this endeavor, which, if successful, will save countless lives and prevent serious illnesses associated with tobacco products.<br /><br />I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg">Register today</a>.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Australia plans bold new initiatives to reduce smoking rate-04-08-2011">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:dbd62a85-e3c1-4774-b617-b3cbdd832434 Improving the future of medical practice, one smartphone app at a time http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a7443ef24-6e6f-4526-ac25-06398ca7b1e6&plckScript=blogScript&plckElementId=blogDest Wed, 06 Apr 2011 13:52:00 GMT <p>I could foresee the endless possibilities with my wife’s brand new rectangular-shaped electronic gadget when she first brought it home. </p><p>Now I, and so many members of the medical community, are living the reality of these so-called “smartphones.” As a long-time AMA member, I am not sure I could have ever predicted this next occurrence: last week’s launch of the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/apps.page" target="_blank">first-ever app</a> for smartphones.</p><p>The CPT® E/M Quick Reference app—designed specifically for physicians—is an on-the-go reference guide, a real time saver, easy and accurate. </p><p>It’s set up to help physicians find and determine appropriate CPT evaluation and management (E/M) billing codes. Physicians can digitally track the codes they select and then email them anywhere. It’s free, and it’s on iTunes ready for <a href="http://itunes.apple.com/us/app/cpt-e-m-quickref/id426712025?mt=8" target="_blank">download now</a>. One great thing about this resource is its versatility. It works on an iPhone, an iPad and an iPod Touch.<br />This is a relatively new concept for medicine—managing the technicalities of practice on a handheld device—but one that’s growing in popularity every day.  <br />According to Manhattan Research from April 2010, 80 percent of U.S. physicians who own a smartphone or PDA agree that their device is essential to their practice. That number is up from 65 percent in 2008. Future physicians are on board with the idea as well. Epocrates research shows that 69 percent of medical students use an iPhone, 14 percent use a BlackBerry and 11 percent use an Android phone. <br />So what’s next? That still is to be determined. It is time for your great medical app idea, physicians and medical students. Have you ever thought, “Gee, I wish I had an app that did this” or “It would really be helpful if I had a resource to help with that.”</p><p>As part of the <a href="http://www.amaidealab.org/" target="_blank">2011 AMA App Challenge</a>—also launched last week—the AMA is heading right to the source. Physicians, residents and medical students, those on the front lines of medicine, you are invited to participate in the first-ever AMA App Challenge.</p><p>We are looking for <a href="http://www.amaidealab.org/guidelines.shtml" target="_blank">ideas</a> for innovative smartphone apps that physicians and medical students can use in their day-to-day lives. You know what medicine needs to help with the efficiencies and future of practice. The AMA can help bring it to life. Share it with the rest of the technologically savvy world, have a chance to be recognized and even receive <a href="http://www.amaidealab.org/prizes.shtml" target="_blank">prizes</a>. </p><p>Two winners will be selected, one from the resident/fellow or medical student category and one from the practicing physician category. You have until 11:59 p.m. Eastern time June 30 to submit your idea.</p><p>As I said, the possibilities are endless. What will physicians and medical students come up with next?</p><p><strong>I want to hear what you think.</strong> Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Improving%20the%20future%20of%20medical%20practice,%20one%20smartphone%20app%20at%20a%20time-04-06-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:7443ef24-6e6f-4526-ac25-06398ca7b1e6 Australian physician shares inspiring tenets of leadership http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a10e2ebc4-cc0d-475a-9141-90db3fe745ec&plckScript=blogScript&plckElementId=blogDest Tue, 05 Apr 2011 16:02:00 GMT <p>One of the wonders of the land “Down Under”—Australia and New Zealand—is that the proximity to the international date line provides an early start on each new day. This means that, as I write this, I am describing events that occurred here Tuesday while it is still Monday in the States. Australia is 17 hours ahead of time on America’s East Coast.</p><p>As I <a href="http://bit.ly/eEsOXR" target="_blank">mentioned yesterday</a>, today’s meeting of the World Medical Association (WMA) consisted of a seminar titled “Medical Leadership: The View from Down Under.” One of the highlights of the morning’s session was remarks from the Honorable <a href="http://en.wikipedia.org/wiki/Brendan_Nelson" target="_blank">Brendan Nelson</a>, MD, the 13th president of the Australian Medical Association, who is Australia’s ambassador to Belgium, Luxembourg and the European Union as well as Australia’s representative to NATO and the World Health Organization.</p><p>Dr. Nelson was the youngest, at age 34, ever to hold the office of president of the Australian Medical Association. He subsequently was successful in running for parliament, became opposition leader and later served in the cabinet as Minister of Education, Science and Training and Minister for Defence. He is an icon among physicians in Australia. </p><p>Some of his comments on leadership today bear sharing:</p><p>“My greatest achievement is that I was there.”</p><p>“You are not doing a good job if you aren’t upsetting a few people.”</p><p>“Leadership is not so much learned as understood.”</p><p>His four principles of leadership are:<br />• Commitment—to a cause.<br />• Choosing to do what is the right thing to do.<br />• Compassion for others—understanding their needs and desires.<br />• Courage—knowing that nothing is achieved without taking a risk.</p><p>“Never pass an opinion on someone you have never met.”</p><p>“Gestures of independence—arrogance, if you will—make it likely that your ideas will live on in obscurity.”</p><p>“Doctors should lead the way in showing that national progress can be made by placing the welfare and consideration of other human beings ahead of their own—asserting their obligation to speak out on issues for the public good.”</p><p>Words of wisdom from “Down Under.”</p><p><strong>I want to hear what you think.</strong> Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Australian%20physician%20shares%20inspiring%20tenets%20of%20leadership-04-05-2011" target="_blank"></a><a href="mailto:amaprezblog@ama-assn.org?subject=Australian%20physician%20shares%20inspiring%20tenets%20of%20leadership-04-05-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:10e2ebc4-cc0d-475a-9141-90db3fe745ec Issues in medicine are common to physicians worldwide http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ab36cd6c4-e311-4ed0-bd20-3a89ef80e7d7&plckScript=blogScript&plckElementId=blogDest Mon, 04 Apr 2011 18:47:00 GMT <p>I just arrived in Sydney, Australia, following a week of visiting New Zealand. Everywhere I went I was reminded of the impact of the Feb. 22 earthquake that decimated the downtown of Christchurch. Two months after the quake, only emergency workers are allowed into the city center.</p><p>This idyllic city I visited nine years ago will never be the same. And, in spite of the fact that the earthquake had no impact on other parts of the country, the economic fallout has been significant. Many international visitors have cancelled their trips and, as a result, few people are visiting New Zealand’s popular tourist areas. In locales where one would customarily see dozens of large tour buses, there are only one or two—and stores and restaurants that depend on this important part of the economy are suffering.</p><p>It is a reminder that what happens to one of us affects many. Or in the words of the English poet, priest and lawyer John Donne (1572-1631), “No man is an Island, entire of itself; every man is a piece of the Continent, a part of the main.”</p><p>Tuesday, as a prelude to the start of the <a href="http://www.wma.net/en/10home/index.html" target="_blank">World Medical Association</a> (WMA) Council meeting on Wednesday, leaders of the Australian Medical Association and the New Zealand Medical Association will share their perspectives on issues of importance to their respective countries during a seminar titled “Medical Leadership: The View from Down Under.” </p><p>Some of the speakers on leadership include Roderick McRae, MD, Chair of Council for the Australian Medical Association; the Honorable Brendan Nelson, MD, 13th president of the Australian Medical Association and Australia’s representative to NATO and the World Health Organization; Sir Michael Marmot, professor of epidemiology and public health at the University College London; and Peter Foley, MD, chair of the New Zealand Medical Association.</p><p>In addition, there will be sessions on e-health and health research, the latter focusing on whole genome sequencing, food anaphylaxis and the issue of patient literacy.</p><p>I look forward to the meeting and know that, as has been the case in the past, I will be struck by the fact that there is a commonality in the issues we face regardless of what hemisphere we live in—and that each of us finds different ways to meet the challenges that confront us.</p><p><strong>I want to hear what you think.</strong> Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Issues%20in%20medicine%20are%20common%20to%20physicians%20worldwide-04-04-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:b36cd6c4-e311-4ed0-bd20-3a89ef80e7d7 The delicate balance of physician-industry relationships http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a84cb1b53-d8bb-47ec-817a-7df5bbfc9050&plckScript=blogScript&plckElementId=blogDest Wed, 30 Mar 2011 16:04:00 GMT Most physicians undoubtedly can think back to a time when they received an item of value from an industry representative.<br /><br />Starting Sept. 30, 2013, the “sunshine” provisions passed last year as part of the Affordable Care Act will go into effect. They mandate that nearly any kind of direct payment—or other transfer of an item of value—of $10 or more from a drugmaker, device maker or other medical industry firm to a physician be posted on a publicly searchable website. The most significant exception to the publication requirement will be drug samples.<br /><br />From food and entertainment to gifts, consulting fees and honoraria, these regulations—applicable to teaching hospitals as well—are aimed at creating a certain level of transparency regarding the relationships that physicians may have with industry. <br /><br />The fact of the matter is that some physician-industry interaction is indeed appropriate and promotes both the scientific practice of medicine and innovation. It can lead to the development of new treatments and can provide patients with access to medications they might not otherwise have. The important thing is that in our interaction with patients, their well-being—not commercial considerations—comes first, and that this guide for our actions is clear to patients, to society and to ourselves.<br /><br />The AMA looks forward to working with the Department of Health and Human Services and other stakeholders to develop meaningful reporting processes that encourage transparency but do not create confusion or add to the perception that physician-industry interactions may be inappropriate. By doing so, we can demonstrate our ethical behavior while promoting quality care. <br /><br />So how is a physician to determine what might be an inappropriate interaction? I suggest starting with the ethics of the profession. The AMA’s <a href="http://www.ama-assn.org/go/code"><em>Code of Medical Ethics</em></a> states that “any gifts accepted by physicians individually should primarily entail a benefit to patients and should not be of substantial value.”<br /><br />The key is to always focus on what’s best for the patient. That is the most important principle to follow.<br /><br />Today, on National Doctors’ Day, I would like to take a moment to honor and thank all physicians who have dedicated their professional lives to providing excellent patient care in the United States. You have all played an important role in helping individual patients and promoting the overall health of the nation. <br /><br /><strong>I want to hear what you think.</strong> Join me for my next <a href="http://www.ama-assn.org/go/officehours">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg" target="_blank">Register today.</a><br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=The delicate balance of physician-industry relationships-03-30-2011">e-mail</a>.<br /><br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:84cb1b53-d8bb-47ec-817a-7df5bbfc9050 Medicine addresses health challenges worldwide http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aff1d0539-b8dc-4992-b5d5-f3c388c711b8&plckScript=blogScript&plckElementId=blogDest Fri, 25 Mar 2011 16:24:00 GMT As I write this blog post, I am about to get on a plane to travel to the other side of the world—the other side and “down under,” to be more exact—to New Zealand and Australia. <br /><br />Over the next two weeks, my wife Betty Jane and I will travel to New Zealand where, among other places, we expect to visit Christchurch, the site of the recent earthquake that devastated the country. <br /><br />The last half of the trip will be in Sydney, Australia, where I will attend the council meeting of the World Medical Association (WMA). My plan is to provide updates on events from the meeting, but given differences in time and geography, my communication over the next couple weeks may be a little less frequent.<br /><br />The WMA—with its 99 member national medical associations—provides a voice to the medical profession on health-related issues of worldwide importance. A sample of topics on the meeting’s agenda shows the depth and breadth of subjects, and the nature of health challenges worldwide.<br /><br />The WMA council will consider papers and reports on issues, such as the use of placebos in research, end-of-life care, ethical organ procurement, the ethics of palliative sedation, violence in the health sector, the global burden of chronic disease, social determinants of health, protection and integrity of medical personnel in armed conflicts, health hazards of tobacco and tobacco products and disaster medicine.<br /><br />Finally, in all of this, I will try mightily to resist the urge to come back home having adopted the Aussie greeting, “G-day mate.”<br /><br /><strong>I want to hear what you think.</strong> Join me for my next <a href="http://www.ama-assn.org/ama/pub/ama-president-blog/office-hours.page">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg" target="_blank">Register today</a>.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Medicine%20addresses%20health%20challenges%20worldwide-03-25-2011">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ff1d0539-b8dc-4992-b5d5-f3c388c711b8 The continuous cycle of measuring and improving performance http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad84c8bcd-f0bd-4d71-8429-5016045b617a&plckScript=blogScript&plckElementId=blogDest Wed, 23 Mar 2011 17:27:00 GMT <p>Living in a world where most things have a beginning and an end, sometimes the terms “continuous,” “never-ending” and “enduring” are hard to grasp. There are very few things I would say fit that mold. But after a recent meeting of the AMA-convened <a href="http://www.ama-assn.org/go/pcpi" target="_blank">Physician Consortium for Performance Improvement</a>® (PCPI), I was reminded that such a concept does in fact exist, particularly when it comes to the process of improvement, clinical progression and patient care and quality.</p><p>That’s something the PCPI has focused on now for more than 10 years and will continue to do: develop quality improvement measures that matter, for physicians and by physicians. Recently—with the passage of the Affordable Care Act—emphasis on quality has become even more relevant. </p><p>Having developed 270 measures across 43 different conditions, the PCPI continues its efforts to give physicians the data they need to provide high quality, cost-effective care. In fact, the consortium—more than <a href="http://www.ama-assn.org/resources/doc/cqi/pcpi-membership.pdf" target="_blank">170 members</a> strong—authored 56 percent of the measures adopted by the Centers for Medicare & Medicaid Services in its Physician Quality Reporting System last year. </p><p>The PCPI also is breaking new ground. It was among the first to work with health IT vendors and practice sites with electronic health record systems (EHRs) to develop and test the incorporation of performance measures. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=ixeuyztdnvqw" target="_blank">Register</a> for a free webinar next week that will help lead you through the process.</p><p>The group has broadened its measures to address a larger number of health conditions, from acute otitis externa and atrial flutter to obstructive sleep apnea and substance use disorders. And just recently, the PCPI opened a <a href="http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/physician-consortium-performance-improvement/public-comments.page" target="_blank">public comment period</a> through April 8 for feedback on the draft stroke and stroke rehabilitation measurement set.</p><p>It is only where <a href="http://www.ama-assn.org/resources/doc/cqi/pcpi-testing-protocol.pdf" target="_blank">performance is measured</a> that performance improves. Two testing networks are being developed by the PCPI to gage the feasibility and reliability of each measure. Results will enable the consortium to build confidence in measure results, to understand where to focus quality improvement efforts and to improve health care delivery and quality. </p><p>And as for 2011, the group decided at its meeting earlier this month in National Harbor, Md., to focus on the use of measures in EHRs, overutilization measures, the evaluation of patient-reported outcome measures as well as composite measures.  </p><p>Together, let’s stay ahead of the curve—and modernize health care—to improve the nation’s health care system and achieve the highest quality of care possible. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=The continuous cycle of measuring and improving performance-03-23-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d84c8bcd-f0bd-4d71-8429-5016045b617a Family health history is crucial on Diabetes Alert Day http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad9296ba3-b521-462c-a057-4cbf7e891924&plckScript=blogScript&plckElementId=blogDest Tue, 22 Mar 2011 18:53:00 GMT <p>The next patient who walks into your office could be among the 7 million Americans who have diabetes but don’t know it. Nearly 26 million Americans have the disease.</p><p>That’s a scary thought—and a wake-up call for all of us. </p><p>Today is <a href="http://ndep.nih.gov/partners-community-organization/awareness-month-alert-day/alert-day-2011.aspx" target="_blank">Diabetes Alert Day</a>. Led by the <a href="http://ndep.nih.gov/" target="_blank">National Diabetes Education Program</a>, Diabetes Alert Day is observed every year on the fourth Tuesday in March. More than 200 partners—including the AMA—have been active participants in this effort. </p><p>You can get involved, too. Help spread the word about the disease and the serious health problems it can cause when left undiagnosed or untreated. Share potential risk factors with patients and emphasize the importance of family health history (NDEP’s <a href="http://ndep.nih.gov/am-i-at-risk/diabetes-risk-test.aspx" target="_blank">Diabetes Risk Test</a> is a good place to start to find out if you are at risk). Or take part in the Diabetes Alert Day <a href="http://www.facebook.com/event.php?eid=183487421686667" target="_blank">Facebook event</a>.</p><p>Equally important to help disseminate is the message that diabetes can be controlled and often prevented by maintaining a healthy lifestyle. Eating healthy, exercising regularly and maintaining a healthy weight all greatly reduce the risk for type 2 diabetes. And getting tested annually is another key step. </p><p>Here are a few simple tips to start living healthier:</p><p>• Pack a healthy lunch at home instead of eating out<br />• To prevent overeating when out, ask for a box and wrap up half your entrée to take home right when it’s served<br />• Park at the furthest spot in a parking lot and walk to the door<br />• At the end of a long day, go out for a walk—it’s a great way to unwind and get exercise too</p><p>For more tips on living a healthier life, check out the <a href="http://www.ama-assn.org/go/healthierlifesteps" target="_blank">AMA Healthier Life Steps™ program website</a>.  </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Family health history is crucial on Diabetes Alert Day-03-22-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d9296ba3-b521-462c-a057-4cbf7e891924 ACOs: the ingredients for success http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a812ba0d6-05a0-4b1b-9c16-e4e8b99309ba&plckScript=blogScript&plckElementId=blogDest Mon, 21 Mar 2011 17:55:00 GMT <p>I represented the AMA at an accountable care organization (ACO) multi-stakeholder meeting early last week in Washington, D.C. The event was held at the Brookings Institute under the joint sponsorship of the Engelberg Center for Health Care Reform at Brookings and the Dartmouth Institute for Health Policy & Clinical Practice. Mark McClellan, from the Engelberg Center, and Elliott Fisher, from Dartmouth, were the moderators of the day-long session.</p><p>Forty people attended, representing the panoply of organizations that have become “household” names for those involved in health care. That includes consumers, physicians, hospitals, businesses, insurance companies, health plans, health care providers, the elderly, accrediting bodies, the federal government, state governments  and institutions involved in developing policy in the health care arena.</p><p>As I write this post, we are still waiting for the release of the Centers for Medicare & Medicaid Services’ regulations that will define the nature of ACOs in the Medicare program as provided for in the Affordable Care Act (ACA).</p><p>Those regulations will likely influence the face of ACOs in the private sector as well. But it was striking to be at this meeting, where the discussion was directed primarily at activity in the private sector that predates the ACA and is moving this type of alternative delivery reform—ACOs—forward in some ways independent of what happens in government programs.</p><p>Participants covered topics that gave some clue to the challenges ACOs will face as well as the status of movement to date. These challenges include: </p><p>1. Forming successful multi-payer ACOs to support accountability <br />2. Furthering provider accountability to create high-value care<br />3. Aligning consumer notification strategies for payers, ACOs and providers</p><p>The AMA’s message on ACOs (whether public or private) is that to be successful, they need to be voluntary for physicians and patients, and have physician leadership and transparency. And, to achieve the teamwork and assumption of responsibility for reducing costs while preserving and even increasing quality that is necessary for continuity and coordination of care to take place, there must not be a one-size-fits-all approach. </p><p>The organization and structure should be flexible to meet the needs of differences in geography, culture and practice patterns. In addition, there must be changes in current antitrust regulations by the Federal Trade Commission and the Department of Justice to allow the 78 percent of physicians in private practice who are in groups of nine or less to work together on ACOs.</p><p>The delay in promulgation of regulations by CMS is understandable due to the complex nature of this alternative delivery mechanism. I hope it also presages that those who are writing the regulations are incorporating the ingredients for success outlined above.</p><p>I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=ACOs: the ingredients for success-03-21-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:812ba0d6-05a0-4b1b-9c16-e4e8b99309ba Medical students: the leaders of today, the physicians of tomorrow http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a8e229ce5-c6ec-47b9-9eb7-f082000ec4e9&plckScript=blogScript&plckElementId=blogDest Fri, 18 Mar 2011 16:16:00 GMT I traveled to Columbia, Mo., yesterday just in time for a dinner with the leaders of the AMA Medical Student Section (MSS) chapter at the University of Missouri School of Medicine. It was inspiring to talk with these incredibly bright, dedicated medical students about their plans for the future—their hopes and aspirations. <br /><br />Later this morning I will be taken on a tour of the medical school and at noon will speak to the medical students. My remarks will focus on the Affordable Care Act (ACA): what’s in the law, what it means for the medical profession and our patients and especially what portends for future physicians as they start their careers.<br /><br />My message will be one of optimism—a message that says while the law is imperfect and there are things that need to be added and things that need to be deleted or modified, it is a significant start toward making our health care system better for the country.<br /><br />Speaking of future physicians, yesterday was Match Day—one of the most important days in a medical student’s life. More than 30,000 medical students and international medical graduates learned their personal results in the National Residency Match Program. To that, I would like to say congratulations. <br /><br />Following the meeting with medical students I will attend the deans’ luncheon to talk with faculty of the school and take an additional tour and meeting with staff of the new Boone Hospital Patient Tower in Columbia. At 4:30 p.m. I will get on (as it turns out) the same plane that brought me here and return home to Winter Park, Fla.<br /><br />The <a href="http://www.ama-assn.org/go/mss">AMA-MSS</a> is the nation’s largest medical student organization and it has a rich history. It was the MSS that called on the AMA to endorse the early demand for smoke-free work place legislation and smoking bans on airplanes. It was the MSS that first brought up the concept of a State Children’s Health Insurance Program (SCHIP). And it was the MSS that pushed for making comprehensive health system reform a top priority at the AMA.<br /><br />Today the MSS is busy responding to the most pressing challenges for both medical students and the nation, from improving resident work conditions to encouraging health lifestyles. AMA-MSS members travel to Washington, D.C., every year to lobby on Capitol Hill. They are taking advantage of an unprecedented opportunity to be a part of history—to help shape the course of American health care for generations to come.<br /><br />Medical students—leaders today—the doctors of tomorrow. I am optimistic about our future.<br /><br /><strong>I want to hear what you think. </strong>Join me for my next <a href="http://www.ama-assn.org/go/officehours">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg">Register today</a>.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Medical students: the leaders of today, the physicians of tomorrow-03-18-2011">e-mail</a>.<br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:8e229ce5-c6ec-47b9-9eb7-f082000ec4e9 AMA targets long-term, bipartisan solution to SGR problem http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a92151952-9d26-47f0-a180-957a9a2b4abf&plckScript=blogScript&plckElementId=blogDest Wed, 16 Mar 2011 13:56:00 GMT <p>A milestone was reached at the end of last year for physicians and patients alike. The Medicare & Medicaid Extenders Act—which President Obama signed into law on Dec. 16—received bipartisan support in Congress.</p><p>Not only did this enactment stabilize Medicare payments to physicians through the end of this year, but it also saved each physician thousands of dollars on average for their practice and their patients.</p><p>This long-sought-after pursuit is really a two-step process. The first has been accomplished. Physician payments have been stabilized through the end of 2011. The AMA collaborated with state and specialty societies, AARP and military families to mobilize seniors and patients across the nation to make this happen.</p><p>The next step takes a little more power and exertion, but it is entirely within reach. Working with the new Congress and policymakers on both sides of the aisle to achieve that same bipartisanship—for the long term—is the AMA’s next target.</p><p>This is not going to happen overnight. Reform of Medicare’s sustainable growth rate (SGR) formula is something physicians and the AMA have been working on for nearly a decade. We will continue to work to replace the current system with one that better reflects the costs and practice of 21st century medical care and that provides stability for physicians and their Medicare patients. </p><p>Of course there will be obstacles—22 percent of the U.S. House of Representatives is new to Congress. I foresee some education efforts in the very near future. It’s best we start now, and we have. </p><p>The AMA and 130 different state and medical specialty societies <a href="http://www.ama-assn.org/ama/pub/news/news/bipartisan-solution-medicare.shtml" target="_blank">sent letters last week</a> to both the <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/sgr-house-letter.pdf" target="_blank">House</a> and the <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/sgr-senate-letter.pdf" target="_blank">Senate</a> with the message that a permanent solution is needed to fix the broken Medicare physician payment formula this year. In fact, these letters were sent the same day the Centers for Medicare & Medicaid Services announced the new Medicare physician payment cut set to occur on Jan. 1 of next year: 29.5 percent. </p><p>When is Congress going to wake up? This cut is the highest we have ever seen under the Medicare payment system. </p><p>While lawmakers dither and delay, access to care for seniors, military families and baby boomers continues to wane. Physicians are the ones dealing with the fallout. And eventually we will be the ones forced to close our doors because caring for patients will no longer be a viable option.  </p><p><strong>I want to hear what you think.</strong> Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=AMA targets long-term, bipartisan solution to SGR problem-03-16-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:92151952-9d26-47f0-a180-957a9a2b4abf Preserving perspective as AMA president http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a4ca6d6fb-6470-4094-8058-82ef59d72e8c&plckScript=blogScript&plckElementId=blogDest Mon, 14 Mar 2011 15:27:00 GMT <p>I had an opportunity on a recent trip to California to speak and participate in a forum on the Affordable Care Act (ACA) at a retirement center, the University Village in Thousand Oaks. </p><p>Following my remarks, a resident came up to me and said: “I am a 60-year AMA member, and I want to thank you for what you are doing and say how proud I am to be a member of the AMA.” </p><p>I then thanked him for the compliment and his membership.</p><p>It has been nine months since I was installed as president of the AMA. The year is three-fourths gone. I am reflecting on the experience thus far and the importance of preserving one’s perspective. </p><p>The accolades and hospitality extended to me during my trips around the country are less about me and how I am doing my job and more about the AMA and its iconic position in America. </p><p>Given the contentious nature of the health system reform debate in this country over the past year and the still simmering partisanship one year after the passage of the ACA, it is not surprising that I still hear from physicians and others who are critical of the ACA and the AMA’s support of it. </p><p>However, a large part of what I do hear is support and praise. And it is easy to at some point think of it—the compliments—as all about me. It’s pretty heady stuff. And the risk is that one becomes so enamored with what one is doing and hearing that the pride in the person reaches proportions that can lead to that overweening pride approaching hubris—to lose one’s perspective.</p><p>Under these circumstances, one is fortunate if there are people around you who can remind you of the proper perspective on all of this. I am exceedingly privileged to have such a person in my life, my wife Betty Jane. She not only provides strong support but also perspective. Let me illustrate.</p><p>A couple of days following the trip mentioned above, I came home from my office in Winter Park, Fla., where we live to repack in preparation for a trip to the AMA’s headquarters in Chicago. The purpose was as “the president of the AMA” (important stuff) to represent the AMA Board of Trustees at the press conference and <a href="http://www.ama-assn.org/ama/pub/news/news/ama-names-new-jama-editor-in-chief.shtml" target="_blank">announcement</a> of the selection of a new editor-in-chief of the <em>Journal of the American Medical Association</em>, the flagship publication of the AMA. The last similar occasion was 11 years ago.</p><p>As I was loading luggage in the car for the trip to the airport, Betty Jane asked if I was going to be around for a few minutes before leaving, to which I replied, “Yes. Why do you ask?” </p><p>She responded: “There is a load of your underwear in the dryer that will be finished and folded soon and ready for you to put up.”</p><p>Perspective—it’s important to have.</p><p>I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, April 13. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=5522lyb2qyqg" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Preserving perspective as AMA president-03-14-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:4ca6d6fb-6470-4094-8058-82ef59d72e8c Naming of new JAMA editor marks a milestone for the AMA http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a754ae1f8-e487-4e17-93c8-a38e113af4aa&plckScript=blogScript&plckElementId=blogDest Fri, 11 Mar 2011 18:20:00 GMT For most of us, it is those milestones – births, weddings, graduations, new jobs, deaths – that provide the structure, the skeleton if you will, on which we base and recount our memories of our lives. We usually can remember those dates with some accuracy, which is especially important, I might add, if it deals with a wedding anniversary.<br /><br />Organizations likewise have milestones, and for the AMA, this year will bring one of those. This June, Cathy DeAngelis, MD, will complete 11 years of service as editor-in-chief of the <em><a href="http://jama.ama-assn.org/">Journal of the American Medical Association</a> (JAMA)</em> and its stable of nine specialty journals, the <em>Archives</em>. During this time she made <em>JAMA </em>one of the pre-eminent medical journals in the world. Dr. DeAngelis is returning to Johns Hopkins School of Medicine in Baltimore to develop the Center for Professionalism in Medicine and the Related Professions.<br /><br />Howard C. Bauchner, MD, from Boston University School of Medicine, will become the next editor-in-chief of <em>JAMA </em>– and the 16th editor in the journal’s 127-year history – on July 1. Dr. Bauchner, a pediatrician, is currently editor-in-chief of the <em>Archives of Disease in Childhood</em>, the official publication of the Royal College of Paediatrics and Child Health in the United Kingdom. He is the first U.S.-based editor of that journal and has held that position since 2003.<br /><br />Dr. Bauchner is a professor of pediatrics and social and behavioral sciences at Boston University Schools of Medicine (BUSM) and Public Health. He is also the vice chairman of the department of pediatrics and assistant dean of alumni affairs and continuing medical education at BUSM. Dr. Bauchner has a distinguished record as a researcher and investigator, having served on many editorial boards and publishing more than 125 papers in peer-reviewed journals.<br /><br />A graduate of the University of California, Berkeley, Dr. Bauchner received his medical degree from Boston University School of Medicine and did his pediatric residency at Boston City Hospital and Yale New Haven Hospital.<br /><br />In a <a href="http://www.ama-assn.org/ama/pub/news/news/ama-names-new-jama-editor-in-chief.shtml">March 10 news release</a> announcing the appointment, Michael Maves, MD, MBA, the AMA’s EVP and CEO, said: “We are pleased that Dr. Bauchner will be the new editor of <em>JAMA</em>. <em>JAMA </em>is a world-class medical journal and we’re confident the journal will continue to grow and prosper under his leadership. The future of <em>JAMA </em>– one of the AMA’s most treasured assets – is in great hands.” I agree.<br /><br />This is one of those milestones for the AMA and American medicine – the transition of <em>JAMA’s</em> leadership from an editor-in-chief, Dr. Angelis, who brought the journal to new heights to one, Dr. Bauchner, who will build on the past to move the journal to new peaks.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Naming%20of%20new%20JAMA%20editor%20marks%20a%20milestone%20for%20the%20AMA-03-11-2011">e-mail</a>.<br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:754ae1f8-e487-4e17-93c8-a38e113af4aa Naming of new JAMA editor marks a milestone for the AMA http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3abea3a9ce-627a-4d34-adca-4b0f115fc433&plckScript=blogScript&plckElementId=blogDest Fri, 11 Mar 2011 15:28:00 GMT <p class="MsoNormal">For most of us, it is those milestones – births, weddings, graduations, new jobs, deaths – that provide the structure, the skeleton if you will, on which we base and recount our memories of our lives. We usually can remember those dates with some accuracy, which is especially important, I might add, if it deals with a wedding anniversary.</p> <p class="MsoNormal">Organizations likewise have milestones, and for the AMA, this year will bring one of those. This June, Cathy DeAngelis, MD, will complete 11 years of service as editor-in-chief of the <a href="http://jama.ama-assn.org/">Journal of the American Medical Association</a> (JAMA) and its stable of nine specialty journals, the Archives. During this time she made JAMA one of the pre-eminent medical journals in the world. Dr. DeAngelis is returning to Johns Hopkins School of Medicine in Baltimore to develop the Center for Professionalism in Medicine and the Related Professions.</p> <p class="MsoNormal">Howard C. Bauchner, MD, from Boston University School of Medicine, will become the next editor-in-chief of JAMA – and the 16th editor in the journal’s 127-year history – on July 1. Dr. Bauchner, a pediatrician, is currently editor-in-chief of the Archives of Disease in Childhood, the official publication of the Royal College of Paediatrics and Child Health in the United Kingdom. He is the first U.S.-based editor of that journal and has held that position since 2003.</p> <p class="MsoNormal">Dr. Bauchner is a professor of pediatrics and social and behavioral sciences at Boston University Schools of Medicine (BUSM) and Public Health. He is also the vice chairman of the department of pediatrics and assistant dean of alumni affairs and continuing medical education at BUSM. Dr. Bauchner has a distinguished record as a researcher and investigator, having served on many editorial boards and publishing more than 125 papers in peer-reviewed journals.</p> <p class="MsoNormal">A graduate of the University of California, Berkeley, Dr. Bauchner received his medical degree from Boston University School of Medicine and did his pediatric residency at Boston City Hospital and Yale New Haven Hospital.</p> <p class="MsoNormal">In a <a href="http://www.ama-assn.org/ama/pub/news/news/ama-names-new-jama-editor-in-chief.shtml">March 10 news release</a> announcing the appointment, Michael Maves, MD, MBA, the AMA’s EVP and CEO, said: “We are pleased that Dr. Bauchner will be the new editor of JAMA. JAMA is a world-class medical journal and we’re confident the journal will continue to grow and prosper under his leadership. The future of JAMA – one of the AMA’s most treasured assets – is in great hands.” I agree.</p> This is one of those milestones for the AMA and American medicine – the transition of JAMA’s leadership from an editor-in-chief, Dr. Angelis, who brought the journal to new heights to one, Dr. Bauchner, who will build on the past to move the journal to new peaks. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:bea3a9ce-627a-4d34-adca-4b0f115fc433 Discuss, delineate and reconcile for the safety of your patients http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad1bcd41f-dca3-4df8-a34f-b6a8c7a0e342&plckScript=blogScript&plckElementId=blogDest Wed, 09 Mar 2011 15:15:00 GMT <p>Discuss, delineate and reconcile for the safety of your patients</p><p>Prescription medications. Check.</p><p>Medications taken without a prescription. Check.</p><p>Home remedies. Check.</p><p>Directions. Check.</p><p>Side effects. Check.</p><p>Can you place a checkmark beside each of these items as “discussed, delineated and reconciled” during each of your patients’ visits? </p><p>I hope so, because these are the types of conversations that should come up: What’s in your patients’ medicine cabinets, when and how are the medications being used, and what, if any, side effects or questions arise while taking them? </p><p>It’s also a key step for physicians in keeping patient safety a priority, and a topic that’s getting a lot of attention, this week during <a href="http://www.ama-assn.org/go/npsaw">National Patient Safety Awareness Week</a>. </p><p>The week is a reminder of what physicians should be doing now and throughout the year—encouraging patient safety, promoting health care quality and highlighting patient education in the office, at home and around our communities. </p><p>I mentioned knowing what’s in your patients’ medicine cabinets. Share the AMA’s “<a href="http://www.ama-assn.org/ama1/pub/upload/mm/433/medication-safety-checklist.pdf">medication safety checklist</a>” with your patients so they can focus on giving their own medicine cabinets an annual “check up” or “clean out.” </p><p>Alongside that is keeping the lines of communication open. Knowing all the medications your patients are taking can help prevent errors, so it’s absolutely critical that they feel empowered to talk freely with us about medication questions. The AMA’s <a href="https://catalog.ama-assn.org/Catalog/product/product_detail.jsp?productId=prod810004?checkXwho=done">patient safety tip card</a> reminds physicians and all health care providers on how to reduce and prevent communication-related adverse events.</p><p>Rather than waiting for your patients to start the dialogue, physicians can help with facilitating the conversation by asking questions. Patient safety really is a team effort, a unified partnership, among both the patient and the physician. Download a <a href="http://www.ama-assn.org/ama1/pub/upload/mm/433/patient-physician-relationship.pdf">tip card</a> on ways to help strengthen the patient-physician relationship, including recommended responsibilities for each. </p><p>And once you have had an opportunity to listen, reconcile. <a href="http://www.ama-assn.org/ama1/pub/upload/mm/370/med-rec-monograph.pdf">Medication reconciliation</a> plays an important role in the safe use of medications, and physicians play an even more vital role in making that happen. </p><p>In writing this post, I was reminded of fellow AMA Board member Raj Ambay, MD. I want to take this opportunity to recognize him for his military service as <a href="http://www.ama-assn.org/amednews/2011/02/28/prsa0228.htm">he was deployed to Iraq last week</a>, where he will spend four months helping to train other physicians and care for wounded soldiers. Dr. Ambay, I believe I speak for all physicians when I say “we salute you” for keeping our troops safe and healthy overseas.  </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Discuss,%20delineate%20and%20reconcile%20for%20the%20safety%20of%20your%20patients-03-09-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d1bcd41f-dca3-4df8-a34f-b6a8c7a0e342 IMGs help alleviate shortage of health care providers http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ae7ec921c-7f39-48d4-9cee-18b1e17dd066&plckScript=blogScript&plckElementId=blogDest Mon, 07 Mar 2011 18:58:00 GMT <p>As we contemplate the challenges our country faces with physician work force shortages and how they will impact efforts to implement health system reform, it is appropriate to reflect on the enormous debt of gratitude owed to physicians practicing in the United States who trained in non-U.S. medical schools (<a href="http://www.ama-assn.org/go/imgs" target="_blank">international medical graduates</a> or IMGs).</p><p>The percent of physicians in the United States who are IMGs has grown from 20.9 percent in 1980 to 26 percent in 2010. To make up for the fact that we do not train enough physicians in this country to provide medical care, one in four physicians now providing that care is an IMG.</p><p>In addition, IMGs have enriched our country medically and scientifically. I was reminded of that this past weekend when I was honored to participate in the 25th annual Symposium of the Iranian Medical Society held at the University of California, Los Angeles, under the direction of its CEO and founder, AMA member S.M. Rezaian, MD, a Los Angeles orthopedist spine specialist.</p><p>The program was richly diverse, scientifically exciting, clinically-oriented and presented by physician experts—many of whom are IMGs. I will briefly highlight just two.</p><p>Samuel Rahbar, MD, is an Iranian-born physician scientist who does research at the City of Hope Center in Los Angeles. It was Dr. Rahbar who originally discovered the link between hemoglobin A1C and diabetes mellitus. His talk focused on the pathophysiology of diabetes including juvenile and adult onset diabetes, advances in treatment and early recognition of diabetic neuropathy, vasculopathy and other complications.</p><p>David Rimoin, MD, originally from Canada, is a pediatric geneticist and chair of the Genetics Institute. Also an AMA member, he works at Cedars Sinai Medical Center in Los Angeles and founded the American College of Genetics and the American Board of Medical Genetics. Dr. Rimoin discussed multicultural genetics especially as it relates to Muslim and Hindu populations in India and those with Persian-Jewish origins in Los Angeles. In each case he pointed out the value and implications of genetic screening.</p><p>We do have a challenge as we work on the shortage of physicians as well as other health professionals—a challenge that would be even more daunting without the help of IMGs. I would like to thank  all IMGs on behalf of America’s physicians and patients.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=IMGs help alleviate shortage of health care providers-03-07-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:e7ec921c-7f39-48d4-9cee-18b1e17dd066 The trusted professional in end-of-life care http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a778b5de2-d8e9-4ff7-85ae-e61845fac30c&plckScript=blogScript&plckElementId=blogDest Fri, 04 Mar 2011 14:55:00 GMT <p>One of the casualties of this contentious health system reform debate in which we have been engaged over the past two years has been the opportunity to begin a serious, adult discussion about end-of-life care and the important decisions patients and physicians need to make. </p><p>Unfortunately, an effort to include physician counseling for patients on end-of-life care that’s paid for failed in reform legislation amidst the intensely partisan debate in which such counseling was mischaracterized with terms such as “death panels.”</p><p>The reality is that up to one-third of health care costs are incurred in the last year of life. The question for us as a caring society is not to decide whether to avoid care at the end of life because it is too expensive. The question is whether that care is helpful and not futile. </p><p>For me as a physician, the question is also:  Is it the level of care my patients tell me they want? Or if they are not able to communicate because of illness, is it what they have indicated they want, as shared with their family or in an advance directive such as a living will? </p><p>It is important that in counseling patients we are able to provide advice and information that helps them make a decision. And our ability to do that depends on our understanding about factors that affect these decisions. </p><p>A recent article and accompanying editorial in the <a href="http://www.annals.org/content/154/4.toc" target="_blank">Feb. 15 issue</a> of the Annals of Internal Medicine (a subscription is required to view the article and editorial) reported on a small part of this equation—determinants of medical expenditures in the last six months of life and reasons for variation in that care. The finding was this: patient characteristics, such as functional decline, race or ethnicity, chronic disease and nearby family, are important determinants of expenditures at the end of life, independent of regional characteristics. </p><p>Of course this is only a part of the story and accounts for 10 percent of overall variance in expenditures. There are obviously others, such as the age of the patient, severity and type of disease, as well as differences in care based on geography.</p><p>Our challenge is to understand, and in understanding, provide our patients the best information and advice in our role as trusted professionals.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=The trusted professional in end-of-life care-03-04-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:778b5de2-d8e9-4ff7-85ae-e61845fac30c Patients seeking clarity on health reform have help with new website http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aee139b34-54a1-487f-a5c4-00ec2ad9076b&plckScript=blogScript&plckElementId=blogDest Wed, 02 Mar 2011 14:46:00 GMT <p>The questions keep coming. </p><p>No matter the state, the population, the venue, the audience, there’s pretty much only one thing I can predict during my travels nationwide—questions about the Affordable Care Act will come up. </p><p>Each one is uniquely phrased, but they all boil down to basically one thing: How is it going to affect me? </p><p>It is a fair question. Navigating health care can be a confusing and complicated process. Adding a 2,000-page piece of legislation into the already convoluted mix does not make things any easier. Needless to say, concern and uncertainty are both natural and quite common feelings among patients these days. </p><p>What if I told you I know a place where your patients can go to get most, if not all, of their questions answered—anytime and from any place? </p><p><a href="http://www.healthcareandyou.org/" target="_blank">HealthCareAndYou.org</a> is a brand new website that just launched yesterday. The AMA joined some of the leading consumers and health care organizations in the country as part of the <a href="http://www.ama-assn.org/ama/pub/news/news/health-care-coalition-website.shtml" target="_blank">Health Care and You Coalition</a> to morph this sought-after need into a reality. </p><p>The site is critical in helping patients make the right decisions about health care for them and their loved ones. Within seconds, they can log on and get factual, reliable information about the health care law and how it affects them. And it’s laid out in simple and clear terms. </p><p>Do you need to know what provisions take effect today, tomorrow and even five years from now? The site details in an interactive timeline when certain parts of the law take effect leading up to and beyond 2014.</p><p>Do you want to know what coverage options are available in each state? The site features information on the law in all 50 states and Washington, D.C.</p><p>Are you looking for info on how the law will affect someone of a specific age? The site allows visitors to personalize the content they access according to whether they are older or younger than age 65, or if they are small business owners. </p><p>Get quick facts, real-life stories from patients who are already benefitting from the law, a list of “words you should know” and the latest health care news. </p><p>Being on the front lines of medicine every day, you need a resource you can trust for answers and share with patients as questions arise. I am pleased to say we now have that key educational component. Use it and encourage your patients to do the same.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Patients seeking clarity on health reform have help with new website-03-02-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ee139b34-54a1-487f-a5c4-00ec2ad9076b Moving forward is the choice http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a3583827c-9440-43ef-9748-81a4d7718bb5&plckScript=blogScript&plckElementId=blogDest Mon, 28 Feb 2011 15:14:00 GMT <p>I told a friend the other day that it seemed ironic that we as Americans hate change but really like variety. He sagely replied: “Variety is about choice. Change all too frequently is not.”</p><p>The reality that we all too frequently do not have a choice about what change is occurring was brought home in another conversation I had with a leader in one of the country’s largest premier group practices.</p><p>I was telling her about the AMA as a membership organization and its role in responding to issues of national importance, such as the recent debate over health system reform. </p><p>She said: “I hope your members are urging you to keep moving forward, and telling you we cannot stay where we are and cannot go back to where we have been.”</p><p>She was right. The reality is that we cannot go back to where we have been. </p><p>The miracles in medical care that provide us tools to prevent illness, care for the sick and save lives in ways we never could before also demand a change in how we deliver that care. It is no longer enough or adequate for one physician to provide all the care a patient needs. The complexity of what is available requires a skilled team of medical professionals, led by a physician—providing coordination and continuity of care—and with all members of the team practicing to their fullest based on their training and experience.</p><p>And we cannot stay where we are. Our current system produces arguably the best health care available anywhere in the world. But it does so at <a href="http://www.ama-assn.org/go/healthcarecosts" target="_blank">costs</a> that are markedly higher than anywhere else and are increasing at unsustainable rates. </p><p>In addition, tens of millions of Americans do not have access to care because they do not have health insurance, and tens of millions more are at risk of losing that insurance because of a job change or pre-existing condition. </p><p><a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/aca-advocating-for-improvements.pdf" target="_blank">Moving forward</a> is the option of choice. We have an opportunity to build on the strengths of the Affordable Care Act, including expanded health care coverage; add things that were left out, such as medical liability reform and Medicare physician payment; and correct things in the law with potential adverse effects, such as the Independent Payment Advisory Board.</p><p>Variety is about choice. We may not have a choice about change, but we do have a choice about how we respond to change. And it is the choices we make about how to respond that define us. </p><p>In my opinion, moving forward is “the choice.”</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Moving forward is the choice-02-28-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:3583827c-9440-43ef-9748-81a4d7718bb5 Leading the nation on climate-related health issues http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad6937044-3176-4a26-8e40-1410cba19dc1&plckScript=blogScript&plckElementId=blogDest Fri, 25 Feb 2011 16:36:00 GMT <p>One of the realities of climate change—whether it be global warming or the accompanying increases in air pollution and extremes of weather—is that there are health consequences. These consequences will not just be seen in the long term; they are being seen now.</p><p>Warming favors insect migration. In the past decade, the incidence of tick-born Lyme disease has risen tenfold in Maine and New Hampshire. In my home state of Florida, Mosquito-borne Dengue Fever—once a rarity in North America—appeared in the Keys, where 27 cases were reported in 2009 alone. And last year, a handful of cases were reported in Central Florida where I currently live.</p><p>Increases in air pollution due to elevated greenhouse gases (carbon dioxide, ozone, water vapor) and diesel and coal combustion contribute to pollen production. As a result, over the past three decades the allergy and asthma season has extended by about 20 days and the incidence of asthma has doubled to 6 percent, <a href="http://www.aafa.org/display.cfm?id=9&sub=42" target="_blank">affecting about 20 million Americans</a>.</p><p>Shorter but more variable winters have produced increased snowfalls, with ice storms and snow-covered roads creating treacherous travel conditions for both motorists and emergency vehicles. And extreme heat events, such as extended high heat waves, have increased. Events including the 2006 California heat wave resulted in 16,000 ER visits, nearly 1,200 hospitalizations and as many as 450 deaths. The approximately 133 million Americans with chronic conditions such as heart disease or diabetes, which are aggravated by heat waves, are increasingly at risk for serious complications and death.</p><p>The AMA is working to ensure physicians understand the rise in climate-related illness so they can prepare and respond to this challenge. Yesterday I attended a state-based CME course on human health and global climate change in Jacksonville, Fla., one of a number of similar courses the AMA is sponsoring around the country.</p><p>One might ask, what can the medical community do to help combat climate change? The answer: Medical and public health groups can take the lead in advocating for climate and energy policies that can improve public health. And we, as physicians, can serve as role models for patients adopting environmentally-responsible, energy- and waste-reducing medical practices.</p><p>The latter means implementing easy, common sense activities, such as using low-energy lights, lowering the thermostat in the building, installing low-flow water faucets, drinking from a water cooler instead of bottled water and recycling paper products.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Leading the nation on climate-related health issues-02-25-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d6937044-3176-4a26-8e40-1410cba19dc1 Enrich your practice, quality of care: start by asking your patients http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a8fada023-debf-469e-a842-df79b928dfd8&plckScript=blogScript&plckElementId=blogDest Wed, 23 Feb 2011 15:18:00 GMT <p>Walt Disney once said, “Do what you do so well that they will want to see it again and bring their friends.”</p><p>I took a moment to really think about this statement and realized the legitimacy and truth to it as it relates to physicians and their practices.</p><p>Patients can teach us a lot about our own practices in terms of increased productivity, greater efficiency and medical liability relief. Most physicians feel strongly about reaching these goals.  </p><p>But consider this: A practice without patients makes all these things irrelevant. So simply having patients is key, but more importantly, we strive for satisfied ones by providing the best possible care and service that exceeds their expectations.</p><p>According to one survey, a patient who is unhappy with a physical exam or an encounter with staff could tell nine other people. I am no mathematician, but I can foresee that number adding up real quickly. The only way to find out if patients are happy with their overall visit is by asking them, but not necessarily in person. </p><p>A new Web-based product—offered by the AMA and Press Ganey Associates—measures patient satisfaction, tracks and improves in-office experiences, and allows patients a constructive, nonthreatening outlet to provide feedback on their experiences. With unlimited surveying capabilities, this data can ultimately help address the things I mentioned above and make meaningful strides in quality improvement efforts. It’s called <a href="http://www.ama-assn.org/go/patientexperience" target="_blank">RealTime</a>. </p><p>Here’s how it works. A patient visiting the practice is asked to participate in the survey at check-in. The patient’s e-mail address is entered into a system right after the visit, and a customized e-mail is then delivered to him or her The patient clicks on the link and is directed to the survey.</p><p>An important component to this survey tool is found in the name. Patient feedback is compiled in “real time,” and results are in physicians’ hands within a day. That way you can quickly and constructively use the data to make changes in the way you manage your practice. And personalized, online, easy-to-interpret reports are accessible at any time, including summaries, trends, comparisons and patients’ comments.</p><p>Finally, RealTime gives physicians access to practice improvement tools, including webinars and online resources, addressing areas in which a practice may need improvement. Some tools have already been developed on improving communication with patients, conducting prospective employee interviews for receptionists and making practices more patient friendly.</p><p>Measuring patient satisfaction is becoming more and more common these days. Medicare and private insurers are measuring it with the <a href="http://www.cahps.ahrq.gov/content/products/CG/PROD_CG_CG40Products.asp" target="_blank">Clinician and Group Practice Consumer Assessment of Healthcare Providers and Systems</a>, recently developed by the Agency for Healthcare Research and Quality. In addition, Medicare’s <a href="http://www.medicare.gov/find-a-doctor/provider-search.aspx" target="_blank">Physician Compare website</a> provides comparative information on quality and patient experience measures. And the American Board of Medical Specialties is planning to incorporate patient experience data collection into the Maintenance of Certification requirements. </p><p>We, as physicians, can spend a lot of time assessing next steps on how to improve our practice or looking for answers on how to fix this or change that. Our patients are the answer. The process starts with them—and their friends. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Enrich your practice, quality of care: start by asking your patients-02-23-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:8fada023-debf-469e-a842-df79b928dfd8 Together, let's reduce administrative waste and costs http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a34e205f9-0b62-46ab-8bec-dfb4e9c5cf7b&plckScript=blogScript&plckElementId=blogDest Mon, 21 Feb 2011 17:37:00 GMT This weekend I had the opportunity to stay in the warm confines of Florida when I traveled from my home in Winter Park to Hollywood. There I gave the keynote speech to attendees of the 34th National Labor and Management Conference. <br /><br />This was my second opportunity to speak at this annual meeting, where representatives of labor and management spend four days in sessions devoted to subjects of common interest, including health and welfare, pension funds and labor/management strategies.<br /><br />My remarks, titled “American Health Care: The Road Ahead,” focused on ways to bend the cost curve of health care expenditures in the context of the Affordable Care Act. <br /><br />As previously detailed in my blog on <a href="http://bit.ly/fqiEcl">Jan. 18</a>, <a href="http://bit.ly/frqvRt">Jan. 26</a> and <a href="http://bit.ly/fcW2Fw">Feb. 1</a>, the AMA has identified four overarching <a href="http://www.ama-assn.org/go/healthcarecosts">strategies for controlling costs</a>:<br /><br /><ul><li>Reduce the burden of preventable disease</li><li>Make the delivery of care more efficient</li><li>Promote value-based decision-making at all levels</li><li>Reduce nonclinical costs that don’t contribute to patient care</li></ul><br />The fourth strategy—reducing nonclinical costs—refers to administrative waste, which system-wide is estimated to add $200 billion yearly to the health care bill for our country. A root cause of the problem is a lack of standardization in our system’s administrative processes. Each health insurance company has its own set of procedures and payment policies, creating a morass of challenges for physician offices.<br /><br />The AMA is promoting a health care administrative simplification campaign—called “<a href="http://www.ama-assn.org/go/htc">Heal the Claims Process</a>™”—to move to a more uniform, automated, industry-wide claims processing system for health insurers, physicians and patients.<br /><br />My challenge to attendees at the meeting in Hollywood and to labor and business interests nationwide is to join the AMA in a dialogue about how to reduce administrative waste and costs in the health care system.  <br /><br />Within the next few weeks, the AMA will be organizing a workgroup that embraces the labor, business and employer community. The goal will be to identify areas of common interest where we can bend the curve of health care costs by improving efficiency and simplifying administrative procedures.<br /><br />For those who would like to be a part of that group, the AMA project coordinator is Kelly Kenney. <a href="mailto:kelly.kenney@ama-assn.org">E-mail her</a> if you are interested.  <br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Together lets reduce administrative waste and costs-02-21-2011">e-mail</a>.<br /><br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:34e205f9-0b62-46ab-8bec-dfb4e9c5cf7b Groups desire freedom and redress of grievances http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3af6a5034e-16c7-4327-b1d3-22e6e3e73579&plckScript=blogScript&plckElementId=blogDest Thu, 17 Feb 2011 16:02:00 GMT <p>America’s physician leaders converged last week on Washington, D.C., from across the country for the AMA’s annual <a href="http://www.ama-assn.org/go/nac" target="_blank">National Advocacy Conference</a>. For me this was juxtaposed by the TV images of Egyptian citizens who were converging on their own capital, Cairo.</p><p>I was also struck by the fact that both groups were alike in sharing values innate in us as humans: the desire to be free, to think and do for ourselves and to petition our government for redress of grievances.</p><p>The differences between the two groups, however, were stark and trigger a list of what in the lingo of speech technique is called “contrasting pairs.”</p><p>• In the U.S.—freedom to travel without hindrance <br />• In Egypt—roadblocks and checkpoints<br />• In the U.S.—peaceful assembly without risk of harm<br />• In Egypt—violence and rock throwing, the wounded and the dead<br />• In the U.S.—entering the halls of government talking to officials <br />• In Egypt—assembling en mass in the town square using loudspeakers<br />• In the U.S.—relying on the orderly electoral process<br />• In Egypt—demanding that not only the president not run again but that he resign and leave the country</p><p>As we now know, what is being described as a peaceful revolution led by young people using the Internet and social media resulted in overturning the existing government.</p><p>There are already “Cassandras” out there, with the evidence of the history of other revolutions on their side, who are publicly warning of the possibility that the peaceful nature of this change may not last.</p><p>They may turn out to be right—and get to say sagely and maybe even pompously: “I told you so.” But I prefer to focus on celebrating what is happening now, including images of the “revolutionaries” proud of their country, picking up trash, cleaning their streets and painting fences.</p><p>I wish for them the ability to safely travel to their capital and peacefully petition their government, as was the case for America’s physicians last week. And I am reminded of and thankful to be living in a country where that freedom is the rule not the exception.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Groups desire freedom and redress of grievances-02-17-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:f6a5034e-16c7-4327-b1d3-22e6e3e73579 Protecting our youth, tackling concussions head on http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a5d42f4b4-5e22-4315-b57c-ea1d796c5a3b&plckScript=blogScript&plckElementId=blogDest Wed, 16 Feb 2011 14:56:00 GMT <p>I cannot imagine being a parent in the stands watching your child take a direct hit to the head or a nasty fall, knocked out cold for seconds or even minutes. But what’s even harder for me to grasp is after some time of lying unconscious, your child regains consciousness, gets up and continues to play in the game—whatever it may be—football, ice hockey, rugby, soccer. </p><p>These are a few of the sports where concussions are most common. I realize athletes and coaches—even parents—are often quite competitive in nature. But there is no competition or victory, for that matter, that’s worth a child’s life.</p><p>According to a 2009 study, this scenario happens all too often. As many as 40 percent of high school athletes who have had concussions return to competition or practice when they may not be fully recovered. Even a mild brain injury can be catastrophic or fatal.</p><p>The scary part is that children and teens are more likely to get a concussion and take longer to recover than adults, the Centers for Disease Control and Prevention reports. It is estimated that, in high school football alone, as many as 250,000 concussions occur each year. And the long-term effects of even just one are still unknown.</p><p>I have a prescription for this: it’s physicians. Protecting young athletes and their health and well-being starts with us. There are two components to it though. The first is what the AMA did last November at its <a href="http://www.ama-assn.org/ama/pub/meeting/index.shtml" target="_blank">Interim Meeting</a> in San Diego. It <a href="http://www.ama-assn.org/ama/pub/news/news/ama-adopts-new-policies-interim.shtml" target="_blank">adopted policy</a> which basically said this: athletes with even the slightest suspicion of a concussion cannot return to play or practice without first having a physician’s written approval.</p><p>And many states have followed suit. Washington state has such a law in place, and since, more than a dozen states have enacted similar laws or are considering similar bills.</p><p>The second component is education. Coaches, players, parents, fans—in locker rooms and grandstands around the world—everyone should be aware of this serious public health problem and understand the dangers of traumatic brain injuries, particularly when they go untreated. Our children are not invincible. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Protecting our youth, tackling concussions head on-02-16-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:5d42f4b4-5e22-4315-b57c-ea1d796c5a3b The intensity rises on medical liability reform http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a884ca5ca-9287-4d3c-ae9d-891819956aee&plckScript=blogScript&plckElementId=blogDest Mon, 14 Feb 2011 22:14:00 GMT This morning I am thinking about one of the songs from the Rogers and Hammerstein musical “Carousel” (1956), titled “June is Busting Out All Over” and the line: “the feeling is getting so intense.” <br /><br />We have been looking for bipartisanship in our country’s political discourse, particularly in the health system reform debate. Evidence is accumulating that it may appear around the issue of reforming our dysfunctional medical liability system—a system that by promoting defensive medicine adds billions yearly to the cost of health care, while failing to promptly and fairly compensate those who have been injured. In the process, this system subjects physicians to nonmeritorious lawsuits. <br /><br />Last week the House Judiciary Committee began markup on the Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act, or H.R. 5, which would establish caps on noneconomic damages in lawsuits. These proven reforms already are working in states like California and Texas. This bill, sponsored by Rep. Phil Gingrey, MD, R-Ga., has bipartisan support.<br /><br />Today President Obama unveiled his budget for 2012 that contains $250 million for projects to investigate alternative medical liability reforms such as medical courts, early offer programs, administrative determination of damages and safe harbors for physicians practicing according to scientific principles.<br /><br />While these are not the MICRA-type reforms the AMA has long supported, these grants represent a tangible acknowledgement of the impact our broken liability system has on patients, physicians and health care spending overall.<br /><br />And these follow support President Obama has given to medical liability reform beginning with his speech to the AMA House of Delegates in June 2009 when he said physicians cannot practice medicine while looking over their shoulder fearful of the threat of being sued for nonmeritorious causes.<br /><br />In December 2009 he followed up those words by authorizing $25 million to investigate alternative medical liability reforms similar to that in the budget announced today.<br /><br />The Affordable Care Act passed last March included an additional $50 million for similar study.<br /><br />And in his State of the Union speech last month President Obama said he would be willing to consider medical liability reform proposals by Republicans in the House.<br /><br />We have another four months before June will be “busting out all over,” but medical liability reform may be another story. “The feeling is getting so intense”—and that is good for our country.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezplog@ama-assn.org?subject=The intensity rises on medical liability reform-02-14-2011">e-mail</a>.<br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:884ca5ca-9287-4d3c-ae9d-891819956aee Physicians carry torch to D.C. as leaders on reform http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a41ebb628-3c52-48a1-9ff7-907ed4a3a2a8&plckScript=blogScript&plckElementId=blogDest Fri, 11 Feb 2011 15:04:00 GMT <p>“Are we going to start planning for the future or are we going to keep fighting the battles of the past?”</p><p>This question sums up the message of the week quite nicely—after the AMA’s three-day <a href="http://www.ama-assn.org/go/nac" target="_blank">National Advocacy Conference</a> where physicians and key stakeholders discussed, debated and proposed opportunities for our nation’s health care system in Washington, D.C.  </p><p>This question, actually posed by MSNBC’s Morning Joe co-host and former Florida congressman Joe Scarborough on Tuesday, can be answered with an emphatic “we are planning for the future.” This was evident to me, to the AMA Board of Trustees and to lawmakers because of the hundreds of engaged physicians who showed up in the nation’s capital for three straight days this week to deliver medicine’s message to lawmakers.</p><p>It wasn’t just physicians but also medical students who made the trek from all parts of the country to meet one on one with their members of Congress and to let them know we need action on medical liability reform (passage of the HEALTH Act), a permanent fix to the Medicare physician payment formula, a new Medicare payment category for private contracting and solutions as to how to address health care’s work force shortages. Time will tell as to whether or not they listened. </p><p>I am among the nation’s largest organization of physicians—and leaders. This is a new era of health system reform. We, the physicians, must be the leaders throughout this time of uncertainty. </p><p>For example, <a href="http://www.ama-assn.org/go/paymentpathways" target="_blank">delivery reforms and accountable care organizations</a>—a couple of terms you may have heard once or twice before—are the coming revolution in payment practices. Harold Miller, executive director of the Center for Healthcare Quality and Payment Reform, gave physicians a rundown on ACOs Wednesday in what I would call “plain English.” And the same point he echoed time and time again is one that I will say once more to you: It is physicians who are a critical element in all of this and need to take the lead for the entire health care industry. Get educated, and help educate others.</p><p>Another important aspect of reform, the <a href="http://www.ama-assn.org/go/hit" target="_blank">implementation of health IT</a>, is a second area where I look to physicians to carry the torch. David Blumenthal, national coordinator for health information technology, spoke to physicians on Thursday about this very topic. By maintaining a profession that’s modern, flexible and dynamic, physicians will be the best they can be for their patients.</p><p>When all these things come together, we will have improved care, better health and lower costs—the three things Centers for Medicare & Medicaid Services Administrator Donald Berwick, MD, pointed out that our health care system needs during a session on Wednesday. Dr. Berwick reminded physicians that health care has shifted. There’s no doubt it has. The latest medical advances, the economic downturn and the pressures of health care costs—these are all reminders of that. </p><p>But just as Dr. Berwick said: “The Affordable Care Act is the step forward we need to respond to these realities.” </p><p>And physicians are responding, we are collaborating, we are planning for the future.  </p><p>What a proud week to be an AMA member. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Physicians carry torch to D.C. as leaders on reform-02-11-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:41ebb628-3c52-48a1-9ff7-907ed4a3a2a8 Warning: Tobacco is deadly—taking action is key to prevention http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a43dbe334-82c3-4f6f-a4dc-d204ea2ea55d&plckScript=blogScript&plckElementId=blogDest Tue, 08 Feb 2011 17:25:00 GMT You might not have noticed the underplayed diminutive message "smoking causes mouth diseases" the last time you picked up a pack of cigarettes. It was there, or some other small written warning on the edge of the pack. But that teeny tiny label is soon to change.  <br /><br />Rather than words, imagine full-blown pictures: a mother blowing smoke on her baby, a corpse lying in a coffin or a man blowing smoke out of his neck. Although quite graphic and appalling, these are the deadly and startling truths that can result from cigarettes and smoking and the kinds of things you will start to see covering a large part of the packaging for cigarettes. <br /><br />The U.S. Food and Drug Administration unveiled 36 new <a href="http://www.fda.gov/TobaccoProducts/Labeling/CigaretteProductWarningLabels/ucm2024177.htm" target="_blank" title="Proposed Cigarette Product Warning Labels - FDA">proposed warning labels for cigarettes</a> last November—required under the Family Smoking Prevention and Tobacco Control Act— nine of which manufacturers will have to start using on their packaging no later than Oct. 22, 2012. Being that tobacco is the leading cause of preventable death in the United States, maybe it is time this issue became obnoxiously evident in the face of the tobacco industry and its consumers.  <br /><br />This is a strong step in the right direction. But unfortunately, I don't think "changing labels" is all we are going to have to do to get the more than 46 million Americans who currently smoke to quit. Our next step is at the state level. <br /><br />A report released last month by the American Lung Association, <em><a href="http://www.lungusa.org/about-us/our-impact/top-stories/sotc-2011-states.html" target="_blank" title="Tobacco Control – Does Your State Make the Grade?">State of Tobacco Control 2010</a></em>, showed that while the federal government got all passing grades on tobacco cessation and control efforts, only five states received all passing grades—and most outright flunked. We need to step up our efforts by implementing and helping fund more tobacco prevention and smoking cessation programs to help Americans quit. <br /><br />I realize these are things physicians cannot do alone, so I encourage everyone to have a partner in this. Work with your local and state medical societies and lung associations to advocate for tobacco prevention and smoking cessation programs. And look to the AMA for guidance and <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/smoking-tobacco-control.shtml" title="Tobacco Control Resources">resources</a>. <br /><br />We just launched a brand new online module—part of the AMA's <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/general-resources-health-care-professionals/educating-physicians-controversies-challenges-health.shtml" title="Educating Physicians on Controversies & Challenges in Health">Educating Physicians on Controversies and Challenges in Health series</a>—entitled, "<a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/general-resources-health-care-professionals/educating-physicians-controversies-challenges-health/epoch-smoking-cessation.shtml" title="EPoCH CME: Smoking Cessation in Special Populations">Smoking Cessation in Special Populations</a>." This video, approved for CME credit, provides an overview of the myths associated with smoking cessation in individuals with a mental illness or substance use disorder and provides counseling tips and actionable strategies for physicians to use in their practices. Check out other online offerings at <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/smoking-tobacco-control/secondhand-smoke.shtml" title="AMA Secondhand Smoke Initiative">www.ama-assn.org/go/secondhandsmoke</a>.  <br /><br />If you are interested in advocating for tobacco control policies and programs and have ideas or insight on this topic, I invite you to <a href="http://www.ama-assn.org/ama/pub/community/groups.shtml?slPage=overview&slGroupKey=5e5ee85d-a514-48cb-8563-4a621b1a6285&slAcceptInvitation=false" target="_blank" title="Tobacco Control and Prevention">join the AMA’s Tobacco Control and Prevention</a> private online community. As a member, you can discuss and comment on current topics pertinent to tobacco control, take part in polls and read and comment on blog posts by your colleagues.<br /><br />The opportunities for involvement and action are endless. The important thing is that we are doing it and saving lives. <br /><br />Benjamin Franklin once said, "Well done is better than well said." Need I say more? <br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Freedom%20to%20control%20our%20destiny-02-07-2011" target="_blank">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:43dbe334-82c3-4f6f-a4dc-d204ea2ea55d Freedom to control our destiny http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ab27de00f-14eb-4589-83f9-cee7152cb6b1&plckScript=blogScript&plckElementId=blogDest Mon, 07 Feb 2011 16:44:00 GMT <p>I spent most of the last week in the cold and snow of Boston participating in an AMA Board meeting which included educational sessions at the Harvard Kennedy School of Government. I am now in Washington, D.C., where today Michael Beschloss, noted author and presidential historian, will give the opening keynote speech at the <a href="http://www.ama-assn.org/ama/pub/advocacy/get-involved/presidents-forum.shtml" target="_blank">AMA Presidents’ Forum</a>.</p><p>Mr. Beschloss has been described by Newsweek as “the nation’s leading presidential historian,” and is an expert on leadership, particularly as exemplified by U.S. presidents. He will be speaking to physician leaders from across the country who are gathering in D.C. to participate this week in the <a href="http://www.ama-assn.org/go/nac" target="_blank">AMA National Advocacy Conference</a>. </p><p>During the conference, physicians will hear from AMA leadership about plans for its advocacy efforts and from members of Congress and the Obama administration on issues important to physicians and their patients. In addition, physician leaders will visit their members of Congress throughout the week to urge them to take action to deal with the flawed Medicare physician payment formula, medical liability reform, implementation of the Affordable Care Act (ACA), physician work force shortages, private contracting and defects in the Independent Payment Advisory Board established by the ACA.</p><p>In thinking about this week’s events in which U.S. citizens (or, in this case, physicians) can freely and without fear of harm petition their government, I am reminded of the heroic efforts of the citizens of Egypt who, in rebelling against an oppressive government and at great risk of bodily harm, are giving expression to that universal yearning we all have for freedom to control our own destiny.</p><p>During the past year, as our country debated the merits of health system reform and looked for a way to extend health care coverage to all, we often lamented the contentiousness of the intercourse, the lack of civility and the divisive way in which we tackled the problem. The events in Egypt should provide perspective that makes us want to celebrate our own democracy and wish Egyptian citizens all the best in their efforts to make changes in their government.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Freedom to control our destiny-02-07-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:b27de00f-14eb-4589-83f9-cee7152cb6b1 “Office Hours” filled with physician concerns on re-entry, work hours, reform http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a8e044517-d4ef-4440-9cad-05b6fb9d8331&plckScript=blogScript&plckElementId=blogDest Thu, 03 Feb 2011 19:37:00 GMT <p>On Wednesday I hosted the sixth in the series of “Office Hours with Dr. Wilson” conference calls, during which AMA members from across the country call in to receive an update on what the AMA is doing, ask questions and share their observations with me. </p><p>I continue to find these sessions very helpful as another way of getting a sense of what our members are thinking about. Wednesday was no exception.</p><p>As we move forward toward implementation of the health system reform law, there are increasing questions about how physicians will adapt to and lead change.</p><p>Several physicians asked about what the AMA is doing to provide help in surmounting barriers to re-entry for those who took a voluntary leave of absence and now want to return to practice. Learn more about the AMA’s <a href="http://www.ama-assn.org/ama/pub/education-careers/finding-position/physician-reentry.shtml" target="_blank">re-entry resources</a> on the <a href="http://www.ama-assn.org/go/reentry" target="_blank">AMA website</a>. </p><p>And in the context of increased work hours, there were questions about how physicians balance personal life and health as well as consider changes in specialty and practice. The AMA <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health.shtml" target="_blank">covered this topic in a conference</a> last October. <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/icph-presentations.shtml" target="_blank">View the presentations</a> and other resources.</p><p>A number of questions centered around concerns about Medicare physician payment reform, medical liability reform, membership, the threats provided by increasing <a href="http://www.ama-assn.org/ama/pub/news/news/competition-health-insurers.shtml">consolidation of the health insurance industry</a> giving it monopoly power, the need to encourage more physicians to enter primary care specialties, the complexity of Evaluation and Management codes, the bureaucratic hassles of the Medicare system as well as private insurance claims filing for physicians.</p><p>One physician in private practice said that while medical liability reform that provides limits on noneconomic damages helps control premiums, it does not decrease her fear of being sued. And because of that fear, she daily orders tests and procedures that are not needed (defensive medicine). </p><p>Hopefully the <a href="http://www.ama-assn.org/ama/pub/news/news/ama-organizations-support-health-act.shtml" target="_blank">alternative liability reforms the AMA is currently pursuing</a> to significantly change the tort system will be helpful--reforms such as medical courts, early offer programs, safe harbors for practicing according to scientific guidelines and administrative determination of damages. Such a system would meet the goals of compensating those who are injured in an expeditious, fair manner while protecting physicians from being brought into the court system because of nonmeritorious claims.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=%E2%80%9COffice%20Hours%E2%80%9D%20filled%20with%20physician%20concerns%20on%20re-entry,%20work%20hours,%20reform-02-03-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:8e044517-d4ef-4440-9cad-05b6fb9d8331 “Go red”—and get ready—for American Heart Month http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3af7de68ff-4d47-4835-b240-37073b17b305&plckScript=blogScript&plckElementId=blogDest Wed, 02 Feb 2011 17:25:00 GMT <p>Everywhere we turn—cigarette smoke, salt, alcohol, trans fats, cholesterols, sugars—it is just one more thing that could potentially place us at a higher risk for the No. 1 cause of death for all Americans: heart disease.  </p><p>I know you have heard me talk time and time again about the burden of preventable disease. As an internist, it is near and dear to me. Well, I cannot stress it enough. Heart disease is one of those things that we can all take steps to prevent and eliminate the factors that put us at a greater risk. </p><p>Everyone has the choice to keep hold of the two things we can control—a healthy diet and a healthy lifestyle—and use them to guide our decisions. </p><p>During February, <a href="http://www.americanheart.org/presenter.jhtml?identifier=4441" target="_blank">American Heart Month</a>, I encourage all Americans to be aware and make others aware of the real risk for heart disease—for both men and women. Tell your patients, your family, your friends, your loved ones. And remember it for yourself.</p><p>Eat better, exercise, stop smoking and drink responsibly. As physicians, we can help direct patients by providing the right tools, through the <a href="http://www.ama-assn.org/go/healthierlifesteps" target="_blank">AMA Healthier Life Steps</a>™ program, that help patients identify and choose healthier behaviors. And we can get more involved in public health initiatives, such as First Lady Michelle Obama’s “<a href="http://www.letsmove.gov/" target="_blank">Let’s Move!” campaign</a>. </p><p>Because the facts are clear and disheartening. In about the time it took you to read the first couple paragraphs of this post, someone in America actually experienced a coronary event. In about the time it took you to read the entire post, another American died from one. </p><p>If you take nothing more from what I have said, take this to heart: The decisions we make today predict our outcomes for tomorrow. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=“Go red”—and get ready—for American Heart Month-02-02-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:f7de68ff-4d47-4835-b240-37073b17b305 Decreasing cost, increasing quality http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aa4c877c8-3028-4d4a-b1d9-c85dd234411d&plckScript=blogScript&plckElementId=blogDest Tue, 01 Feb 2011 15:32:00 GMT <p>Over the past several weeks I have had the opportunity in interviews and appearances on panels at meetings to discuss the need to decrease the cost of health care while preserving or even increasing quality. On each of those occasions the question has been asked: What is the one thing we can do to control health care costs?</p><p>If only that were the case—that there was a single silver bullet or a killer app—to solve the problem. Unfortunately, it is not that simple.</p><p>It is the case that expansion of health care coverage to some 32 million who currently do not have health insurance will decrease costs by assuring that they receive ongoing care in physician offices and do not wait to visit an emergency room, where they are more ill and the cost of care is greater. </p><p>However, having health insurance coverage in and of itself will not solve the problem of rapidly growing costs of health care in our country. In fact, if that is all we do as part of health system reform, we are likely to just compound the problem of cost.</p><p>The AMA has identified four strategies to <a href="http://www.ama-assn.org/go/healthcarecosts" target="_blank">address the cost of health care</a>—all of which must be pursued if we are to get a handle on this problem.<br /> <br />• Reduce the burden of preventable disease by addressing prevention and wellness and health behaviors that contribute to disease (obesity, tobacco use, alcohol abuse and sedentary lifestyle).<br />• Increase efficient care by delivering care at the right time, the right place and the right manner using, for example, alternative delivery systems such as accountable care organizations and patient-centered medical homes.<br />• Decrease costs that do not contribute to the quality of care, such as administrative costs of claims filing and defensive medicine due to a dysfunctional medical liability system. <br />• Increase value-based purchasing of health care by having doctors and patients consider value in making decisions about drug treatment  through, for example, the use of comparative effectiveness research to help decide not just what works (evidence-based medicine) but what works best (comparative effectiveness). Also, health insurance companies must consider value in developing health plans and the government should develop policies with value as a part of the equation.</p><p>It is critical to the success of health system reform that we address not only the imperative to expand health care coverage and make health insurance more reliable but that we also address costs. And for the latter, there is no single solution but a constellation of options that, together, offer promise for successfully tackling the problem.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Decreasing cost, increasing quality-02-01-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:a4c877c8-3028-4d4a-b1d9-c85dd234411d We are in it together http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a4939f6fd-1b85-453d-a665-33b51d219b55&plckScript=blogScript&plckElementId=blogDest Fri, 28 Jan 2011 14:56:00 GMT <p>Physicians and veterinarians—as healers—have a lot in common, whether our patients walk on two legs or four. And our patients share a lot of diseases in common, whether they talk, bark, moo, oink, purr…or whinny.</p><p>I was reminded of this when I participated on a panel last week in Orlando with another physician and two veterinarians at the North American Veterinary Conference. We were talking about opportunities for interdisciplinary action in association with the “<a href="http://www.onehealthinitiative.com/" target="_blank">One Health Initiative</a>,” which the AMA supports.  </p><p>This is a movement also supported by the <a href="http://www.onehealthcommission.org/" target="_blank">One Health Commission</a> of which the AMA is a member. The commission was formed in 2009 to forge collaborations between physicians, osteopaths, veterinarians, dentists, nurses and other scientific disciplines. </p><p>Here’s why it is important for this interaction:</p><p>• Sixty percent of the nearly 1,500 infectious diseases now recognized in humans are caused by pathogens that have an animal vector.<br />• Three of every four newly emerging human infectious diseases originate in animals (zoonotic).<br />• Many zoonotic diseases pose increasing threats to the human race (Ebola, Lassa fever and the Nipah, Hendra and Marburg viruses).<br />• Pollution and environmental contamination affect human and animal health.<br />• Many drugs and most medical devices are tested and refined in animals before use in humans.<br />• Humans, animals and the environment also intersect at farms, slaughterhouses and processors.<br />• Monitoring animal health has led to the discovery that environmental contaminants, such as lead or mercury, can be unhealthy for humans.</p><p>We are in it (this world) together, whether man or animal. And sharing information and science through collaboration between the veterinary and medical professions benefits us all.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=We are in it together-01-28-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:4939f6fd-1b85-453d-a665-33b51d219b55 More for our money—bending the health care cost curve http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a157058c3-8544-4bd9-861d-304386af5c41&plckScript=blogScript&plckElementId=blogDest Wed, 26 Jan 2011 15:00:00 GMT <p>The best deals, the lowest prices, the greatest quality—more often than not we are on the lookout for ways to “get the most for our dollar.” But what about health care? Do you consider cost when making health care decisions?</p><p>Maybe it is time we start.  </p><p>U.S. health care spending continues to rise faster than the economy, wages and inflation. We spend more than $2 trillion a year on health care costs in the United States; that’s about $7,681 per person. </p><p>Unfortunately, there is no magic bullet or single idea that can fix the health care spending crisis. The system is complex, with many moving pieces.</p><p>I sat down with several influential industry leaders during the University of Miami Global Business Forum on Jan. 13 to discuss this very topic. Everyone agrees we need to contain health care costs, but it was difficult to concur on <em>how</em> we do it.</p><p>The AMA has put together <a href="http://www.ama-assn.org/ama/pub/about-ama/2010-strategic-issues/health-care-costs/strategies-outline.shtml" target="_blank">four broad strategies</a> that we believe will contain health care costs and <a href="http://www.ama-assn.org/ama1/pub/upload/mm/health-care-costs/strategies-rising-costs.pdf" target="_blank">give us the most for our health care dollars</a>. And we developed a whole <a href="http://www.ama-assn.org/ama/pub/about-ama/2010-strategic-issues/health-care-costs.shtml" target="_blank">series of publications</a> that highlight specific topics and actions that can help move the health care system in a direction that aligns costs and benefits in ways that make sense. </p><p>The first—and probably the most important—is reducing the burden of preventable disease. More than 75 percent of health care spending in the United States is devoted to individuals with chronic conditions, such as heart disease, diabetes, lung cancer and stroke—but they are preventable. To reduce the risk factors associated with them, we need things like better training for physicians and more public health campaigns to drive home the message to Americans that they need to <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/healthier-life-steps-program/healthy-eating-resources.shtml" target="_blank">eat better</a>, <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/healthier-life-steps-program/physical-activity-resources.shtml" target="_blank">exercise</a>, <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/healthier-life-steps-program/resources-quitting-smoking.shtml" target="_blank">stop smoking</a> and <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/healthier-life-steps-program/resources-reducing-risky-drinking.shtml" target="_blank">drink responsibly</a>.</p><p>The second strategy is making the delivery of care more efficient. I am talking about reducing the use of unnecessary services, <a href="http://www.ama-assn.org/ama1/pub/upload/mm/health-care-costs/health-info-technology.pdf" target="_blank">implementing health IT</a> and shifting care from emergency rooms to physician offices and clinics.</p><p>The third, <a href="http://www.ama-assn.org/ama1/pub/upload/mm/health-care-costs/administrative-costs.pdf" target="_blank">reducing nonclinical costs</a> that do not contribute to patient care, is also a significant step. By that I mean streamlining administrative costs, developing more accurate accounting methods and enacting proven medical liability reforms. </p><p>And finally, we need to promote value-based decision-making at all levels. Value can be integrated into decisions when physicians and patients choose among drug therapies, insurers design health plan features, and legislators determine public health budgets or mandated coverage of particular benefits.</p><p>The question is all over front page news: Are we as individuals and as a country getting the most for our health care dollars?</p><p>Let’s commit, together, to making that answer “yes”—that is, with a continual focus on improving health outcomes and quality of care for our patients.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=More for our money—bending the health care cost curve -01-26-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:157058c3-8544-4bd9-861d-304386af5c41 “Nothing is certain but death and taxes” http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3adb6d077f-c03c-401b-87d1-e534c509aca5&plckScript=blogScript&plckElementId=blogDest Tue, 25 Jan 2011 16:58:00 GMT <p>For as long as I have been in practice (longer than I care to admit), one of the banes of physicians’ existence has been the challenges posed by a medical liability system that fails to fairly and expeditiously compensate those who are injured—and all too often threatens physicians with nonmeritorious law suits. </p><p>The AMA’s support of the Affordable Care Act (ACA) included the caveat that, while historic, it is imperfect, and work still needs to be done on health system reform. Last week, <a href="http://www.ama-assn.org/ama/pub/news/news/hoven-medical-liability-system.shtml" target="_blank">in testimony before the House Judiciary Committee</a>, Ardis Hoven, MD, chair of the AMA Board of Trustees, provided a reminder that medical liability reform—mentioned in the ACA—is an important part of reforms still needed for the health system and a major ongoing AMA priority. </p><p>Dr. Hoven voiced the <a href="http://www.ama-assn.org/ama/pub/news/news/health-act-support.shtml" target="_blank">AMA’s strong support</a> of the “Help Efficient Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011”—legislation to repair our nation’s liability system, reduce the growth of health care costs and preserve patients’ access to medical care.</p><p>Here’s what the flawed medical liability system is all about:</p><p>• 64 percent of liability claims against physicians are dropped, withdrawn or dismissed without payment, with an average cost to defend more than $26,000<br />• Of those cases that go to trial, 88 percent are resolved in the physician’s favor, with an average cost to defend more than $140,000<br />• Where damages are awarded, the patient injured must wait months, and usually years, before being compensated<br />• Nearly 61 percent of physicians age 55 and older have been sued<br />• Before they reach the age of 40, more than 50 percent of obstetricians/gynecologists have already been sued<br />• Of general surgeons, 90 percent of those age 55 and older have been sued<br />• According to a <a href="http://archinte.ama-assn.org/cgi/reprint/170/12/1081?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=defensive+medicine&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT" target="_blank">national study</a> of physicians in the Archives of Internal Medicine, 91 percent of respondents said that physicians practiced defensively because of the threat of medical liability lawsuits. <br />• The cost of defensive medicine, according to Health and Human Services in 2003, is $70 to $126 billion annually (for Medicare alone)<br />• Implementation of medial liability reform would reduce total health care spending by $54 billion over 10 years </p><p>What the AMA supports:</p><p>• A federal cap of $250,000 on noneconomic damages, such as what has worked for decades at the state level in California (since 1975), Texas (a stacked cap) and others<br />• Protection for existing state medical liability reform programs that are already working<br />• Funding for state-based pilot programs to develop promising alternative medical liability reforms to help improve access to care, such as medical courts, early offer programs, safe harbors for the practice of evidence-based medicine and administrative determination of awards</p><p>Back to the “as long as I have been in practice” theme: In 1789 (I actually don’t remember that) Benjamin Franklin, at the age of 83, wrote to Jean Baptiste Leroy, a French physicist, about the U.S. Constitution. He said: “Our Constitution is in actual operation. Everything appears to promise it will last; but in this world nothing is certain but death and taxes.”</p><p>Sometimes it seems that a medical liability system run amok should be added to death and taxes as among those certainties in life. Hopefully activity at the federal level, within the ACA and in Congress, will mean otherwise.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=“Nothing is certain but death and taxes”-01-25-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:db6d077f-c03c-401b-87d1-e534c509aca5 Advocating for improvements to the ACA http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a11201f6c-1e65-4cc3-b5c6-e2cfaf103d80&plckScript=blogScript&plckElementId=blogDest Mon, 24 Jan 2011 14:55:00 GMT <p>The U.S. House of Representatives passed legislation last week to repeal the Affordable Care Act (ACA) and instructed committees of jurisdiction to develop legislation to replace it. This is all under the mantra of “repeal and replace.” </p><p>The AMA does not support outright repeal of the ACA but does advocate for changes needed to improve the law. The following are observations we have made on repeal and replace.</p><p>First, it would make sense to repeal the ACA if the law had so little “good” and so much “bad” as to make it not worth keeping. I think neither is the case, and repeal would risk losing major gains in the bill and be like the proverbial throwing the baby out with the bathwater.</p><p>The ACA contains major reforms of the health care system that have been on the country’s agenda for years. Some of these, include:</p><p>• Expansion of health insurance coverage to 32 million people who currently do not have it, and as a result, are at a greater risk of living sicker and dying younger <br />• Health insurance reforms to eliminate pre-existing condition provisions of policies and lifetime caps on coverage, thus providing protection to millions who change jobs or have severe chronic diseases, such as cancer <br />• Expansion of benefits for preventive and wellness services  <br />• Closing the doughnut hole in Medicare Part D, thereby helping seniors purchase needed medications <br />• Research to improve medical care <br />• Expansion of health insurance market competition through health exchanges to improve choice and price</p><p>That being said, there is still much work to be done, including:</p><p>• Fixing the Medicare physician payment system<br />• Reforming the medical liability system<br />• Changing the Independent Payment Advisory Board <br />• Addressing work force shortages in physicians and other medical professions<br />• Enacting proven medical liability reforms<br />• Getting rid of regulations that impair physicians’ ability to work together (antitrust reform)</p><p>A <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/aca-advocating-for-improvements.pdf" target="_blank">summary</a> recently released by the AMA  provides more detail on the AMA’s plans on advocating for improvements to the ACA.</p><p>Second, I would contend that the likelihood that “replace” will happen is slim to none. The ACA was put into place after almost a year of effort by Congress and the Obama administration that required immense focus on the issue of health system reform in an atmosphere of partisanship and discord -- the intensity of which reflected how important Americans’ health care is to them. It transpired with a government in which both houses of Congress and the presidency were in control of one party. To expect that members of Congress (now divided) and the administration will be willing to take on the task of developing and passing major health system reform legislation all over again defies belief.</p><p>My suggestion: Wash the baby and drain out the dirty water. </p><p>I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, Feb. 2. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Advocating for improvements to the ACA-01-24-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:11201f6c-1e65-4cc3-b5c6-e2cfaf103d80 Exercise, meditation, video games improve brain function http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a582d1265-5948-4f24-b0c8-7ce6bfc065b6&plckScript=blogScript&plckElementId=blogDest Fri, 21 Jan 2011 14:44:00 GMT <p>As I have reported in my blog previously, my weekday form of exercise is a 4-mile walk, with a 6.5-mile walk on the weekend (when, of course, I am at home, which is admittedly a significant moderating caveat). These walks give me time to think, plan and compose speeches, and they also allow me to eat more without the concomitant weight gain. For those of us enamored by the benefits of exercise, the opportunity to preach about it just keeps coming.</p><p>In the <em>Newsweek</em> article, “<a href="http://www.newsweek.com/2011/01/03/can-you-build-a-better-brain.html" target="_blank">Can you build a better brain</a>?” the author, Sharon Begley, provides an exhaustive, even exhausting, report of current work by scientists on mechanisms of intelligence and the quest to improve brain function. She reports on three studies I would highlight:</p><p>• Simple aerobic exercise, such as walking 45 minutes a day, three times a week, improves episodic memory and executive-control functions by 20 percent. A year of exercise can give a 70-year-old the connectivity of a 30-year-old, improving memory, planning, dealing with ambiguity and multitasking (Art Kramer, University of Illinois at Urbana-Champaign).<br />• Meditation can increase the thickness of regions that control attention and process sensory signals from the outside world, enhancing mental agility (Amishi Jha, University of Miami).<br />• Some video games might improve general mental agility, including better performance in the areas of memory, motor speed, visual-spatial skills and tasks requiring cognitive flexibility such as reasoning (Yaakov Stern, Columbia University, and Kramer).</p><p>And back to exercise; clearly, at least in some of us, it stimulates the desire to write about it.</p><p>I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, Feb. 2. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Exercise, meditation, video games improve brain function-01-21-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:582d1265-5948-4f24-b0c8-7ce6bfc065b6 Get back to work—overcoming physician re-entry barriers http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ab317e245-0ef0-432f-bf92-594dc15ab943&plckScript=blogScript&plckElementId=blogDest Wed, 19 Jan 2011 15:04:00 GMT <p>When I look at the people around me, I can almost always pinpoint someone who has left their profession at some point for family or health issues, for retirement reasons, or for a career change. This temporary hiatus happens a lot—and, especially for physicians, their time away is not always permanent.   </p><p>Each year close to 10,000 physicians could re-enter clinical practice after a period of inactivity, according to a small <a href="http://onlinelibrary.wiley.com/doi/10.1002/chp.20079/pdf" target="_blank">study of physicians in Arizona</a> that was published in the <em>Journal of Continuing Education in the Health Professions</em>. </p><p>The problem is that trying to come back after not having practiced for a period of time can be, well, challenging. There is no comprehensive re-entry system in the United States. The state medical regulatory process lacks consistency. Data on when physicians need a re-entry process do not exist. And maintenance of certification issues for inactive physicians presents another growing hurdle. </p><p>That’s not to mention other barriers, including the lack of information on the re-entry process and requirements for re-entry; high program costs; and accessibility issues with so few programs out there.  </p><p>For these reasons, a new <a href="http://www.ama-assn.org/go/reentry" target="_blank">AMA Web page</a> is quickly becoming a popular source of information for physicians seeking to re-enter the clinical work force. It includes facts about physician re-entry as well as <a href="http://www.ama-assn.org/ama1/pub/upload/mm/40/physician-reentry-regulations.pdf" target="_blank">re-entry regulations of state medical boards</a>, a list of commonly asked <a href="http://www.ama-assn.org/ama1/pub/upload/mm/40/reentry-program-survey.pdf" target="_blank">questions</a> and <a href="http://www.ama-assn.org/ama1/pub/upload/mm/40/reentry-program-survey.pdf" target="_blank">answers</a> about physician re-entry programs, and a <a href="http://www.ama-assn.org/ama1/pub/upload/mm/40/physician-reentry-bibliography.pdf" target="_blank">bibliography</a> with a section on re-entry programs and links to programs’ sites. </p><p>But helping physicians negotiate the current system is only half the battle. We also need to fix the system itself to make it work better, and more smoothly, for physicians. </p><p>Last year the AMA convened a meeting of key stakeholders in licensure, medical education and re-entry, including the Federation of State Medical Boards and the American Academy of Pediatrics. This conference led to a set of “<a href="http://www.ama-assn.org/ama1/pub/upload/mm/40/physician-reentry-recommendations.pdf" target="_blank">Recommendations for a Coordinated Approach to Physician Re-entry</a>,” to guide licensing and certifying organizations and other regulators in improving the re-entry process through new program policies and funding, research and evaluation, and better collaboration among the various stakeholders. </p><p>The AMA has been working on this issue for quite some time—since June of 2008, to be exact. That’s when an <a href="http://www.ama-assn.org/ama1/pub/upload/mm/377/cmerpt_6a-08.pdf" target="_blank">AMA Council on Medical Education report</a> on re-entry was passed. Since then, we have developed <a href="http://www.ama-assn.org/ama1/pub/upload/mm/377/cme-report1i-09.pdf" target="_blank">10 guiding principles</a> for a physician re-entry system, and we are an active participant in the <a href="http://www.physicianreentry.org/" target="_blank">Physician Re-entry into the Workforce Project</a>. </p><p>We have seen many changes in the health care system over the past several years—demographic changes and a growing shortage of physicians in many states and specialties. Physicians need a coordinated and a more trouble-free approach to re-entry into the work force. By easing the barriers to re-entry, we can help address some of the concerns our health care system faces and ensure access to care for many more patients. </p><p>I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, Feb. 2. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Get back to work—overcoming physician re-entry barriers-01-19-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:b317e245-0ef0-432f-bf92-594dc15ab943 Lower costs for care, better outcomes for patients http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aad59a22d-d052-4333-9028-c6d8ddafd794&plckScript=blogScript&plckElementId=blogDest Tue, 18 Jan 2011 16:03:00 GMT <p>Last week I was reminded again that the cost of health care is one of the drivers that determines whether people can benefit from the best in care. I also was reminded that changing—lowering—the cost can result in measurably better outcomes and that the business community is taking the lead in moving in this direction. </p><p><em>Health Affairs</em> reported a <a href="http://www.flhcc.com/documents/FHCC%20STUDY%201-6-2011%20PRESS%20RELEASE%20-%20APPROVED.pdf" target="_blank">study</a>, sponsored by the Florida Health Care Coalition (in my home in Central Florida), that found that when an Orlando employer cut the copayments for diabetes medications, the program paid for itself in three years through fewer hospitalizations and lower disability payments.</p><p>The study covered 3,752 diabetic employees and their families. All participants were given a disease management education plan. Half were able to purchase their diabetic drugs at the cost of generic drugs. The other half used the company’s program that required higher co-pays for brand-name drugs.</p><p>During the first year, the group with the lower copays had a 3.8 percent higher use of diabetic medication. That figure rose to 6.5 percent  after three years. As reported by Becky Cherney, president of the Coalition, for every $1 the employer put into these patients, it received $1.33 in return—and the patients benefited from better health.</p><p>There are many reasons for the increasing cost of health care in this country. A major one and one we must address is the fact that 75 percent of health care spending is devoted to chronic conditions, such as heart disease, diabetes, lung cancer and stroke.</p><p>The good news is that these conditions are largely preventable by changing behaviors. The bad news is that our ability to change behavior is relatively modest. This study and an accumulating body of similar evidence show it can be done with outcomes not only of savings in dollars spent for health care but also, and most importantly, with better outcomes for patients.</p><p>I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, Feb. 2. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Lower costs for care, better outcomes for patients-01-18-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ad59a22d-d052-4333-9028-c6d8ddafd794 Financing the future of health care http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a128576b5-645f-486e-ae9f-fa5931cfb2ff&plckScript=blogScript&plckElementId=blogDest Fri, 14 Jan 2011 16:02:00 GMT <font face="arial,helvetica,sans-serif" size="1"><span style="font-size:12pt;"><font face="Times New Roman"><p style="margin:0in 0in 0pt;" class="MsoNormal"> </p></font></span></font><div align="center"><a href="http://pluck.ama-assn.org/ver1.0/Content/images/store/15/14/bf455b7f-7d3b-4cb7-9e08-2a6582447023.Large.jpg" target="_blank" title="Click here to view this image at full size in another window..."><img id="bf455b7f-7d3b-4cb7-9e08-2a6582447023" src="http://pluck.ama-assn.org/ver1.0/Content/images/store/15/14/bf455b7f-7d3b-4cb7-9e08-2a6582447023.Large.jpg" alt="blog post photo" /></a><br /><br /><font><font size="1"><span style="font-size:12pt;"><font><span style="font-size:10pt;font-family:Arial;">Dr. Wilson and panelists discuss ways to improve the quality and financing <br />of health care during the University of Miami Global Business Forum Jan. 13.</span></font></span></font></font><br /></div><font face="arial,helvetica,sans-serif" size="1"><span style="font-size:12pt;"><font face="Times New Roman"><p style="margin:0in 0in 0pt;" class="MsoNormal"> </p><p style="margin:0in 0in 0pt;" class="MsoNormal"><span style="font-size:10pt;font-family:Arial;"><br /></span></p><p style="margin:0in 0in 0pt;" class="MsoNormal"><span style="font-size:10pt;font-family:Arial;">Yesterday I traveled from my home in Winter Park to Miami (note both sites are in Florida, the only state without snow) to participate in the <a href="http://www.bus.miami.edu/events/gbf2011/">University of Miami Global Business Forum</a>, titled “The Business of Health Care: Defining the Future.” This is the second such event sponsored by the University of Miami under the direction of its president, Donna Shalala, former secretary of Health and Human Services (HHS). <br /></span></p><p style="margin:0in 0in 0pt;" class="MsoNormal"><span style="font-size:10pt;font-family:Arial;"><br />The goal of this truly outstanding three-day meeting was to explore and exchange ideas on the economics of health care, the aging population, medical technology, biotechnology, telemedicine, wellness, prevention and education, innovative therapies, global health issues, hospital design and delivery systems of the future. It was sponsored by the university’s school of business and uniquely incorporated involvement from the schools of medicine, nursing, architecture, arts and sciences, marine and atmospheric science, communication, education, law, engineering and music.<br /></span></p><p style="margin:0in 0in 0pt;" class="MsoNormal"><span style="font-size:10pt;font-family:Arial;"><br />The interest in such an event was demonstrated by the fact that registration had to be limited to a little more than  600 attendees. Keynote addresses were provided by HHS Secretary Kathleen Sebelius and Food and Drug Administration Commissioner Margaret Hamburg. The luncheon speaker was James Forbes, head of Global Principal Investments Bank of America Merrill Lynch.<br /></span></p><p style="margin:0in 0in 0pt;" class="MsoNormal"><span style="font-size:10pt;font-family:Arial;"><br />It was my privilege to participate in a signature panel in the afternoon session moderated by Shalala, entitled “Insuring the Future: The Financing of Health Care,” along with Richard Clarke, president and CEO of the Healthcare Financial Management Association; Richard Umbdenstock, president and CEO of the American Hospital Association; and Richard Tuffin, executive vice president of America’s Health Insurance Plans.<br /></span></p><p style="margin:0in 0in 0pt;" class="MsoNormal"><span style="font-size:10pt;font-family:Arial;"><strong><br />I want to hear what you think.</strong> Join me for my next <a href="http://www.ama-assn.org/go/officehours">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, Feb. 2. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh">Register today</a>.</span></p><p style="margin:0in 0in 0pt;" class="MsoNormal"> </p><p style="margin:0in 0in 0pt;" class="MsoNormal"><span style="font-size:10pt;font-family:Arial;"><br /></span></p></font></span></font> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:128576b5-645f-486e-ae9f-fa5931cfb2ff Tread with caution http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aa460081c-f852-4f29-9db5-c53e36203ef6&plckScript=blogScript&plckElementId=blogDest Wed, 12 Jan 2011 15:48:00 GMT <p>I never knew “liking” something, sending “a friend request” or “poking” someone could be so popular. With more than 500 million active users spending more than 700 billion minutes a month on Facebook, this ever-popular social media site has taken the world by storm. </p><p>From social networking sites and blogs to media sharing sites and podcasts, there is no doubt that having an online presence offers an endless world of opportunities for self expression, collegiality and communication that reaches so much farther and so much faster than what I have ever seen in my lifetime. </p><p>Finding answers or providing them takes only a matter of seconds. And with our hectic lives and schedules, time is something you cannot put a value on these days. </p><p>Physicians, of all people, realize this. A recent study by Google indicated that 86 percent of U.S. physicians use the Internet to gather health and medical information. If they are already online, it is likely that most, if not all, of them also are using the Internet for nonclinical stuff too. </p><p>But here is where it gets tricky. Social media create a new set of challenges for physicians. Saying something inappropriate or simply saying something that is taken out of context can negatively affect one’s reputation with patients or colleagues or the entire public’s trust in the medical profession. </p><p>Every word put out into cyberspace is permanent. It is searchable and capable of reaching millions of people quicker than you can blink your eyes. Therefore, confidentiality and maintaining appropriate relationships in an online world are key. </p><p>The AMA wants to help physicians and medical students navigate this delicate process. So during the <a href="http://www.ama-assn.org/go/interim2010" target="_blank">Interim Meeting of the AMA House of Delegates</a> last November in San Diego, we adopted new ethics policy on <a href="http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml" target="_blank">professionalism in the use of social media</a> and in any online presence a physician might have. </p><p>A Dec. 20 <a href="http://www.ama-assn.org/amednews/2010/12/20/edsa1220.htm" target="_blank"><em>American Medical News</em> editorial</a> provides an excellent synopsis of what is in the policy. I encourage you to read it, particularly the very last sentence: “If you wouldn’t say or do something offline, you probably shouldn’t say or do it online, either.” </p><p>I know at times we might feel invisible, sitting in the comforts of our own homes, while we update our “status” for the day and upload a few photos from an event last weekend. But the truth is, we are not—invisible, that is. </p><p>Face to face or face to computer screen—the only difference is that you are sitting at home in your pajamas next to your pet Sparky sipping a cup of hot cocoa. People are always watching. According to Facebook, 500 million people are watching—and every word counts.</p><p>I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, Feb. 2. You talk, and I listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Tread with caution-01-12-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:a460081c-f852-4f29-9db5-c53e36203ef6 Clouds and clarity for Groundhog Day http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3abf7dfcc0-3ca1-4ba4-980e-23f9dfd8554f&plckScript=blogScript&plckElementId=blogDest Mon, 10 Jan 2011 15:15:00 GMT <p>The one day I hope for clouds rather than sunshine is on Feb. 2. Of course we all know what happens on Groundhog’s Day when Punxsutawney Phil comes out of his burrow, only to retreat back in if he spots his own shadow, signifying six more weeks of winter. Lets hope the little animal emerges for good. </p><p>But this year things are a bit different. I also am looking for AMA members to emerge as well. This is same day I will be hosting my sixth <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call. I would like physicians and medical students to come out and participate on the call. I want to listen to what you are thinking and what has been on your mind. </p><p>Questions, comments, suggestions, concerns—it does not matter. Bring them all to the table and help bring clarity to what’s top of mind for AMA members and the issues you find of utmost concern. </p><p>Unlike the movie Groundhog Day, I do not want you to feel like you are living the same day over and over again. I am here to listen to what you have to say, take your suggestions and recommendations seriously and take action. </p><p>I want you to feel heard and be heard, and I want you to know that you are. </p><p>In addition, I will be providing a brief update on any new developments in Congress. Don’t miss it. AMA members can join me at 7 p.m. Eastern time on Feb. 2 by <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh" target="_blank">registering today</a>. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Clouds and clarity for Groundhog Day-01-10-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:bf7dfcc0-3ca1-4ba4-980e-23f9dfd8554f An alternative to long shifts, nights on call http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a57cd846b-50bb-4003-bd99-eecd074555a7&plckScript=blogScript&plckElementId=blogDest Wed, 05 Jan 2011 16:20:00 GMT <p>Imagine for a moment you are a surgeon, or maybe you are. You logged more than 80 hours at work this week. You were on call several nights. You have not been able to spend quality time with family or friends in days. You are not sleeping. Your health is suffering. Now what? </p><p>What happens now is what happens to many surgeons the more hours they work each week: burnout and depression. Researchers found this out from a <a href="http://www.ncbi.nlm.nih.gov/pubmed/20851643" target="_blank">2008 study</a> that was published in the November 2010 issue of the Journal of the American College of Surgeons. But what’s more, of the surgeons who work 80 hours or more a week, nearly two-thirds said they had conflicts between work and personal obligations, and more than 10 percent said they had made a major medical error in the last three months.  </p><p>These trends unfortunately more often than not are par for the course. Time and again, physicians find it hard to say “no,” put down their BlackBerries and take a day off. Wanting to help, heal and treat is an innate desire within us, and it’s hard to turn that off.  </p><p>It is important, therefore, to take a step back for a moment and focus on what’s best for you and your health and what steps you can take to live a healthy life. Yes, it’s important to do this now—kicking off the new year—but it’s something we, as physicians, must revisit throughout the year on a regular basis. </p><p>As part of its <a href="http://www.ama-assn.org/go/healthierlifesteps" target="_blank">Healthier Life Steps ™ program</a>, the AMA recently launched a new toolkit, “<a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/healthier-life-steps-program/physicians-personal-health.shtml" target="_blank">A Physician’s Guide to Personal Health</a>,” to help physicians take time for themselves and reflect on which steps they may need to take to live healthier and serve as role models to their patients.<br /> <br />The toolkit provides background information and resources to help physicians improve four key health behaviors: healthy eating and physical activity, as well as elimination of risky drinking and tobacco use. In addition, physicians can access a screening milestone document, action plans and progress tracking calendars. </p><p>A life of harmony, a healthy merging of work and personal obligations—that’s the goal. </p><p>I want to hear what you think. Join me for my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> at 7 p.m. Eastern time on Wednesday, Feb. 2. You talk, and I listen. Join me by <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh" target="_blank">registering </a>today.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=An alternative to long shifts, nights on call-1-05-2011" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:57cd846b-50bb-4003-bd99-eecd074555a7 The effects of the payment system on access to medical care http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a527041c8-93a4-4def-baab-4835a3fff780&plckScript=blogScript&plckElementId=blogDest Tue, 28 Dec 2010 17:57:00 GMT Alternative payment models, such as accountable care organizations (ACOs) and the effect they will have on controlling the costs of health care—or so-called bending the curve—is integral to the potential success of the Affordable Care Act (ACA).<br /><br />In our enthusiasm to embrace yet another solution, we need a considerable dose of humility that should come as we remember a prior attempt at controlling the rapidly increasing costs of heath care: the managed care, health maintenance organization (HMO), capitated payment system—a solution that has at least some similarities to the proposals on the table now.<br /><br />As a reminder, below is a column that I wrote as president of the Orange County Medical Society in Orlando for the September 1990 issue of the medical society’s journal during the height of the managed care revolution.<br /><br /><em><strong>How physicians are paid: Does it matter?</strong><br /><br />Most physicians provide skilled, compassionate medical care for their patients regardless of whether the system under which they are paid is fee-for-service, prepaid/capitation, salary or no pay at all. How physicians are paid, however, does have an effect on the delivery and receipt of medical care. Therefore, it is important that the payment system—regardless of what it is—be structured to encourage and promote access to good care. It should not interfere with a physician’s ability to make medical decisions related to the care of his or her patients.<br /><br />The recently reported monetary penalties levied against some primary care physicians by a local HMO-type Medicare program are a strikingly brutal example of a payment system being used to interfere with a physician’s medical judgment. The physicians involved were members of the plan, providing medical care on a capitation basis. Because they ordered tests and hospitalization for their patients, which cost in excess of what the plan had determined was appropriate, they were fined tens of thousands of dollars.<br /><br />The basis for such actions is the assumption that an average group of patients will require a certain dollar amount of medical care; and if physicians determine patients need more care, then physicians are overutilizing. But this ignores the fact that patients require different amounts of care and physicians should make decisions regarding what care is needed.<br /><br />One may decide how much medical care one can afford based on cost. Deciding how much medical care is needed based on cost is unconscionable. The need for medical care depends on what type of illness a patient has and the severity of the illness. Determination of that need should be made by a physician.<br /><br />It has been said that ancient Chinese rulers paid their physicians as long as the rulers remained well and stopped paying if they became ill. The point of such a payment plan was reportedly to encourage the practice of preventive medicine. Failure to prevent illness was considered poor medical care and was not compensated.<br /><br />In the current quest for control of health care costs, one of the proposed solutions is the HMO or capitation plan—reminiscent of that ascribed to the Chinese. The physician is paid a set fee per patient enrolled in the plan, regardless of whether medical services are provided. And as the primary care physicians mentioned above discovered, if the patient becomes too ill, the physician pays. The economic incentives in such a plan are that the less care a physician provides to patients, the more his or her services are worth; and providing less care avoids monetary penalties. Since the patient pays a fixed amount regardless of the care received, the incentive for the patient is to seek more care.<br /><br />Historically medical care in this country has been based on fee-for-service. The physician provides medical service. The patient pays for services received directly or through some form of health insurance. Under such a system the physician is free to recommend as much medical care as is needed. The economic incentive is that the more care the physician provides the more the financial reward. The patient’s incentive to seek care is inversely related to the size of the deductible and co-payment in his or her health insurance policy.<br /><br />The fee-for-service system, providing as it does for a contractual relationship between physicians and patients for delivery and receipt of health care, has been an integral part of the success of the American health care system. Public and private health insurance has increased access to health care and contributed in part to the increase in health care expenditures. Proposed solutions to the problem of health care costs, which exclude fee-for-service, are ill-advised.<br /><br />Physicians can provide good medical care under any payment system which allows them to make decisions based on the medical needs of the patient. Physicians’ strongest  motivation to provide good care is based on a sense of professional integrity and concern for people.<br /><br />In a fee-for-service system, it is in the physician’s financial interest to provide more medical care. In a capitation system, it is in the physician’s interest to provide less care. When I am older and have extensive medical problems, I hope my physician will be motivated to provide as much care as I need.</em><br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=The effects of the payment system on access to medical care-12-28-2010" target="_blank">e-mail</a>.<br /><br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:527041c8-93a4-4def-baab-4835a3fff780 It's not over yet http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a33fcfd27-7b3d-4abb-8a0f-2701bebf0b44&plckScript=blogScript&plckElementId=blogDest Wed, 22 Dec 2010 13:00:00 GMT I am not talking about the hustle and bustle of the holiday season when we sometimes endure weeks of a “so much to do, not enough time to get it done” mentality. I am referring to a different kind of season—one that starts around October and has been known to run all the way through May. It brings its own challenges to the public—and our health—every year. It’s called influenza. <br /><br />The influenza season is unpredictable, but there is no reason to bear it unprotected. Telling our patients to cover their mouths when they cough and wash their hands with soap and water are good defense mechanisms. But the best—the first and most important step in protecting against all three strains of flu viruses—is a yearly <a href="http://www.ama-assn.org/go/flu">flu vaccine</a>. <br /><br />Yes, we are approaching January, but it is not too late. In fact, the Advisory Committee on Immunization Practices (ACIP) recommends vaccinating into March and beyond. We have to communicate the significance of this precautionary measure to our patients now. <br /><br />While communicating, keep a couple of things in mind. ACIP released new guidelines earlier this year on who should be vaccinated. The list now includes everyone over 6 months of age. And we physicians—and all health care professionals—need to be vaccinated, too. After all, our recommendation is the No. 1 reason why a patient makes the decision to get vaccinated in the first place. <br /><br />According to the Centers for Disease Control and Prevention’s <a href="http://www.cdc.gov/nchs/nhis/nhis_2009_data_release.htm" target="_blank">2009 National Health Interview Survey</a>, patients need a little boost. The survey showed that vaccination rates for adults 19 and older continued to fall below optimal levels in 2009. And of the 50,000 adults who die from vaccine-preventable diseases each year, influenza is among the biggest killers.  <br /><br />So I want to leave you with this:<br /><br />What do you get when you cross a turtle with a flu shot? A slow poke. <br /><br />Do not be a slow poke this flu season. This is urgent and not a joking matter. Get vaccinated if you have not already, and talk to your patients about doing the same. <br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=It's not over yet-12-21-2010">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:33fcfd27-7b3d-4abb-8a0f-2701bebf0b44 "What's it all about, Alfie?" http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a65cb3592-6556-4a27-a044-43fdc1ed901d&plckScript=blogScript&plckElementId=blogDest Mon, 20 Dec 2010 17:29:00 GMT “What’s it all about, Alfie?”<br /><br />Working on behalf of organized medicine involves dealing with issues that are far removed from what most physicians went to medical school to learn. It is critical that physicians are involved in the making of health policy in order to preserve the ability to practice in a milieu that allows them to provide the best possible care to patients.<br /><br />This world of health policy is rife with initials, such as  CLIA, ACA, ACOs, CMS, CMMI, AQF, PCPI, RBRVS, CPT, HHS, FTC, OIG, FDA, AHA, IPAB, SGR, CHIP, MedPAC, IOM and NIH, ONC, EHR, PECOS and RBRVS, just to name a few. It may just be that the streets of hell are paved with acronyms. Sometimes when engrossed in dealing with the myriad of health care issues framed by these acronyms, one is reminded of the memorable question from Michael Caine’s old movie, “What’s it all about, Alfie?”<br /><br />Several years ago one of my patients reminded me.<br /><br />Joe (not his real name) came to my office for an evaluation of intermittent episodes of chest pain. In the examining room, just as my nurse was about to take his vital signs, he fell to the floor in cardiac arrest. My staff and I immediately began resuscitative measures.<br /><br />Fifty years ago, the techniques of closed chest cardio-pulmonary resuscitation, which we used to treat Joe, had only recently been introduced at the University of Miami.<br /><br />Fifty years ago, the 911 emergency system that brought the fire department rescue team to my office in four minutes had not been dreamed of.<br /><br />Fifty years ago, the DC defibrillator that we used to convert Joe’s heart from ventricular fibrillation to a normal sinus rhythm had not been invented.<br /><br />Fifty years ago, the coronary care unit with monitors to detect cardiac arrhythmias to which Joe was admitted had not been organized.<br /><br />Fifty years ago, many of the medications that we used to prevent recurrence of Joe’s arrhythmia had not been discovered.<br /><br />Fifty years ago, arterial blood gas determinations that we used to routinely monitor Joe’s blood oxygen saturation were rarely used—and even then only by pulmonary fellows in teaching facilities.<br /><br />Fifty years ago, the cardiac catheterization technique that the cardiologist used to identify critical areas of coronary stenosis in Joe’s heart was not available.<br /><br />Fifty years ago, coronary bypass surgery that the cardiac surgeon performed to save Joe’s life had not been invented.<br /><br />Fifty years ago, Joe would have died.<br /><br />Three months after surgery Joe came back to my office for a routine post-hospitalization visit.<br /><br />And that’s what it’s all about. <br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=What's it all about, Alfie?-12-20-2010">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:65cb3592-6556-4a27-a044-43fdc1ed901d A community boost http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a508287e0-209a-4b42-8da3-5061b90cf47a&plckScript=blogScript&plckElementId=blogDest Wed, 15 Dec 2010 15:14:00 GMT <p>“What do we need to do to be part of the community?” That’s the first question I asked one of the physicians I was practicing with when I got out of the Navy. His answer was “see patients.” I was perplexed when I heard his response, because to me, “being a part of a community” meant—and still to this day—means so much more.<br /><br />As AMA members, we too are like members of our own community. And if we’re not engaged and involved in setting the environment in which health care is delivered, other people—particularly those who are not part of medicine—will do it for us. That’s one component of the AMA community.<br /><br />Another component is how the community can help: help through day-to-day practice, support in ensuring the best quality of care for your patients, assistance throughout each stage of your medical career, and backing in situations outside of your control. </p><p>Day in and day out we place our entire focus on our patients—taking care of them, healing them in any way we possibly can. Who takes care of us? The AMA does.<br /><br />The AMA offers help with daily administrative hassles, through its <a href="http://www.ama-assn.org/go/pmc" target="_blank">Practice Management Center</a> so you won’t have to be the one to battle with health insurers over contracts, payments and paperwork.<br /><br />The AMA lends a hand in making informed decisions about electronic prescribing. When utilizing its <a href="http://www.ama-assn.org/go/eprescribing" target="_blank">ePrescribing Learning Center</a>, you won’t have to determine the cost and time savings of implementing a system for your practice on your own.<br /><br />The AMA brings ease to physicians in meeting <a href="http://www.ama-assn.org/go/cme" target="_blank">continuing medical education</a> requirements by offering a wide range of activities physicians can participate in to earn AMA PRA Category 1 Credit™, such as webinars, educational sessions and local workshops.<br /><br />And the AMA provides a voice for physicians in the courtroom through the <a href="http://www.ama-assn.org/go/litigation" target="_blank">Litigation Center of the AMA and State Medical Societies</a>, recently claiming victory in AMA v. United HealthCare to ensure honest and fair compensation for physician services; Murphy v. Baptist Health to protect physicians against inappropriate economic credentialing policies; and Lawnwood Medical Center v. Lawnwood Medical Center Medical Staff to defend the self-governance of hospital medical staffs.<br /><br />The community is welcoming. It is open. It is there as a foundation to help you help your patients. What do you need to do to be part of it?<br /><br />If you're not an AMA member but would like to take advantage of these and other resources, <a href="http://www.ama-assn.org/go/join" target="_blank">join today</a>.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=A community boost-12-15-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:508287e0-209a-4b42-8da3-5061b90cf47a Seniors and physicians working together http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3af90c16a7-28fe-4745-bc03-609428e5e414&plckScript=blogScript&plckElementId=blogDest Tue, 14 Dec 2010 17:12:00 GMT <p>The passage last week of H.R. 4994 blocking the 25 percent cuts scheduled for Jan. 1 and providing stability for the Medicare program for all of 2011 was, as I noted yesterday, a triumph of bipartisanship in both houses of Congress on both sides of the aisle. </p><p>In addition, President Obama, looking toward the future, said last week, “It’s time for a permanent solution that seniors and their doctors can depend on, and I look forward to working with Congress to address this matter once and for all in the coming year.”</p><p>Clearly seniors and physicians agree with this observation. It was reflected by the major advocacy effort in which they were a part of leading up to passage of the legislation. When Congress came back for its lame-duck session Nov. 15, AMA physician members bombarded Congress—at times, tying up phone lines into the Capitol—with messages calling for preventing the impending cuts and providing 13 months of stability throughout 2011 to allow time to find a permanent solution.</p><p>In addition, AARP members and activists called and e-mailed their members of Congress more than 100,000 times. At more than a dozen tele-town hall events more than 130,000 AARP members heard directly from AARP experts about the Medicare physician payment problem. AARP also used paid radio and print advertising, phone calls, e-mails and direct mail to the group’s members, activists and the public to contact their legislators about this important issue. In the days leading up to Thanksgiving, a phone campaign alone generated 18,000 phone calls to congressional offices over a few days. In addition, an electronic newsletter was sent to 3 million AARP activists.</p><p>AARP and its members understand that the Medicare physician payment problem threatens access to care for seniors. They know that in excess of 80 percent of their members are concerned about this issue—and they are putting their concerns into action.<br /> <br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Seniors and physicians working together-12-14-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:f90c16a7-28fe-4745-bc03-609428e5e414 Diogenes today might be looking for bipartisanship http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a1468cf20-d327-4ec0-a034-4aaf8aa4fbad&plckScript=blogScript&plckElementId=blogDest Mon, 13 Dec 2010 15:17:00 GMT <p>Diogenes, the Greek cynic philosopher (404–323 B.C.), used to stroll around in full daylight with a lamp. When asked what he was doing, he would answer, “I am just looking for an honest man.” Given the partisan nature of our public debate of late, he might, if transported in time to Washington, D.C., feel called upon to walk around saying, “I am just looking for some bipartisanship.”</p><p>So for the cynics among us, I am glad and relieved to point out that a rash of bipartisanship just broke out in our capital on the issue of Medicare physician payment. The massive (25 percent) cuts scheduled for Jan. 1, were blocked by the passage of H.R. 4994. In an impressive show of bipartisanship, as well as White House leadership, the Senate approved the bill last week by unanimous consent and the House passed it by a vote of 409-2. The bill now goes to the president for his signature.</p><p>The legislation, postponing Medicare cuts for 12 months, is vital to preserve seniors’ access to care for 2011. Many physicians had made it clear that this year’s roller coaster ride caused by five delays of cuts was forcing them to make difficult practice changes, such as limiting the number of Medicare patients they could treat.</p><p>Of course, blocking the cuts—while providing temporary relief—does not fix the flawed formula that has for the past eight years been the cause of repeated annual threatened cuts, making the Medicare program unreliable. The AMA looks forward to working with the new Congress and the administration over the coming 12 months to find a permanent solution that will, on an ongoing basis, provide payments that reflect the cost of providing care and protect seniors’ access to the medical care they need.<br /><br />In passing H.R. 4994, Congress and the White House have demonstrated in a commendable way to our country and to themselves that they can come together in a bipartisan effort to pass needed legislation. Hopefully this is contagious and we will find bipartisanship breaking out all over—and no lamp will be needed.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Diogenes today might be looking for bipartisanship-12-13-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:1468cf20-d327-4ec0-a034-4aaf8aa4fbad Aladdin and the “red flags” rule http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3accd4aa47-6928-465f-b5a8-3ec80ec53443&plckScript=blogScript&plckElementId=blogDest Fri, 10 Dec 2010 16:04:00 GMT <p>In one of the stories from the Arabian nights, the impoverished young ne’er-do-well Aladdin comes in possession of a wonderful magic oil lamp. When he rubs it, a genie appears who magically and instantaneously grants him his every wish. In real life, of course, the magic—or result—is rarely that easy or quick. </p><p>We were reminded of that this week when <a href="http://www.ama-assn.org/ama/pub/news/news/red-flags-rule-bill.shtml" target="_blank">Congress passed the “Red Flag Program Clarification Act of 2010</a>,” exempting physicians from the “red flags” rule that requires financial institutions and “creditors” to develop and implement written identity theft prevention and detection programs. This was the culmination of a two-year effort by the AMA to exempt physicians from a law, called the “Fair and Accurate Credit Transactions (FACT) Act of 2003.” Congress never intended for this legislation to apply to physicians, but the Federal Trade Commission (FTC) decided that it did.</p><p>The chronology of this saga is copied below to emphasize the work of the AMA in this successful endeavor protecting physicians from irrational bureaucratic burdens.</p><p>For me, this story is a powerful example of the strength and reach of the AMA. During a period when the AMA was engaged in the health system reform debate dealing with issues of high priority and great consequence for the profession, our patients and the country, the AMA was able to address an issue of lesser priority—but an issue that, among many the AMA works to address, would, if unchecked, add additional hassles to practice while not contributing anything to the quality of care. This was a rule that would be duplicative of the responsibility physicians already have to protect their patients—a responsibility ensconced in our <a href="http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.shtml" target="_blank">Code of Medical Ethics</a> and codified in law by the requirements of HIPAA.</p><p>The moral of the story: rub the lamp—work hard, be persistent, do not give up. Magic will happen.</p><p>“Red flags” rule chronology:</p><p>2003—Congress passes the “FACT Act,” which required financial institutions and “creditors” to develop and implement written identity theft prevention and detection programs.</p><p>November 2007—The FTC issued the “red flags” rule, requiring compliance by November 2008. There was no mention in either the proposed or final rule that this requirement applies to physicians.</p><p>September 2008—The FTC staff contacted physician organizations, including the AMA, to relay its belief that the “red flags” rule applies to physicians.</p><p>September 2008 onward—Following the AMA’s persistent and repeated strong objections to the lack of notice and contention that the rule should not apply to physicians—including the AMA’s organizing a multisociety sign-on letter to the FTC—the FTC agreed to postpone the compliance date, ultimately a total of five times (May 1, 2009; Aug. 1, 2009; Nov. 1, 2009; June 1, 2010; and Dec. 31, 2010).</p><p>May 2010—The AMA Litigation Center, along with the American Osteopathic Association (AOA) and the Medical Society of the District of Columbia, (MSDC) filed a lawsuit in federal court seeking to block the FTC from applying the “red flags” rule to members of the AMA, members of the AOA or members of state medical societies. The FTC staff acknowledged that the relief the AMA sought would benefit all physicians.</p><p>June 2010—The FTC entered into a stipulation with the AMA agreeing not to enforce its “red flags” rule until the D.C. Circuit Court issues a decision on a pending challenge brought by the American Bar Association (ABA) to block the FTC from applying the “red flags” rule to attorneys.</p><p>August 2010—The Council of Medical Specialty Societies joined the AMA suit.</p><p>September 2010—The AMA filed an amicus brief in the ABA suit. Also included in the amicus brief were the AOA, the MSDC, the American Congress of Obstetricians and Gynecologists, the American Society of Cataract and Refractive Surgery, the American College of Physicians, the Missouri Association of Osteopathic Physicians and Surgeons, the Ohio Osteopathic Association and the Osteopathic Physicians and Surgeons of Oregon.</p><p>Nov. 30, 2010—The Senate unanimously passed S. 3987, the “Red Flag Clarification Act of 2010”—legislation that limits the type of “creditor” that must comply with the “red flags” rule.</p><p>To further clarify protection for physicians from misguided federal regulation, Sens. John Thune, R-S.D., and Christopher Dodd, D-Conn., spoke in support of the “Red Flag Clarification Act of 2010” and for the Congressional Record. They indicated that the purpose of this legislation is to clarify that doctors should no longer be classified as “creditors” for the purposes of the “red flags” rule.</p><p>Dec. 7, 2010—The House passed S. 3987 and sent it to President Obama for signing to facilitate its enactment into law prior to the Dec. 31 deadline.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Aladdin and the “red flags” rule-12-10-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ccd4aa47-6928-465f-b5a8-3ec80ec53443 Check, please http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ac206391c-b043-406c-9902-fbbbac3347f0&plckScript=blogScript&plckElementId=blogDest Wed, 08 Dec 2010 15:34:00 GMT <p>Patients deserve the <em>absolute</em> maximum value for their health insurance. But, instead, they have been paying increasing amounts of premium dollars and receiving less and less value. <br /><br />From disguising administrative expenses as medical ones to artificially inflating medical-loss ratio numbers, health insurers have been drifting down a path of fuzzy math in how they spend our patients’ dollars on actual medical care. None of these scenarios say “value,” “transparency” or “patients” to me. That’s because the health insurance industry seems focused on spending premium dollars on their own salaries, not the medical needs of our patients. </p><p>Much of this will change very soon. Over the last six months, the AMA has been working closely with the National Association of Insurance Commissioners (NAIC) on recommendations for regulations to hold health insurers accountable.<br /><br />And on Nov. 22, the Department of Health and Human Services (HHS), accepting the recommendations of the NAIC, issued a regulation that requires health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. Very soon, they will be required to start publicly reporting—in great detail—on how they spend premium dollars. And if they do not meet the requirements for spending on direct patient care, what they will need in 2012 is a checkbook and a pen—to write rebate checks to customers.  </p><p>These regulations, the medical-loss ratio provisions of the Affordable Care Act that take effect next month, will enable a more transparent marketplace and greater value for consumers’ money.<br /><br />Let me suggest an alternative term like “medical-<em>care</em> ratio”—would that not be a better depicter of what health insurance companies should be striving to do? Medical-<em>loss</em> ratio suggests the need to spend as little as possible on patients’ medical care. But medical-<em>care</em> ratio implies spending more of health insurance premiums on medical care for our patients.<br />  <br />These regulations recommended by the NAIC with input from the AMA and approved by HHS will help in maintaining strict standards to keep the health insurance industry from diverting premium dollars away from medical care. This will help ensure millions of Americans receive greater value for their health insurance dollar and the utmost quality of care. And if the insurance companies veer out of line, we will say “check, please!” <br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Check, please-12-08-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:c206391c-b043-406c-9902-fbbbac3347f0 Administrative simplification: a meaningful part of health system reform http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ac4a3ee32-b96d-4d02-91ec-17722183708f&plckScript=blogScript&plckElementId=blogDest Tue, 07 Dec 2010 16:24:00 GMT <p>One of the AMA’s eight guiding principles for health system reform was a requirement to streamline and standardize health insurance claims processing requirements to eliminate unnecessary costs and administrative burdens. These costs and burdens add nothing to the quality of medical care and account for 10 to 14 percent of office practice costs. This principle was incorporated in the Affordable Care Act (ACA) with a requirement that, beginning in 2010, national rules will be developed (for implementation beginning in 2013) to standardize and streamline health insurance claims processing requirements.</p><p>Physicians should benefit from these changes because it will be easier to track claims and, in many cases, should improve physician revenue cycles and lower overhead costs.</p><p>The AMA is already involved in providing input on development of the regulations on administrative simplification. In addition, we were reminded of the importance of measures to change how insurance companies operate in a recent survey released Nov. 22. It is the first national physician survey by the AMA to quantify the burden of insurers’ preauthorization requirements for a growing list of routine tests, procedures and drugs.</p><p>The survey of 2,300 physicians indicates that health insurer requirements to preauthorize care have delayed or interrupted patient care, consumed significant amounts of time, and complicated medical decisions.</p><p>Highlights from the survey, include:</p><p>• 46 percent of physicians experience a one in five rejection rate for preauthorization requests for tests and procedures.<br />• 57 percent of physicians experience a one in five rejection rate for requests for drugs.<br />• 63 percent of physicians typically wait several days to receive preauthorization from an insurer for tests and procedures; 13 percent wait more than a week.  <br />• 69 percent of physicians wait several days to receive preauthorization for drugs; 10 percent wait more than a week.<br />• 64 to 67 percent find it difficult to determine which test, procedures or drugs require preauthorization by health insurers.</p><p>In a <a href="http://www.ama-assn.org/ama/pub/news/news/survey-insurer-preauthorization.shtml" target="_blank">statement</a> accompanying the release of the survey, AMA Immediate Past President J. James Rohack, MD, said: “Nearly all physicians surveyed said that streamlining the preauthorization process is important. The AMA is urging health insurers to automate and streamline the current cumbersome preauthorization process so physicians can manage patient care more efficiently.”</p><p>While administrative simplification of claims processing and health insurance company regulations is important and addressed in the ACA, the AMA is working to make it meaningful.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Administrative simplification: a meaningful part of health system reform-12-07-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:c4a3ee32-b96d-4d02-91ec-17722183708f Questions about private contracting, prescription drug abuse surface during last week’s “Office Hours” http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a528814f6-d929-43ca-a458-b23890ddf6b7&plckScript=blogScript&plckElementId=blogDest Mon, 06 Dec 2010 18:04:00 GMT <p>Last Wednesday, Dec. 1, it was once again my privilege to host <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> and to talk with AMA members from across the country about issues of importance to them. This was the fifth in a series of such teleconference calls. </p><p>I began the session by providing an update on the status of <a href="http://www.ama-assn.org/ama/pub/news/news/congress-delays-medicare-cut.shtml" target="_blank">Medicare physician payments</a> (the SGR) that is being addressed by the lame-duck session of Congress. I also gave a brief overview of the AMA’s strategic plan for 2011 that was introduced last month at the <a href="http://www.ama-assn.org/go/interim2010" target="_blank">Interim Meeting</a> in San Diego.</p><p>Based on reporting of the San Diego meeting, one member asked if the AMA had changed its position on health system reform supporting an individual mandate. He expressed his concern that if that were the case, it would effectively demolish health insurance reform provisions in the Affordable Care Act (ACA) that eliminate pre-existing conditions and lifetime caps on coverage for chronic disease. My answer was that the House of Delegates did not change AMA policy.</p><p>Additional issues discussed on the call included: the status of private contracting legislation, changes in the political scene following the November elections and their effect on the ACA, direct-to-consumer advertising, the work of the new Center for Medicare and Medicaid Innovation authorized by the ACA, the corporate practice of medicine, the effect of accountable care organizations on private practice, and implications of the ACA for surgical specialties.</p><p>Concerns about health insurance company rules controlling patient treatment and physician fees as well as the increasing cost of insurance premiums, co-pays and deductibles were the source of a number of questions. In addition, one member asked a question about informing the public about the excessive costs of hospital care and pharmaceuticals. Other concerns were related to making health care more efficient and cost-effective while preserving quality.</p><p>One subject that generated discussion was what appears to be rampant nationwide—prescription drug abuse and the need for strictly enforcing laws to deal with this problem. Also emphasized was the importance that prosecutorial zeal in enforcing laws in this area not result in mistakenly bringing charges against those in the legitimate practice of pain medicine, with a resulting chilling effect on appropriate palliative care. </p><p>As has been the case for previous sessions, I found this “Office Hours” most helpful to me in getting a sense of the issues AMA members are concerned about. I very much appreciate  the members who take the time from their schedules to share their thoughts in this way. Those who had sent questions ahead of time but did not get an answer during the call will receive a response via e-mail. </p><p>And, as usual, a report of the event will be shared with the AMA Board of Trustees and senior staff, so that what is said on the call goes directly to informing AMA leadership. I look forward to hearing from you on the next call, scheduled for Feb. 2, 2011. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=b0860bsosoxh" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Questions about private contracting, prescription drug abuse surface during last week’s “Office Hours”-12-06-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:528814f6-d929-43ca-a458-b23890ddf6b7 Bypass the soda, bring on the stairs http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a833a0865-777e-48ce-a167-d66f328de6e7&plckScript=blogScript&plckElementId=blogDest Wed, 01 Dec 2010 18:30:00 GMT <p>Shedding a few extra pounds is something we usually do not talk about during the holiday season. The conversation more often than not centers around putting the pounds on. But according to <a href="http://www.bloomberg.com/news/2010-11-23/unitedhealth-says-diabetes-will-cost-3-4-trillion-over-the-next-decade.html" target="_blank">UnitedHealth Group in a report last week</a>, unless people drop the extra weight, half of all adult Americans will have diabetes or prediabetic conditions by the end of the decade. That is truly mind-boggling. So while you may not have the disease, your neighbor, your loved one, your spouse—someone you know—more than likely will. </p><p>This is just one example of the countless serious consequences—heart disease, high blood pressure, cancer, asthma—that can stem from one of the most deadly conditions this country faces: obesity. <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm59e0803a1.htm?s_cid=mm59e0803a1_e%0D%0A" target="_blank">More than 72 million U.S. adults</a> were obese in 2007-2008.  </p><p>It has gone so far now as to have impacted our children. Over the past three decades, <a href="http://www.letsmove.gov/learnthefacts.php" target="_blank">childhood obesity rates</a> in America have tripled, leaving nearly one in three children today overweight or obese. These facts speak for themselves, and so do the solutions and actions we need to take. </p><p>Making healthier lifestyle choices through diet and exercise dramatically reduces the risk for obesity and its health complications. For example, cutting out unhealthy snacks and soft drinks and cutting down on portion sizes, along with getting the <a href="http://www.health.gov/paguidelines" target="_blank">recommended levels of physical activity</a>, are important contributing factors to a healthy lifestyle.  </p><p>That’s what the AMA’s <a href="http://www.ama-assn.org/go/healthierlifesteps" target="_blank">Healthier Life Steps™ program</a> is all about. It offers key steps that patients and physicians can take to improve healthy eating and physical activity, eliminate risky drinking and discontinue tobacco use. The program offers a format to encourage greater discussion between patients and physicians about healthy lifestyle choices and empower patients to jump-start a healthy eating and physical activity plan that works for them. </p><p>And that’s also what First Lady Michelle Obama’s <a href="http://www.letsmove.gov/" target="_blank">Let’s Move Campaign</a> focuses on: helping kids be more active, eat better and get healthy. <a href="http://www.ama-assn.org/ama/pub/news/news/first-lady-childhood-obesity.shtml" target="_blank">We are in full support</a> of this comprehensive, collaborative and community-oriented initiative that launched back in February. And we will be working to address all the various factors that lead to childhood obesity. </p><p>As the First Lady said during the launch of Let’s Move: “The physical and emotional health of an entire generation and the economic health and security of our nation is at stake.”</p><p>Make your health—and the health of others—a priority this holiday season. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Bypass the soda, bring on the stairs-12-01-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:833a0865-777e-48ce-a167-d66f328de6e7 My ears are open http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a107c986b-7d83-4c76-a673-e4f33da5668b&plckScript=blogScript&plckElementId=blogDest Mon, 29 Nov 2010 14:46:00 GMT <p>I suspect like me you are wondering and thinking a lot about what Congress will do regarding the combined 25 percent cut in Medicare physician payments that are scheduled to take place, and hopefully you will want to know what the AMA has in store in its strategic plan for 2011. I will be talking about both of these topics during my next <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference call at 7 p.m. Eastern time on Wednesday, Dec. 1.</p><p>As we enter the time of the year in which physicians must make decisions about their <a href="http://www.ama-assn.org/go/medicareoptions" target="_blank">Medicare participation options</a> for 2011, what Congress decides to do will likely be a major factor in what you decide to do. I will provide an update on Congress’ action during the call.</p><p>In addition, the AMA’s strategic plan for 2011 is structured around five urgent issues. I am going to share those issues with you and detail why we chose them. I want you to understand the direction the AMA is taking for next year. </p><p>And finally, as has been the case on previous “Office Hours,” I will take the majority of the time to respond to your questions, concerns, comments, suggestions, whatever is on your mind. </p><p>My ears are open—wide open—and I am listening. So talk to me. AMA members can <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=ljhbuam0mtw1" target="_blank">register</a> for the next “Office Hours” today. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=My ears are open-11-29-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:107c986b-7d83-4c76-a673-e4f33da5668b A brighter future is on the horizon http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a4f61f545-43ce-4846-9993-4e865993599d&plckScript=blogScript&plckElementId=blogDest Wed, 24 Nov 2010 14:00:00 GMT <p>I would be considered a witch doctor if I practiced medicine the way I used to right out of medical school. The advances in medicine over the years have given physicians a variety of medications, procedures and tools that greatly expand our capacity to care for those who are ill.</p><p>This evolution over time means that, likewise, the education and training environment has had to adapt to such changes. Quite frankly, it still is, and we have a ways to go.</p><p>A group of nearly 300 leaders in medical education met in September—during the “<a href="http://www.ama-assn.org/go/newhorizons" target="_blank">New Horizons in Medical Education</a>” conference, co-sponsored by the AMA and the Association of American Medical Colleges—to discuss exactly what needs to be done to make medical education the absolute best it can be for the future of medicine and our patients. </p><p>Conference attendees discussed the importance of education in the context of real-life medical practice—making sure students are ready to practice effectively on their first day of independent practice without extensive “on-the-job” training.</p><p>Social accountability was a hot topic as well. What that means is ensuring an adequate and appropriately balanced medical work force; producing compassionate physicians with the interpersonal skills needed in today’s diverse communities; and supplying evidence that all physicians have the ability to provide high-quality, up-to-date care for patients. </p><p>And not surprisingly, embracing the advantages of the information age was a third focus for change in medical education—without, of course, losing the “art of medicine” and the one-on-one physician-patient relationship that is an essential element of our role as healers. </p><p>Speaking of “embracing the information age,” the AMA has launched a <a href="http://www.ama-assn.org/ama/pub/education-careers/new-horizons-medical-education.shtml" target="_blank">new online community</a> for physicians and leaders in medical education so we can have a place to discuss and debate these issues, talk about best practices and share ideas, passion and wisdom. </p><p>I’m happy to report that the AMA has already realized the need for such changes and gotten the ball rolling, so to speak. Our 2011 strategic plan features several key objectives I have been hinting at. One is working for expanded funding for graduate medical education (GME) alongside state and national work force leaders and developing innovative solutions to funding challenges. Encouraging an all-payer pool, with health insurers and others responsible for their fair share of GME funding, is one aspect of that plan. </p><p>Through the House of Delegates, the AMA Council on Medical Education has pushed for change with recently adopted reports that aim to increase the availability of practicing physicians in underserved areas, expand funding to increase the number of GME positions and enhance primary care as a medical career choice. </p><p>What’s left? The AMA’s Center for Transforming Medical Education is working on improving the medical education learning environment so the next generation of physicians is inculcated with a strong sense of professionalism. This work, through the <a href="http://www.ama-assn.org/go/istep" target="_blank">Innovative Strategies to Transform the Education of Physicians</a> (ISTEP) program and the AMA’s <a href="http://www.ama-assn.org/go/itme" target="_blank">Initiative to Transform Medical Education</a> (ITME), also includes <a href="http://www.ama-assn.org/ama1/pub/upload/mm/40/behavioral-competencies-medical-students.pdf" target="_blank">changing the criteria used in medical school admissions</a> to emphasize social skills and humanistic behaviors and helping physicians who have left clinical practice for a period of time to <a href="http://www.ama-assn.org/go/reentry" target="_blank">re-enter medicine</a>. </p><p>One thing definitely hasn’t changed since my training days: the focus, the center, the heart of medical education all along—and that’s patient care. Improving the medical education environment will create a brighter future for us. But it will create an even brighter future for patients. And that is what we are aiming for. </p><p>Do you have a question or a concern you would like to be heard? If so, and if you’re an AMA member, join me for my next “Office Hours” at 7 p.m. Eastern time on Wednesday, Dec. 1. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=ljhbuam0mtw1" target="_blank">Register today</a>.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=A brighter future is on the horizon-11-24-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:4f61f545-43ce-4846-9993-4e865993599d “Have you no sense of decency, sir?” http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a7a12c9ef-13dd-46d0-85f8-23834b33304a&plckScript=blogScript&plckElementId=blogDest Tue, 23 Nov 2010 18:00:00 GMT <p>An editorial in the <em>Wall Street Journal </em>yesterday—denigrating the AMA’s role in the health system reform debate and the current Medicare mess—talked about buy-offs, deception and being treated as fools.  It was obviously an opinion piece and thus unfortunately not necessarily subject to the rules of accuracy or facts. That being said, it was breathtaking in making assumptions and drawing conclusions about events that never happened—that bear no resemblance to reality. </p><p>In a time when everyone is castigating politicians for being partisan, it struck a new low in a harsh note of discord that does not add to responsible debate on how this country can improve our health care system. It was a diatribe more suitable to the proverbial muck-raking tabloid than to a venerable news organization.</p><p>To set the record straight, Democrats and Republicans share responsibility for the combined steep 25 percent Medicare cuts to physicians that loom ahead. There is bipartisan understanding that the current Medicare physician payment system is fatally flawed, yet both political parties allowed the problem to grow, increasing the cost of permanent reform from $48 billion to more than $250 billion. Both Republicans and Democrats have said the problem needs a real solution but neither has delivered.</p><p>The AMA’s focus—before, during and after the health system reform debate—has been to ensure that physicians can continue to deliver high quality patient care. More thoughtful problem-solving and less partisan sniping is the way to make our health system work better for patients and physicians.</p><p>The <em>Wall Street Journal</em> editorial puts me in mind of an event on June 9, 1954, when Sen. Joseph McCarthy was using his position as chair of the Senate Committee on Government Operations to destroy the careers of many people by being “judge, jury, prosecutor, castigator and press agent, all in one.”</p><p>This came to a head during one committee hearing when the senator was being particularly vicious in a vendetta against the Army, unfairly attacking a witness and attempting to destroy his reputation. Joseph Welch, the attorney representing the Army (and the witness), went on the offensive against Sen. McCarthy, saying: “Until this moment senator, I think I never really gauged your cruelty or your recklessness. Senator you’ve done enough. Have you no sense of decency, sir? At long last, have you left no sense of decency?”</p><p>So, I say to the <em>Wall Street Journal</em> …?</p><p>Do you have a question or a concern you would like to be heard? If so, and if you’re an AMA member, join me for my next “Office Hours” at 7 p.m. Eastern time on Wednesday, Dec. 1. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=ljhbuam0mtw1" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=“Have you no sense of decency, sir?”-11-23-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:7a12c9ef-13dd-46d0-85f8-23834b33304a Thank you—you helped make White Coat Wednesday a success http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a36cd1c31-2457-4df1-83a4-39ecc6b09bae&plckScript=blogScript&plckElementId=blogDest Mon, 22 Nov 2010 14:28:00 GMT <p>Congress didn’t know what hit them during White Coat Wednesday last week, which extended into Thursday due to an overwhelming response by physicians. I do; more than 10,000 phone calls—that’s what. Physicians were dialing up their senators to demand that Congress stop the looming cuts in Medicare physician payments set to begin Dec. 1. </p><p>The AMA received reports that the phones were so inundated by calls that some physicians and patients could not get through and some senators had voicemail boxes so full that they could not accept any more messages. The event caused such an uproar that it was even picked up by the <a href="http://www.nytimes.com/2010/11/18/us/politics/18berwick.html" target="_blank"><em>New York Times</em></a> last week. Do you think we made our point?</p><p>Apparently we did. By bipartisan, unanimous consent, the Senate voted Nov. 18 to postpone the Medicare cut for one month. Now it’s the House of Representatives’ turn. They must act before the Dec. 1 deadline as well. While I am pleased to see the Senate act and make the necessary first step, a 30-day extension is not the final word. There is more work that needs to be done to prevent a Medicare meltdown. </p><p>The AMA is urging Congress to pass a one-year fix as soon as it returns from the Thanksgiving holiday—the week of Nov. 29—to eliminate the threat of SGR cuts for all of 2011. We are doing everything we can so physicians do not experience a repeat of 2010 with “patches” that last a few months and create a great amount of uncertainty and disruption for physicians and their patients. </p><p>I would like to personally thank all the physicians and state and specialty medical societies who participated to make last week’s event a success. We could not have done it without you. And it all stems from our efforts of working together and delivering a strong, united message to Capitol Hill. </p><p>Just as Henry Ford once said, “If everyone is moving forward together, then success takes care of itself.” </p><p>Do you have a question or a concern you would like to be heard? If so, AMA members can join me for my next “Office Hours” at 7 p.m. Eastern time on Wednesday, Dec. 1. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=ljhbuam0mtw1" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Thank you—you helped make White Coat Wednesday a success-11-22-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:36cd1c31-2457-4df1-83a4-39ecc6b09bae Medicare finalizes changes to its quality reporting program—are you ready? http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a38145329-ade9-407f-902d-75994a414a90&plckScript=blogScript&plckElementId=blogDest Wed, 17 Nov 2010 15:23:00 GMT <p>While physicians may not see the letters P-Q-R-I anymore, the program still exists. It has a new name—the Physician Quality Reporting System, or PQRS. The Centers for Medicare & Medicaid Services (CMS) made a formal announcement on Nov. 2  about the name change. Hopefully this will start a trend of changes, or should I say improvements, to the program.  </p><p>There are a few already. The name, PQRS, reflects the permanency of quality measurement reporting under the Medicare program. Prior to passage of the Affordable Care Act, CMS only had the authority to continue quality measurement reporting payments for a specified period of time.</p><p>In addition, several changes will take effect on Jan. 1, 2011. The first—and one the AMA advocated for, I might add—is that CMS has lowered the PQRS threshold for successful claims-based reporting of quality measures and measure groups from 80 percent to 50 percent. What this means is that PQRS participants who selected to report individual measures through the claims-based reporting option will only have to do so on 50 percent of their Medicare fee-for-service patients. And as indicated by this chart in the July 1 edition of Health System Reform Insight, PQRS incentive payments will start in 2011 and end in 2014. </p><p>An additional incentive payment will be provided from 2011 to 2014 for physicians who satisfactorily report PQRS measures and participate in a Maintenance of Certification (MOC) program required for board certification by a recognized physician specialty organization for at least one year. Participation in MOC must also include completion of a practice assessment, such as a practice improvement module, as part of that organization’s MOC program.  </p><p>Now for the question on everyone’s minds—what about the penalties? PQRS penalties will begin in 2015 for those who do not satisfactorily submit quality data. The AMA is working aggressively  to delay or eliminate these penalties until the PQRS program has been refined to be more efficient and physician friendly. </p><p>The overall structure and processes of the program must improve. This includes the protocol for successful participation and the distribution of timely and actionable feedback reports during the actual reporting period—not seven to 10 months after the reporting period has ended. </p><p>The good news is that CMS will establish an informal appeals process in 2011, which will allow physicians to file a request for review within 90 days of receiving their 2011 feedback report. The 2011 PQRS also includes a second “Group Practice Reporting Option,” where physician groups of two to 199 can participate. </p><p>Understanding quality measure specifications is a critical first step in promoting accurate data capture for meaningful quality improvement. It is from this perspective that the AMA develops and distributes worksheet tools based on PQRS requirements for individual and group measures.  </p><p>For each measure, a description document and data collection sheet has been developed. The data collection sheet facilitates the capture of allowable clinical codes in addition to basic patient demographics. For individual measures, a clinical coding specification document is also available. Look for 2011 PQRS worksheet tools on the AMA’s clinical quality website soon.  </p><p>And make sure you check out Medicare’s PQRS website. It contains all the details about the program. In the next several weeks, more information about next year’s measures, reporting periods and criteria will be made available.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Medicare finalizes changes to its quality reporting program—are you ready?-11-17-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:38145329-ade9-407f-902d-75994a414a90 Pick up the phone http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a63f8962c-57f4-480e-ae79-f05ce8b3f273&plckScript=blogScript&plckElementId=blogDest Tue, 16 Nov 2010 19:52:00 GMT <p>Despite Congress’ return just yesterday to Washington, D.C., physicians are putting the pressure on. And rightfully so. </p><p>A 23 percent Medicare physician payment cut is scheduled for Dec. 1—followed by another 2 percent cut on Jan. 1—and it is going to cause massive problems for seniors and military families who rely on Medicare and TRICARE. There is already a 20 percent gap between Medicare payments and the increasing cost of caring for seniors.</p><p>Tomorrow, during White Coat Wednesday, physicians are dialing up their senators to send a message to Congress: now is the time to stop looming Medicare payment cuts. </p><p>The sad part is that Congress already knows the problems these cuts will cause for seniors but they have yet to act on their concern. That’s why we must demand it. Congressional action is the only way to stop the cuts.</p><p>All physicians can call the AMA’s grassroots hotline at (800) 833-6354, connect to their senators, and tell them how these cuts will impact their ability to care for their patients. </p><p>Our time is running out. Congress has a responsibility. Remind them of that. A cut of this magnitude could be the tipping point for physicians making difficult decisions in order to even keep their practice doors open. Let’s avoid a Medicare meltdown and preserve seniors’ access to care. </p><p>Physicians are united on this issue. Now, let’s be united in our action. </p><p>Make the call tomorrow on White Coat Wednesday. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Pick up the phone-11-16-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:63f8962c-57f4-480e-ae79-f05ce8b3f273 Consultations: an integral part of modern medical practice http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a13f464e0-7fe4-493d-ab99-f7aeb3351748&plckScript=blogScript&plckElementId=blogDest Mon, 15 Nov 2010 18:08:00 GMT <p>One of the realities of modern medicine is that no one physician can know enough or have enough expertise to manage every medical problem. This makes the practice of medicine complicated and challenging. But it is a positive confirmation of the fact that we have knowledge and methods of treating patients and saving lives that could only be imagined 50 years ago.</p><p>When a physician treating a patient finds a problem for which he or she cannot provide the best treatment, another physician possessing the requisite expertise is asked to provide guidance and treatment. This is called a consultation and is identified by a code that allows the consulting physician to bill for that service.</p><p>In another of those “what in the world are they doing?” moments last year, the Centers for Medicare & Medicaid Services (CMS) decided to stop paying for consultation codes. The action was in effect a determination that the consulting doctor did not provide a service that had special value. I disagree. The result has been confusion and a negative impact on physicians whose specialty practice is primarily that of a consultant.</p><p>Last year, the AMA House of Delegates established policy to oppose all public and private payer efforts to eliminate payments for inpatient and outpatient consultation service codes and support legislation to overturn recent CMS action to eliminate payment. During the AMA Interim Meeting in San Diego last week, physicians from around the country described the damaging effect eliminating payment for consultation codes is having on physician practices, and the AMA reaffirmed its policy.</p><p>During the past year, the AMA has advocated strongly for reversing the action of CMS on consultation codes, and it will continue that effort. This is yet another example of the power that regulatory bodies have over medical practice as it relates to federal programs. And it imposes a special responsibility on those bodies to do their work with an understanding of the impact their regulatory pronouncements have on medical practice -- and the potential for the unintended consequences that they may harm, not help.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Consultations: an integral part of modern medical practice-11-15-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:13f464e0-7fe4-493d-ab99-f7aeb3351748 AMA delegates meeting shows democracy at its finest http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a7b152af8-ede4-43c7-b5e4-59d901fdc32e&plckScript=blogScript&plckElementId=blogDest Fri, 12 Nov 2010 16:03:00 GMT <p>I write this sitting in my hotel room Tuesday afternoon in San Diego, basking in the warm afterglow of another AMA meeting that just concluded.</p><p>This was a meeting in which, as in the past, physicians from across the country came to consider, discuss and make decisions about important issues affecting the profession and the patients we serve. These decisions take on added importance during this time of change in our country as we deal with the continued challenge of deciding what the face of health system reform will look like.</p><p>My reflections take me to a speech Sir Winston Churchill gave to parliament in 1947. He (quoting an unknown predecessor) said: “It has been said that democracy is the worst form of government except for all others that have been tried.” This quote succeeds in a single sentence in elegantly expounding on both the difficulty of governing and the clear superiority of democracy.</p><p>I would hesitate to try to improve on a quote from Churchill, but since he was quoting someone else let me take the liberty to say: Governing is hard, and democracy is the best form of government.</p><p>And I saw both in evidence at the meeting of the AMA.</p><p>Delegates to the House debated issues thoughtfully, elegantly and appropriately. They were at times intellectual, at times impassioned, at times angry, at times humorous and, dare I say it, occasionally tedious, dull and boring. And in the end, they celebrated through their participation a process that provides for majority rule while respecting the right of the minority to have their voices heard.</p><p>One measure of the success of this democratic process for the AMA is that delegates were able to give careful consideration to more than 100 reports and resolutions and come to decisions about the desired course of action for the association. If, like me, you are enamored of the value of “process,” this is exhilarating. If not, it’s OK.</p><p>For those who question whether the AMA represents the interests of physicians, I recommend a visit to the AMA House of Delegates to see physicians from every part of the country, every state and specialty society, every political leaning, every age segment, reflecting much of the cultural ethnic and racial diversity of this country, taking time from their “day job” as physicians to participate in this important work. There is no other forum like this for physicians.</p><p>Now it’s back home to Winter Park, Fla. On Monday I will be in Washington, D.C., with AMA Board Chair Ardis Hoven, MD, to continue AMA discussions with government officials about one aspect of the Affordable Care Act, accountable care organizations.</p><p>Meanwhile, look for highlights and video recaps of the Interim Meeting on the <a href="http://www.ama-assn.org/ama/pub/meeting/highlights.shtml" target="_blank">AMA website</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=AMA delegates meeting shows democracy at its finest-11-12-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:7b152af8-ede4-43c7-b5e4-59d901fdc32e Moving medicine forward—together http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a883ff5d1-a0de-49f6-ba63-d7f1f2c3c035&plckScript=blogScript&plckElementId=blogDest Wed, 10 Nov 2010 16:28:00 GMT <p>Being at the <a href="http://www.ama-assn.org/go/interim2010" target="_blank">AMA’s Interim Meeting</a> this past weekend in San Diego—a place with a rich history and tradition tied to the U.S. Navy—and being that tomorrow is Veteran’s Day, has made me reflect on my own personal past.</p><p>More than 40 years ago, as a young Naval medical officer, I was part of the team that examined the crew of the U.S.S. Pueblo—a U.S. communications monitoring ship that had been in international waters, legally, when it was surrounded and fired upon by North Korean warships.</p><p>The crew—all 82 of them—had been beaten, tortured, starved and humiliated on a daily basis during nearly a year as prisoners, and it showed in their eyes, their faces and their damaged bodies when they arrived at Balboa Naval Hospital, where I was stationed at the time. They walked in just 36 hours after they were released from captivity in North Korea and had limped across the “Bridge of No Return”—together—toward freedom.  </p><p>Despite malnutrition, hepatitis, respiratory infections, and bruises and facial lacerations, I saw something different about their spirits and their souls. The captain and the crew had a quiet courage, a will to live and a generosity of spirit. They were united, loyal and upbeat. </p><p>As a group, they had bonded. There was no finger pointing, no assignment of blame, no hunt for scapegoats, no search for conspiracies. They had passed through a hell not of their own making, but had stuck together, bound by a common plight and a common cause—service to their country.</p><p>This is a reminder of the importance of learning from one another and being united. If they did not break under the brutalities of torture, then it should be easy for physicians as a profession. We are not captives. We face no physical danger. We can help determine our own fate—and the fate of medicine.</p><p>The surest path to failure is to succumb to those who sow dissent—who would have us submit—divided and conquered. If we resist division and work together, we can move medicine forward to a better place. This is our path, our quest, our charge. </p><p>It is brave men like the Pueblo crew that I hope you will reflect upon when we take time to honor America’s veterans tomorrow. I am humbled by the enormous sacrifices our young people make every day in the armed forces of our country. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Moving medicine forward—together-11-10-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:883ff5d1-a0de-49f6-ba63-d7f1f2c3c035 Time is now to stop looming Medicare payment cuts; call your senators today http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a185dec58-7946-4f43-b4ed-61c5222cb967&plckScript=blogScript&plckElementId=blogDest Tue, 09 Nov 2010 16:02:00 GMT <p>As we move perilously closer to deep cuts in Medicare reimbursements scheduled to go into effect Dec. 1, the AMA is reminding Congress of its duty to senior citizens and military families. </p><p>A <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/medicare-par/medicare-ad.pdf" target="_blank">new ad</a> appeared in Monday’s USA Today and also will run in Washington, D.C., publications next week when Congress reconvenes. The ad reminds Congress that military families and seniors did much to help make this country great. Now Congress must do right by them and stop the cuts to Medicare.</p><p>A staggering 94 percent of Americans are concerned about a looming Medicare cut to doctors, according to a new AMA poll released at the Interim Meeting. Without congressional action, physicians caring for seniors face a 25 percent cut that will hurt seniors' health care. We’re asking Congress to stop the cuts for at least 13 months, and then work on a permanent repeal of the sustainable growth rate formula.</p><p>Patients should call (888) 434-6200 and tell Congress to stop the cuts to Medicare payments. The public certainly is concerned about the impact of the cuts on seniors. Already about <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/medicare-survey-results.pdf" target="_blank">one in five physicians</a> say they have been forced to limit the number of Medicare patients in their practice because of the ongoing threat of cuts and the fact that Medicare payment rates were already too low. </p><p>Also concerned is AARP, the voice of senior citizens in America. "Americans 65 and over have earned their Medicare and the right to keep seeing the doctors they count on," said AARP board member Mara Mayor. "Congress has a responsibility to keep doctors in the Medicare program. It's time for politicians to come together to stop these cuts so seniors can have the peace of mind they've earned."</p><p>Physicians can send a special message to Congress on Nov. 17 by participating in White Coat Wednesday. That’s when physicians from across the country will call their U.S. senators to urge them to act on the issue. Call the AMA’s grassroots hotline at (800) 833-6354, and we’ll put you in touch with your respective senators so you can express your outrage about the impending cuts.</p><p>The AMA also has a <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/medicare-par/medicare-patient-flyer.pdf" target="_blank">new flier</a> that physicians can display in waiting rooms or distribute to patients to educate them about the severity of the problem.</p><p>The time for action is now. Be a part of that action.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Time is now to stop looming Medicare payment cuts; call your senators today-11-09-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:185dec58-7946-4f43-b4ed-61c5222cb967 AMA’s strategic plan focuses on five key issues http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a3653f33d-a47b-4d5e-b65c-d2d44f28fdf1&plckScript=blogScript&plckElementId=blogDest Mon, 08 Nov 2010 17:30:00 GMT <p>At the opening session of the <a href="http://www.ama-assn.org/ama/pub/meeting/index.shtml" target="_blank">Interim Meeting</a> of the AMA House of Delegates on Saturday in San Diego , the Board of Trustees unveiled the strategic plan for the Association for 2011.</p><p>This plan is the core strategy to carry out the AMA’s mission of promoting the art and science of medicine and the betterment of public health – helping doctors help patients by working on the most important professional and public health issues.</p><p>The strategic plan is structured around five urgent issues of broad, national concern for physicians. None of these five elements stand alone in the context of delivery of care, and the AMA’s constituencies will be best served by a plan that recognizes the connections and seeks to achieve a balanced set of actions.</p><p>The five key issues are:<br />1. Access to care and work force shortages: Advancing AMA policies in emerging federal regulations (under the Affordable Care Act) with the goal of improving access and protecting coverage for patients while advocating for the need to expand graduate medical education. <br />2. Next generation physician payment: Aligning incentives with quality of care while covering the cost.<br />3. Prevention and wellness: Emphasizing addressing unhealthy behaviors as a major cause of chronic diseases and premature death in the U.S. and as a major contributor to unsustainable health care expenditures.<br />4. Quality of care: Using measuring, reporting on, and improving the quality and efficiency of care provided to patients as promising approaches to reforming care delivery and reimbursement systems.<br />5. Cost of health care: Addressing cost through four strategies: reduce the burden of preventable disease, make health care delivery more efficient, reduce non-clinical health system costs that do not contribute value to patient care and promote “value-based decision-making” at all levels.</p><p>It is an ambitious agenda for challenging times. However, the AMA has since its founding in 1847 been heavily involved in the veritable plethora of issues so important to the health of this country. The 2011 strategic plan is a continuation of the involvement that we see as an essential ingredient to the role the AMA plays representing the medical profession.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=AMA’s strategic plan focuses on five key issues-11-08-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:3653f33d-a47b-4d5e-b65c-d2d44f28fdf1 Be a part of the AMA; help determine medicine’s course http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aca08696d-723b-4b0d-a124-3e9cd59d5b77&plckScript=blogScript&plckElementId=blogDest Fri, 05 Nov 2010 14:13:00 GMT <p>This weekend, physicians from across the country will converge in San Diego for the <a href="http://www.ama-assn.org/go/interim2010" target="_blank">Interim Meeting</a> of the AMA House of Delegates. This is one of two meetings held yearly during which policy is established by the AMA. It is decisions at these meetings that guide the actions of the association in its efforts to influence public policy on health-related issues.</p><p>There are those who, frequently not wishing the AMA well, look at the membership of the AMA and make note of the fact that not every physician in the country is a member. They wonder in loud frequently angry voices how the AMA can assert that it represents the opinion of American physicians.</p><p>This is why.</p><p>The American public believes that the AMA speaks for doctors. And polls show that the public has a high opinion of the AMA.</p><p>When those in government want to know what physicians think on an issue, they invariably turn to the AMA for its opinion.</p><p>The AMA is the largest, most powerful medical association in the country</p><p>The AMA House of Delegates -- when it sets policy for the AMA -- does so as a democratic body that includes representatives from every state medical association and national specialty society in the country. </p><p>Since there are very few physicians in this country who are not members of either a state or a specialty society, the vast majority of physicians have a voice through their representatives in determining the course for the AMA. </p><p>No other organization representing physicians can claim to be the source of input from almost all physicians. And no other organization can convene physicians from every geographic and specialty interest to set policy.</p><p>Individual state medical societies can claim to represent the interests of their members but not those of physicians in other societies across the country. National specialty societies can claim to represent members of their specialties but not others.</p><p>So does the AMA represent the physicians in this country? My answer is an unequivocal “yes.” And the AMA does this by setting policy and working closely in support of the disparate interests of all state and specialty societies and the physicians they represent.</p><p>My prescription for physicians who want to influence health policy for this country and preserve the practice of medicine for our profession and the patients for whom we care: Join the AMA, and be a part of the process. The alternative is to be left out, on the side of the road, without clout or influence -- the passive object of  policies set by others.</p><p>Does the AMA represent the physicians of this country? You betcha. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Be a part of the AMA; help determine medicine’s course-11-05-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ca08696d-723b-4b0d-a124-3e9cd59d5b77 Working toward a claims cure http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ac9f9b4b8-9ae0-4f9f-a6e1-9bd5495f5c5d&plckScript=blogScript&plckElementId=blogDest Wed, 03 Nov 2010 15:34:00 GMT <p>While $928.50 may not sound like a lot of money, it certainly can be when you multiply it by five, seven or even 15 or more. This is an example of an amount physicians could be repeatedly shortchanged by health insurers for a commonly performed medical practice procedure. And for <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process/htc-physician-practices-experience-saving.shtml" target="_blank">one Chicago practice</a>, it is a real-life scenario. </p><p>But it is something happening across the country—thousands of physicians battling health insurers for not processing or paying a claim in a timely manner, for not paying enough for a medical claim, or in some cases, for not paying it at all.   </p><p>One in five medical claims is processed inaccurately by health insurers, according to the AMA’s <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process/national-health-insurer-report-card.shtml" target="_blank">National Health Insurer Report Card</a>. This intolerable level of inefficiency wastes an estimated $15.5 billion annually that could be better used to enhance patient care and help reduce overall health care costs. </p><p>But the <a href="http://www.ama-assn.org/ama/pub/news/news/november-heal-that-claim-month.shtml" target="_blank">AMA has set ou</a>t to significantly reduce this number. Right now, physicians divert as much as a whopping 14 percent of their revenue on making sure they are getting proper payment from health insurers. We want that number to one day read merely “1 percent.” </p><p>Clearly, we have our work cut out for us. That’s why the time to act is now. <a href="http://www.ama-assn.org/go/htc" target="_blank">Heal that Claim</a>™ month, designated by the AMA, is part of the AMA’s <a href="http://www.ama-assn.org/ama1/pub/upload/mm/368/htc_general_flier.pdf" target="_blank">Heal the Claims Process</a>™ campaign—devoted to helping physicians fight flawed and inefficient claims processing and make sure physicians are reimbursed accurately. </p><p>To get your practice back on track and back to health, we have so many easy-to-use <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process/htc-toolkit.shtml" target="_blank">online resources</a> on <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/claims-management-revenue-cycle.shtml" target="_blank">preparing, following and appealing a claim</a>, <a href="http://www.ama-assn.org/ama1/pub/upload/mm/368/claims-checklist.pdf" target="_blank">simplifying your internal claims process</a>, <a href="http://www.ama-assn.org/ama1/pub/upload/mm/368/claims-checklist.pdf" target="_blank">determining the best steps</a> to reverse denials and <a href="http://capitolconnect.com/pmalerts" target="_blank">staying up to date</a> on unfair payer practices.   </p><p>Today—and throughout the year—I am asking you for your help. Review your health insurer payments for accuracy. Appeal payments that have been inappropriately denied or reduced. And be sure that your practice is preparing and submitting claims accurately. You can <a href="http://capitolconnect.com/pmalerts" target="_blank">pledge your support</a> for the campaign, <a href="http://www.ama-assn.org/go/clickandcomplain" target="_blank">report any unfair health insurer practices</a>, or <a href="mailto:practicemanagementcenter@ama-assn.org" target="_blank">share</a> your success stories with us too. </p><p>Show your commitment to reducing the cost of claims processing and join me in taking a stand. Let’s make sure health insurers get it right the <em>first</em> time. That way, we can spend our time focusing on those who need and deserve our undivided attention—our patients. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Working toward a claims cure-11-03-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:c9f9b4b8-9ae0-4f9f-a6e1-9bd5495f5c5d Seniors suffer as members of Congress continue to sit on their hands http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ab6eefe11-e6d7-40e2-ac74-1ef52e101563&plckScript=blogScript&plckElementId=blogDest Tue, 02 Nov 2010 14:00:00 GMT <p>Every year since 2002, private practice physicians in this country have been <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare.shtml" target="_blank">threatened with cuts in Medicare payments</a> due to the universally recognized, fatally flawed payment formula, the sustainable growth rate (SGR). Congress has blocked this veritable sword of Damocles annually without fixing the problem. </p><p>But this year is different. Throughout 2010, Congress has let what were, at the time, current rates expire three times before passing legislation to stop the cuts. And each time, Medicare carriers have been forced to hold up claims processing, causing many practices to take steps to avert disaster, such as taking out loans, laying off staff or not taking new Medicare patients.</p><p>Now a 23 percent cut is looming on Dec. 1; another cut of 2 percent is slated for Jan. 1, for a total of 25 percent. The next opportunity for relief is a lame-duck session of Congress starting Nov. 15. And there is no guarantee that Congress will block the cuts or do so in a way that will not disrupt physicians’ practices.</p><p>The very viability of practices, which are in essence small businesses, is threatened by a payment scheme that is paying the same now as in 2002 -- 22 percent less than the cost of providing care and only 52 percent of the direct costs of providing care.</p><p>What this means is that physicians must increasingly look at whether they can continue to see all the Medicare patients that come to their practice -- or any Medicare patients at all -- in this federal program that Congress, by its inaction, has let become unreliable. This is a threat to access to care for seniors and military families on TRICARE.</p><p>Carriers will inform physicians in November that they have until Dec. 31 to decide on their Medicare participation status for 2011. These decisions will be binding throughout 2011. As of 2009, 95 percent of physicians had signed participation agreements with Medicare.</p><p>The three options for physicians to consider are: </p><p>1. Sign a participation (PAR) agreement and accept Medicare’s allowed charge as payment in full for all of their Medicare patients <br />2. Elect non-participation (non-PAR), which permits physicians to make assignment decisions on a case-by-case basis and to bill patients for more than the Medicare allowance for unassigned claims <br />3. Become a private contracting physician, agreeing to bill patients directly and foregoing any payments from Medicare to their patients or themselves</p><p>Information on each of these options is available on the <a href="http://www.ama-assn.org/go/medicareoptions" target="_blank">AMA’s website</a>, along with sample documents and letters to share with patients about what a change in Medicare status will mean to them.</p><p>I strongly urge physicians, as they are making decisions about whether to change their status in relation to the Medicare program, to <a href="http://www.ama-assn.org/ama/pub/advocacy/get-involved.shtml" target="_blank">contact their members of Congress</a> and tell them in no uncertain terms the havoc this problem is causing for their practices. And tell them about the decrease in access it is causing for seniors -- one that is sure to become a catastrophe if members of Congress continue to sit on their hands.   </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Seniors%20suffer%20as%20members%20of%20Congress%20continue%20to%20sit%20on%20their%20hands-11-02-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:b6eefe11-e6d7-40e2-ac74-1ef52e101563 There is a fire in the house http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3abcdd4b23-8a23-4cca-a9a1-0314ea319bda&plckScript=blogScript&plckElementId=blogDest Fri, 29 Oct 2010 12:00:00 GMT <p>This week I was in Washington, D.C., for three days, and one of the items on my agenda was leading the AMA webinar “Understanding your Medicare choices: preparing for the 2011 Medicare participation decision.” Physicians will be making their annual decision about participation in Medicare during the latter part of November and before the Dec. 31 deadline.</p><p>I have two observations:  the level of interest (more than 400 registered) in this webinar makes it clear that for physicians, this year is different. And for the first time, the AMA provided detailed information about the options not just for those who will be participating (par) or not participating (non-par) but also for those who want to opt out of Medicare altogether. Check out the AMA’s <a href="http://www.ama-assn.org/go/medicare-participation" target="_blank">Medicare options kit</a> -- which includes a helpful revenue calculator and various sample materials -- to help you choose the direction that is right for your practice.</p><p>As has been described ad nauseum, because of a flawed Medicare payment formula, physicians have faced the threat of annual cuts for the past eight years -- culminating this year as a 30 percent cut if Congress does not act by Jan. 1, 2011.</p><p>Average Medicare physician payment rates are only 3 percent above 2001 levels and 23 percent below the government index of practice cost inflation. And they cover only half of the direct costs of providing care.</p><p>The fact that members of Congress have not acted to correct this problem should be an embarrassment for them and threatens seniors’access to care. It appears that at least part of the reason for inaction is members of Congress do not believe physicians will have to stop seeing Medicare patients regardless of the level of payment.</p><p>They are comforted in this view by the knowledge that 95 percent of physicians have participating agreements with Medicare. What is missing from this statistic is the fact that physicians who stop seeing new Medicare patients do not have to change their status with Medicare. So, the 95 percent number does not account for the fact that, according to a survey last year by MedPAC, a quarter of seniors looking for a new primary care physician reported having difficulty finding one. It also does not account for the report last December that a Mayo Clinic primary care facility stopped seeing Medicare patients.</p><p>I would contend that this evidence of a trend toward decreased access will continue if nothing is done and accelerate to tsunami proportions because of a number of factors. </p><p>There is already a shortage of physicians in the U.S., and it’s expected to exacerbate.</p><p>The number of Medicare patients, as baby boomers become eligible in 2011, will increase enrollment from 47 million now to 53 million in 2014.</p><p>In 2014, when the insurance exchanges provided for in the Affordable Care Act go online, there will be a net increase of 8 million people who can buy private insurance -- giving physicians who cannot afford to keep an office open with Medicare payments an option for a viable practice.</p><p>A grease fire in the kitchen if extinguished early will not cause irreparable damage. A grease fire unnoticed until it spreads may be successfully put out when the fire department arrives -- but not uncommonly in the process, the house has been destroyed. There is a fire in the house. Congress needs to stop fiddling and put this fire out before the Medicare program and seniors’ access to care is irreparably damaged.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=There is a fire in the house-10-29-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:bcdd4b23-8a23-4cca-a9a1-0314ea319bda What works; what works best http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ab506b3ee-fedf-4a4e-91a6-a300d327faa8&plckScript=blogScript&plckElementId=blogDest Thu, 28 Oct 2010 13:55:00 GMT <p>For the past two decades, there has been much talk about the need for doing what works -- evidence-based medicine. But recently, the mantra is about doing what works best -- comparative effectiveness.</p><p>All of this is against the backdrop of what one might fairly call the scientific era of medicine that began in large part during the middle of the last century with the discovery of penicillin and sulfa antibiotics just before World War II.</p><p>The reality however, is that although there has been a lot of science developed since then, much of what we as physicians do continues to be based on clinical experience and judgment. </p><p>The “art” in the “art and science of medicine” is still essential and will continue to be not only because people are different and respond differently to treatment but also because the evidence base for much of what physicians do has significant gaps. This leads to variations in practice influenced by geography, training locales, payment methods, culture and socioeconomic factors.</p><p>Early on, the speed of scientific advances and availability of money allowed us to avoid making some hard decisions in this area. The challenge we now face—spending that outstrips funding and costs that do not always seem to be value-related—is forcing us as a country to confront the questions of what works and what works best.</p><p>And I would contend that the ultimate success of the Affordable Care Act will depend not only on providing expanded coverage but providing health care based on evidence and comparative effectiveness. That would give us a health care system that provides the right care to patients at the right time and the right place based on scientifically-valid guidelines and performance measures. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=What works; what works best-10-28-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:b506b3ee-fedf-4a4e-91a6-a300d327faa8 Going the distance http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aa9a8ea50-6c91-4faa-ac02-95bbdff3c523&plckScript=blogScript&plckElementId=blogDest Tue, 26 Oct 2010 13:09:00 GMT <p>It is kind of like a marathon—this never-ending race with Congress. On Dec. 1, Medicare physician payments will be slashed by 23 percent. My hope is that it is the physicians and their patients who will come out ahead.   </p><p>We have endured a long and arduous undertaking, testing our stamina and our limitations, during this perpetual chase. This year alone, Congress delayed scheduled cuts on three separate occasions, wreaking havoc on physician practices across the country. And recently, it adjourned for the election season, leaving a great deal of unfinished business on the table. </p><p>Some physicians have been forced to seek short-term loans just to meet payroll and keep their doors open. Others have been forced to forego pay while Congress hems and haws. And if Congress does not act to change the flawed SGR formula, an additional cut of more than 6 percent will be implemented on Jan. 1, 2011.</p><p>Unfortunately, permanent repeal between now and the end of the year is unlikely. And physicians cannot continue to care for Medicare patients and still keep their practices viable when they are operating on 30 percent less.</p><p>So the reality is physicians have a decision to make about the role Medicare will play in their practice next year.</p><p>From mid-November through Dec. 31, physicians can review and change their participation status with the Medicare program. This is not an easy decision to make. Just as you would train for any marathon, preparation is key.</p><p>The AMA has developed a kit to help you <a href="http://www.ama-assn.org/go/medicareoptions" target="_blank">evaluate your Medicare options</a>. It includes an informational guide—“<a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/medicare-par/know-options-medicare-participation-guide.pdf" target="_blank">Know your options: Medicare participation guide</a>”—as well as financial worksheets, sample documents for those who choose private contracting and examples of how you can communicate with your patients if you decide to change your status. </p><p>We have the energy and determination, and we will continue to run hard toward the finish in an effort to prevent the December cuts. And by no means is a short-term patch the finish line. It is merely a mile marker along the way. The AMA’s ultimate goal is achieving permanent repeal of the SGR, and we are committed to making that happen—getting Congress to do its job and adequately fund Medicare—however long it takes. </p><p>We have put in the hard work and the effort. Let’s stay dedicated and work as a team to cross the finish. Tell Congress to stop the cuts through the AMA’s <a href="http://capwiz.com/ama/home/" target="_blank">Physicians’ Grassroots Network</a>. Ask your patients to do the same by joining the AMA’s <a href="http://www.patientsactionnetwork.org/" target="_blank">Patients’ Action Network</a>. And <a href="mailto:killsgr@ama-assn.org" target="_blank">share your story</a> about the drastic measures you have been forced to take in order to deal with the Medicare cuts. Congress needs to know how its inaction has hurt your patients and practices. </p><p>Time is running out. Do your part to keep Medicare reform at the forefront of lawmakers’ minds as Election Day approaches. Otherwise, the best interests of you and your patients could be left in the dust.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Going the distance-10-26-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:a9a8ea50-6c91-4faa-ac02-95bbdff3c523 Providing care, not maximizing profits http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a25f13895-fb7d-4e4b-a1d6-8a41b5c8fb13&plckScript=blogScript&plckElementId=blogDest Mon, 25 Oct 2010 13:59:00 GMT <p>One of the provisions in the Affordable Care Act (ACA) related to health insurance reform was a requirement that a certain portion of consumers’ health insurance premiums would be spent on providing medical care. </p><p>The ratio of spending to insurance premiums in the health insurance industry is called the “medical-loss ratio”. The ACA gave responsibility to the National Association of Insurance Commissioners (NAIC) for making recommendations to the U.S. Department of Health and Human Services (HHS) on federal regulations implementing this provision.</p><p>At its meeting in Orlando last week, the NAIC endorsed a proposed federal regulation that would spell out how the medical-loss ratios would be calculated. This work was critical to the success of the law since without a clear definition of what medical care is, health insurance companies would be free to include some of their expenses that are mainly administrative -- not related directly to medical care -- making the requirement meaningless and the goal of providing more care unattainable.</p><p>The regulations being sent to HHS would require that health insurance companies spend at least 80 percent of a customer’s premium on providing health care and medicine. For customers in large-group plans, the requirement is 85 percent.</p><p>That brings me to a pet peeve of mine -- the term “medical-loss ratio.”  When one describes something as a loss, the tendency is to think of how to make it less. In reality, what the medical-loss ratio measures is how much is spent on health care. Clearly for health insurance companies, the lower that ratio is, the greater the profits -- and in a perverse way, calling it “a loss” adds justification to attempts to make it lower. </p><p>My contention is that since, at least in the area of health care, the  purpose of health insurance is to pay for care that patients need. The goal should be to pay for more needed care, not less. Changing the name to “medical-care ratio” would put the emphasis where it should be -- on providing care, not on maximizing profits.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Providing care, not maximizing profits -10-25-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:25f13895-fb7d-4e4b-a1d6-8a41b5c8fb13 How reform affects our future http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ade901ac0-e449-4cac-9c74-e69a034e0f3a&plckScript=blogScript&plckElementId=blogDest Thu, 21 Oct 2010 14:36:00 GMT <p>I recently participated in a health care summit in Chicago. Sixty CEOs of major health-care-related companies were there. Former Democratic Senator Tom Daschle and former Republican House Speaker Newt Gingrich were featured, providing fascinating insight from their years of political experience on opposite sides of the aisle. The focus of the meeting was the implications of the Affordable Care Act (ACA) on the future, particularly for health-care-related businesses.</p><p>Daschle described the goal for health system reform as developing a high-performance, high-value system. Gingrich agreed and said that the medical profession should develop “best practices,” but it must not be too narrowly confined to the profession.</p><p>Answering a question from the audience regarding tort reform, Daschle said tort reform at the federal level is needed and inevitable. Gingrich agreed and emphasized what he described as the high cost of defensive medicine in the present system and the need for safe harbors for best practices against lawsuits.</p><p>In a discussion of the ACA and calls for repeal, Gingrich stated that Republicans will have to support repeal. They have no choice. In addition, Gingrich said the House -- assuming a Republican majority after the election in November -- will pass repeal but the Senate will not. He called it “the political drama” of Washington. </p><p>A part of the meeting was spent eliciting responses from the attending CEOs on questions related to health system reform. Here are the questions that were asked, followed by the CEOs’ responses:</p><p>• Do you support repeal? (53 percent said yes; 47 percent said no)<br />• Is it highly likely that employers will stop providing insurance as a result of ACA? (36 percent said yes; 64 percent said no)<br />• What is the effect of ACA on business? (44 percent said positive or slightly positive; 59 percent said negative or slightly negative)<br />• What are the priorities in this election? (48 percent said the economy; 33 percent said jobs; 18 percent said federal spending; no one said health care; no one said foreign policy)<br />• What is the top challenge presently facing business? (73 percent said regulation)<br />• Is the Obama administration anti-business? (85 percent said yes)<br />• Will the trend toward increased health care costs continue? (85 percent said yes)<br />• Do you have advance directives for end-of-life care? (68 percent said yes)</p><p>I strongly (no surprise) agree with Daschle and Gingrich on the critical need for tort reform to have a system that compensates those who are injured fairly and expeditiously while avoiding threatening physicians with so many nonmeritorious cases. I was also pleased to see that so many of the executives have advance directives.</p><p>Otherwise, I have no conclusions -- I am just reporting.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=How reform affects our future-10-21-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:de901ac0-e449-4cac-9c74-e69a034e0f3a Move your mouth http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3abb155ce7-8e03-4909-ab4e-190b51fe1c90&plckScript=blogScript&plckElementId=blogDest Tue, 19 Oct 2010 19:37:00 GMT <p>Sometimes it is the simple things that can make a big difference. Physicians understand the value of this statement on the job, like when it comes to washing our hands or wearing shoes. </p><p>But I certainly cannot imagine a practice, or all of medicine for that matter, being able to function without the mere effortless act of moving our mouths. </p><p>Talking is essential to the care of physicians and the <a href="http://www.ama-assn.org/go/patientsafety" target="_blank">safety of patients</a>. This month—during “<a href="http://www.talkaboutrx.org/" target="_blank">Talk about Prescriptions Month</a>”—we can help to ensure medicines are being used in a safe and appropriate manner. And it would be nearly impossible to do this without talking. </p><p>More than 3.5 billion prescriptions are dispensed yearly. But, let’s say for example, you have a 75-year-old patient that takes 10 different medications. Does your patient know how to take them and fully understand the side effects of each one? And are all caretakers in the loop on the medications your patient is taking?</p><p>Hopefully, you are nodding “yes” to these questions. As part of its <a href="http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/programs-events/amas-quality-care-program/making-strides-safety.shtml" target="_blank">Making Strides in Safety</a>® campaign, the AMA offers a variety of online resources to help get physicians and their patients on the right track. </p><p>They are designed to help facilitate patients’ conversations with physicians about the medications they are taking and the questions they should be asking. They help educate patients, strengthen the physician-patient relationship and boost patient involvement in and the safe management of their care. As physicians, we strive for excellence, and these resources can help us do that.</p><p>Some of you have probably noticed a pattern I have developed throughout my term thus far as AMA president—in my speeches, my columns, my blog—of handing out “my prescriptions” on how I believe organized medicine could help cure some of the issues ailing our health care system. </p><p>Well since we’re on the topic, today’s is simple and may come as no surprise: start talking. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Move your mouth-10-19-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:bb155ce7-8e03-4909-ab4e-190b51fe1c90 Looking at medicine from a global point of view http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad3a6bfd2-5746-40ba-81b2-3066ec90c2c8&plckScript=blogScript&plckElementId=blogDest Fri, 15 Oct 2010 16:16:00 GMT Today I am in Vancouver, Canada, attending the 186th Council Session followed by the General Assembly of the <a href="http://www.wma.net/en/10home/index.html">World Medical Association</a> (WMA). <br /><br />Founded in 1947, the WMA is composed of 99 member medical associations from around the world. Its primary focus over the years has been to be the authoritative voice worldwide for a common understanding of medical ethics. In this role, the WMA develops declarations in the area of ethics and provides guidance to governments and other organizations.<br /><br />Some of the topics on the agenda for this meeting include:<br /><br /><ul><li>End-of-life care </li><li>The use of placebos in medical research</li><li>Medical care for refugees and asylum seekers</li><li>The health effects of climate change</li><li>And drug prescriptions </li></ul>The latter will emphasize that physicians are the best-qualified to prescribe independently.<br /><br />I was pleased to present the AMA’s initial draft of a proposed WMA statement titled the “Global Burden of Chronic Disease.” This paper was developed with the assistance of many experts, including the American Academy of Family Physicians and the World Organization of Family Doctors (also known as Wonca), as well as a team of experts from the AMA. This paper will be distributed to member nation associations for their comments and subsequently presented for adoption by the WMA next year.<br /><br />One of the experiences I most value from work at the WMA level is my interaction with colleagues from around the globe. It provides me with an opportunity to understand their commitment to the profession. And it helps me realize that many of the challenges we face in the United States are similar to those they experience, and understand that there are a variety of ways to respond – each of which has value. Or, in the vernacular of my youth, there are a number of ways to skin a cat.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Looking%20at%20medicine%20from%20a%20global%20point%20of%20view-10-15-2010">e-mail</a>.<br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d3a6bfd2-5746-40ba-81b2-3066ec90c2c8 We need to be moving medicine forward http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a7dce29a7-93a7-4207-a72a-0e8efe8016c5&plckScript=blogScript&plckElementId=blogDest Thu, 14 Oct 2010 14:00:00 GMT <p>Stuck in reverse – I don’t think so.</p><p>I am dumbfounded that in many parts of the country, even now,  seven months after passage of the Affordable Care Act, there continues to be a litany of myth and distortion about what is in the law and what it means to our country, a cacophony of partisanship and discord.</p><p>And, not uncommonly, those who criticize find the AMA a target of choice, taking potshots and making false accusations to create headlines for their point of view, but providing an astonishing lack of leadership about moving medicine forward to deal with the problems of our current health care system.</p><p>These destructive voices give credence to the quote by John F. Kennedy, who said: “The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic.”</p><p>However, I believe there is a different, encouraging picture emerging among large segments of the medical community. Over the past four weeks, I have visited six state medical associations and two national specialty societies. In each case I found physician members and their leaders focused on how to help physicians deal with the realities of the new law. They are working to make physicians able to provide leadership in the new delivery systems envisioned by ACA,  such as accountable care organizations, gain sharing, bundling and the patient-centered medical home.</p><p>The AMA also is working hard to provide physicians with the advocacy and practical tools physicians need to care for patients and lead improvements to our health care system.</p><p>In the past two weeks alone, the AMA has engaged FTC Chairman Jon Leibowitz on antitrust issues, helped physicians collect settlement payments from UnitedHealth and organized a letter to Congress urging action to stop Medicare physician payment cuts – a letter that was signed by all 50 state medical societies and 66 national medical specialty societies.</p><p>Stuck in reverse? Hardly. Moving forward? Absolutely.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=We need to be moving medicine forward-10-14-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:7dce29a7-93a7-4207-a72a-0e8efe8016c5 Protecting your practice against audits and getting on the “PATH” to price transparency http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a939d02cc-537d-4062-adbd-16cbb36674ea&plckScript=blogScript&plckElementId=blogDest Tue, 12 Oct 2010 17:17:00 GMT <p>Some physicians report higher level CPT® codes more often than their peers in the same specialty. In the eyes of a payer auditor, this fact may suggest that these physicians are being overpaid for that particular service. But the physicians (depending on the situation, of course) may see it differently. They may be coding at a higher level because, in accordance with the documentation guidelines, their patient mix consists of more complicated cases. </p><p>Did you know you can be audited at any time? Some physicians are not aware of this fact—until it is happening to them. In the current health care environment and with the likelihood that billing audits will happen more frequently, it is essential that physicians know <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/recovery-audit-contractors.shtml" target="_blank">how their practice data may look to an auditor</a> at all times. </p><p>You can spend thousands of dollars and hours of time working with a consultant to figure that out, or consider a much less expensive option: you can do it online. </p><p>A new comprehensive set of analytical tools from the AMA helps prepare a medical practice for billing audits by giving a clear picture of physicians’ coding and billing practices. These tools also assist the practice in creating its own individual fee schedule that reflects the costs incurred by the practice and the value it provides.   </p><p>These are the two signature components of the AMA’s Practice Analysis Tools for Healthcare (<a href="http://www.ama-assn.org/go/amapath" target="_blank">AMA PATH</a>™)—and also two processes essential to the health and longevity of any practice. I have touched on evaluating your audit risk; the second—fee schedules—is not an easy one to tackle. </p><p>The key to a realistic fee schedule for any specific medical practice is to understand both the practice’s costs of providing care <em>and</em> the value of those services. Quantifying costs and valuing services can be a challenge. Updating fee schedules periodically is good for the health of the practice.  </p><p>But the process is not easy. AMA PATH™ can help you set your practice’s fees based on solid data. It can help promote trust within the physician-patient relationship—showing the practice’s patients what is being charged and why—and strengthening your back-office performance and oversight. After entering or uploading your practice data into AMA PATH™, it is just like having your own consultant online, on call and available 24 hours a day, seven days a week.</p><p>Physicians can have all of this through the end of next year for only $299. If you’re an AMA member, you can purchase a license to AMA PATH™ through 2011 for $224. But this introductory offer is only for a limited time—from now until December 31. After that, the prices go up. </p><p>What that license gets you is access to all three modules—the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/practice-management-center/ama-path/module-1.shtml" target="_blank">Physician Fee Analyzer</a>, the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/practice-management-center/ama-path/module-2.shtml" target="_blank">Modifier Utilization Analyzer</a>, and the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/practice-management-center/ama-path/module-3.shtml" target="_blank">Procedure Code Utilization Analyzer</a>. </p><p>The Physician Fee Analyzer compares your fees against the cost of delivering services and national average charges for your specialty and general locality, and the Modifier and Procedure Code Utilization Analyzers generate <a href="http://www.ama-assn.org/ama1/pub/upload/mm/368/ama-path-analysis-summary.pdf" target="_blank">reports</a> that compare your coding practices with national coding rankings for your specialty.  </p><p>This is just one example of how the AMA is committed to helping physicians take the lead in responding to calls for price transparency in health care. Using this tool will make it more efficient for individual physician practices to develop and maintain a fee schedule that is based on the practice’s costs and the value it provides. </p><p>If you would like to learn more about how AMA PATH™ works, watch a <a href="https://cc.readytalk.com/cc/playback/Playback.do?id=1k2cca" target="_blank">video explanation</a> of it online or read the AMA’s <a href="http://www.ama-assn.org/ama1/pub/upload/mm/368/ama-path-frequently-asked-questions.pdf" target="_blank">frequently asked questions</a> document. Visit the <a href="http://www.ama-assn.org/go/amapath" target="_blank">website</a> or call (800) 621-8335 to purchase AMA PATH™ to help your practice withstand payer audits and maintain a fee schedule based on the facts of the practice.</p><p>Editor's note: To comment on this post, send us an e-mail.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:939d02cc-537d-4062-adbd-16cbb36674ea Office hours recap: Physicians look to the future, prepare for a new health system http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a2ed020a5-a93b-4144-8122-d582f9fc107d&plckScript=blogScript&plckElementId=blogDest Mon, 11 Oct 2010 13:35:00 GMT <p>Last Wednesday was the fourth of my monthly <a href="http://www.ama-assn.org/go/officehours" target="_blank">Office Hours with Dr. Wilson</a> conference calls. And, as has been the case with previous calls, I found the interaction with AMA members immensely valuable to me in getting a sense of what physicians are thinking.</p><p>There continues to be concern about the Affordable Care Act and the AMA’s rationale for supporting it. There also continues to be a great deal of anger over the lack of a permanent solution for the fatally flawed Medicare physician payment formula, the SGR. However, increasingly, physicians are looking to the future. Their questions are: “How will health system reform effect me and my practice?” and “How can I best prepare myself to compete in a new system?” </p><p>Discussion on the call last week surrounded the difference in payments for hospitals compared with physicians; the future for international medical graduates in the United States, particularly in light of work force shortages; the image of physicians; the challenges of practicing in rural areas; dealing with the challenges of long-term care; and the composition of the Patient Center Outcomes Research Institute.</p><p>In addition, we discussed accountable care organizations and the AMA’s efforts to assure that anti-trust rules are modified to allow physicians in small groups to participate and provide leadership.</p><p>We also discussed <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/arkansas-baptist-health-ruling.pdf" target="_blank">the decision</a> of the Arkansas Supreme Court that Baptist Health, Arkansas’ largest hospital system, acted improperly by inappropriately restricting hospital admitting privileges and interfering with the patient-physician relationship through economic credentialing—<a href="http://www.ama-assn.org/ama/pub/news/news/arkansas-baptist-health.shtml" target="_blank">a big win for medicine</a>.</p><p>The <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.shtml" target="_blank">Litigation Center of the AMA and State Medical Societies</a> and the Arkansas Medical Society intervened in the case in support of physicians who were subjected to Baptist’s inappropriate credentialing policies.</p><p>I also reported to the group that the AMA, together with medical societies representing 50 states and the District of Columbia, as well as 66 national specialty societies, sent <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/medicare-sign-on-letter-29sept2010.pdf" target="_blank">a letter</a> on Sept. 29 urging Congress to act in the first week of its lame-duck session (the week of Nov. 15) to stabilize Medicare physician payments through the end of 2011 while a new payment plan to get rid of the SGR is developed.</p><p>Thanks again to those who have participated in these sessions. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Office hours recap: Physicians look to the future, prepare for a new health system-10-11-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:2ed020a5-a93b-4144-8122-d582f9fc107d A time of transition, an opportunity for improvement http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a6591dca3-94a5-482e-9f29-30af1ee574e3&plckScript=blogScript&plckElementId=blogDest Fri, 08 Oct 2010 14:02:00 GMT <p>For the past year and a half, the AMA has been working with the FTC and the Department of Justice to achieve changes in anti-trust rulings. We want to allow physicians in small groups to work together to participate in <a href="http://www.ama-assn.org/ama/pub/about-ama/2010-strategic-issues/payment-model-resources.shtml" target="_blank">new delivery models</a> associated with the Affordable Care Act, such as accountable care organizations, gain sharing, shared savings and the patient-centered medical home. It has been our contention that existing anti-trust rules, unless modified, will preclude this major segment of physicians in the United States from participating.</p><p>To this end, I met with Jon Leibowitz, chairman of the FTC, when he spoke at the AMA Annual Meeting in June. Leibowitz agreed that changes need to be made and, at the request of the AMA, indicated he would schedule meetings to discuss these issues. </p><p>As a result, on Tuesday, I traveled to CMS headquarters in Baltimore to participate as a panelist in a workshop regarding ACOs and implications regarding anti-trust, physicians self-referral, anti-kickback and civil monetary penalties.</p><p>Opening comments were provided by CMS Administrator Donald Berwick, MD, HHS Inspector General Daniel Levinson and Leibowitz. All three recognized the need for change. The three panels that convened during the day discussed clinical integration and ACOs, encouraging competition among ACOs and HHS waiver authority related to the physician self-referral law.</p><p>Participants in the panels were in remarkable agreement that the new delivery models must involve removal of legal barriers to allow physicians to participate in a leadership role. This includes the establishment of waivers and safe harbors for physicians and legal reforms to allow physicians in all practice sizes and areas of the country to effectively participate in ACOs.</p><p>The AMA is pleased that these agencies are coming together to discuss how physicians can best participate in the new models of care, and we will continue to work with all stakeholders as the rulemaking process moves forward. These models hold promise to improve our health system—but only if physicians are able to effectively participate.</p><p>I am encouraged by this initial indication of understanding of the challenges we face, and I urge the FTC, the CMS and the OIG to work closely with physicians to successfully lead the transition into these new models and ensure the best care possible for patients. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=A time of transition, an opportunity for improvement-10-08-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:6591dca3-94a5-482e-9f29-30af1ee574e3 “Are you still walking?” http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aab2925c1-dda5-458b-990b-895245336af4&plckScript=blogScript&plckElementId=blogDest Thu, 07 Oct 2010 11:57:00 GMT <p>My <a href="http://bit.ly/96ZeXE" target="_blank">post</a> on Monday on the International Conference on Physician Health was a reminder of the importance of one’s own approach to healthy behavior, particularly in the area of physical activity. I walk four miles—an hour daily (when I am at home)—starting at 6 a.m. On weekends, my route is six-and-a-half miles.</p><p>I call the latter the “great circle route.” It is a reflection of my love for sailing and the at-least-partial understanding of the mystery of the Mercator projection for charts used in sailing around the globe—as well as a certain lack of humility about the fact that I am doing what I am doing in the area of exercise.</p><p>My Saturday walk takes me through the Winter Park Farmers Market— the home of a variety of plants and healthy foods, such as fruits and vegetables, as well as temptations, such as fresh-baked bread, cakes, cookies and the usual delicious but fatty array of hot dogs, hamburgers and barbecue.</p><p>Since I do not carry any money on my walks, I am immune at least temporarily from such temptation.</p><p>This has been my routine for many years, and the example it sets is interesting on several levels.</p><p>I do not listen to any audio device while walking and find it a good time to think and frequently plan speeches.</p><p>In addition, it is not uncommon to be seeing a patient or attending local meetings or parties and have someone say they saw me walking or ask if I am still walking.</p><p>So, in addition to the value I receive from my exercise, there is the realization that an example is being set for others. And the notices and comments push me to continue exercising so I can in the future answer in the affirmative when asked:</p><p>Are you still walking?</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Are you still walking?-10-07-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ab2925c1-dda5-458b-990b-895245336af4 Medicine's team triumphs in economic credentialing case http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3abdc1815e-5492-457c-8c52-b661f3edad55&plckScript=blogScript&plckElementId=blogDest Tue, 05 Oct 2010 17:09:00 GMT <p>Napoleon Bonaparte once said: “Victory belongs to the most persevering.” After more than six years of litigation which resulted in a <a href="http://www.ama-assn.org/ama/pub/news/news/arkansas-baptist-health.shtml" target="_blank">big legal win</a> for physicians against Arkansas’ largest hospital last week, I would say these words could not ring any more true.</p><p>For years—after implementing an economic credentialing policy back in 2003—Baptist Health has been threatening the hospital-admitting privileges of medical staff members based on financial concerns. Just as an official would call interference during a pass of a football game, I’m throwing my bright yellow flag at this play.</p><p>This policy has allowed hospitals to interfere in decisions that should be kept between doctors and patients. It is unfair. By using their financial interest to justify policies that interfere with patients’ health care choices, hospitals have been letting the best interest of patients fall by the wayside. </p><p>But on Sept. 30, the Arkansas Supreme Court basically said “not anymore.” The court put a permanent end to such behavior when it <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/arkansas-baptist-health-ruling.pdf" target="_blank">upheld a decision</a> that was made last year by a lower court that the economic credentialing policy was improper. </p><p>Several players joined in on defense to intervene and help support physicians who were subjected to Baptist’s inappropriate credentialing policies. The <a href="http://www.ama-assn.org/go/litigationcenter" target="_blank">Litigation Center of the AMA</a> and State Medical Societies and the Arkansas Medical Society teamed up in the case as plaintiffs, challenging the unfair hospital policy. They argued that the primary factor in credentialing physicians should be competency, not economic factors unrelated to quality.</p><p>I could not agree more. Mark this case down as a big “W” in the record book. Physicians can now offer patients the benefit of choosing a facility that best suits their needs for costs, quality and convenience. But most importantly, we can protect and uphold what’s at the heart of every patient encounter, every health care decision and all of medicine: the physician-patient relationship. </p><p>Do you have a similar story related to this case that you would like to share? E-mail Jim DeNuccio, director of the AMA’s Organized Medical Staff Services and Physicians in Practice, at <a href="mailto:omss@ama-assn.org">omss@ama-assn.org</a> and tell us your situation. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Medicine%E2%80%99s%20team%20triumphs%20in%20economic%20credentialing%20case-10-05-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:bdc1815e-5492-457c-8c52-b661f3edad55 “Physician heal thyself” http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad8cc2b7e-53c8-46e1-ae0e-d1348aac727c&plckScript=blogScript&plckElementId=blogDest Mon, 04 Oct 2010 18:33:00 GMT <p>I had the privilege of being in Chicago yesterday to give the welcoming keynote address to 350 attendees from across the globe at the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health.shtml" target="_blank">International Conference on Physician Health</a>. </p><p>This conference—which takes place every two years—is sponsored by the AMA, the Canadian Medical Association and the British Medical Association. It has existed since 1975 with a goal of highlighting health risks for physicians and promoting a healthier culture of wellness, while reducing the stigma associated with ill health in physicians.</p><p>The purpose of the conference is to emphasize the importance of personal health and chronic disease prevention, defining strategies and building skills to prevent burnout and creating support networks for physicians. It is a forum for practitioners and researchers to present recent findings, innovative treatments and educational programs in the various areas of physician health.</p><p>Physicians face the same diseases and health risks as patients. And, considering the current global environment related to health care and the economy, physicians experience more stress than ever before balancing the demands of practicing medicine.</p><p>As physicians, we prioritize the health of others. Our patients’ health comes first. It is the foremost thing on our minds and why we chose the profession of medicine. One of the more difficult tasks any physician faces is focusing on one’s own personal health.</p><p>Research shows, however, that if a physician adopts a healthier lifestyle—be it increased physical activity, eating better, losing weight, not smoking, limiting alcohol intake—they will be more likely to ask patients the right questions related to those behaviors when they are doing a history and physical.</p><p>In addition, improved physician health helps to enhance patient care. A healthy, mentally alert doctor can better care for his or her own patients.</p><p>So, my prescription: “physician heal thyself.” It’s not only good for you but also good for your patients.</p><p>Evidence shows that the health of physicians and patients are intertwined. Both are important.     </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=“Physician heal thyself”-10-04-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d8cc2b7e-53c8-46e1-ae0e-d1348aac727c Shifts in cardiology call patient care, quality into question http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3afff44107-d38d-48ac-b631-1fbeeaa5327f&plckScript=blogScript&plckElementId=blogDest Wed, 29 Sep 2010 15:15:00 GMT <p>Imagine for a moment a patient who has chest pain or an irregular heartbeat. He or she needs an ultrasound, an EKG or a pacemaker implant. But they cannot get one. This scenario—while it would seem to be unthinkable—has gradually become a reality for some Americans today.</p><p>As a result of Medicare’s fee schedule reductions in payments for cardiology services that took effect on Jan. 1—totaling an 8 percent cut this year and additional cuts to come over the next three years—the practice landscape for cardiologists is changing. </p><p>A new <a href="http://www.cardiosource.org/ACC/Features/ACC-Practice-Census.aspx" target="_blank">American College of Cardiology survey</a> points out that nearly 40 percent of cardiology private group practices are integrating with hospitals or merging with other practices. Meanwhile, 13 percent of all cardiovascular practices are considering hospital integration or a merger in the next three years to help curb the financial burden. And some have stopped practicing altogether.</p><p>While physicians are experiencing these changes now, this trend actually started years ago. The Deficit Reduction Act of 2005 accelerated it. This piece of legislation called for reductions in payments for imaging services provided in physician offices. And it’s important to note that cardiology is just one example of a specialty that is increasingly being employed by hospitals; there are others. </p><p>So where does that leave patients, you might ask? In the hospital—that’s where. Patients are being pushed to hospitals to get the care and the services they need. But with the costs of procedures much higher in the hospital setting, patients are left with higher co-pays, longer turnaround in treatment and increased costs.</p><p>The result can be fatal—and costly. Heart disease kills more than 600,000 Americans each year. It’s the leading cause of death in the United States. And the demand for cardiology services will only increase as baby boomers age, the obesity epidemic grows and people live longer with chronic heart disease.</p><p>But an even scarier thought is what an <a href="http://cardiobrief.org/2009/09/10/acc-survey-finds-critical-shortage-of-cardiologists-now-and-in-the-future" target="_blank">ACC survey</a> found last year. There’s a shortage of more than 3,000 cardiologists in the United States today, and that  number is expected to reach 16,000 by 2050. </p><p>In terms of dollars, the ACC survey revealed that more than 80 percent of cardiology private group practices have taken some form of cost-cutting action—slashing staff and their benefits and salaries—or limiting patient services, such as reducing hours and availability and the number of new Medicare patients.</p><p>The good news is that patients today are surviving heart attacks and living longer with heart disease. Patients are going to need ongoing cardiac care and surveillance to keep this trend going. And the profession will need the unique expertise that cardiologists bring to the table. It is what our patients deserve.</p><p>Do you have a question or a concern you would like to have heard? If so, AMA members can join me for my next “Office Hours” at 7 p.m. Eastern time on Wednesday, Oct. 6. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=mt40duzyupkf" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Shifts in cardiology call patient care, quality into question-09-29-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:fff44107-d38d-48ac-b631-1fbeeaa5327f How’s your handshake? http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a95b4bf3f-a744-48a7-9785-35467d55b993&plckScript=blogScript&plckElementId=blogDest Tue, 28 Sep 2010 16:05:00 GMT <p>Research shows that regular physical activity, even in small amounts, such as walking 30 minutes five days a week, improves health and extends life. And this evidence continues to accumulate -- as does the risk of unhealthy behaviors, such as cigarette smoking, alcohol abuse, obesity and a sedentary lifestyle. </p><p>In addition, researchers are finding innovative ways to assess people based on certain physical activities. One of the most recent comes from a <a href="http://www.bmj.com/content/341/bmj.c4467.full" target="_blank">report</a> published in the <em>British Medical Journal</em> (as reported in the <em>Orlando Sentinel</em> on September 17) by Rachel Cooper of the Medical Research Council. </p><p>In a study pooling existing research data from 33 studies, researchers found that elderly people who could still give a firm handshake and walk at a brisk pace were likely to outlive their slower peers. They found that measures of physical capability, like shaking hands, walking, getting up from a chair and balancing on one leg were related to life span.</p><p>Researchers also found that the death rate over the period of study for people with weak handshakes was 67 percent higher than for people with a firm grip; the slowest walkers were nearly three times more likely to die during the study period than swifter walkers; and the people who were slowest to get up from a chair had about double the mortality rate compared with the quick risers. </p><p>The take-home message: better physical performance is an indicator of better health and a longer life. The possible message for the future -- a firm handshake could be helpful to physicians as a screening tool.</p><p>Pending further proof, I will try to reassure people of my good health by continuing to extend them a firm handshake. </p><p>Do you have a question or a concern you would like to have heard? If so, AMA members can join me for my next “Office Hours” at 7 p.m. Eastern time on Wednesday, Oct. 6. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=mt40duzyupkf" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=How’s your handshake?-09-28-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:95b4bf3f-a744-48a7-9785-35467d55b993 Value of education and knowledge, and desire for caring for others grows stronger over time http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a37f13c35-cafd-45b4-8ca0-809405c83077&plckScript=blogScript&plckElementId=blogDest Mon, 27 Sep 2010 17:57:00 GMT <p>As I <a href="http://bit.ly/aUFqpQ" target="_blank">reported in my blog</a> Friday, I attended a dinner at Emory University School of Medicine in Atlanta during which I was honored by being awarded the Arnall Patz Lifetime Achievement Award. The following are remarks I shared with the group -- remarks which I suspect capture the feelings many physicians have on their own medical school experience: </p><p>I remember it as if it were yesterday.</p><p>Of course, as some of you in this room know, at this time in life it’s the distant -- not the recent -- memory that seems to work so well.</p><p>It was a cool, sunny day in the fall and I walked from the Phi Delt house to the old post office on Clifton road to get my mail.</p><p>There was a white envelope in the box addressed to me. It had an elegantly understated official appearance.</p><p>The letter inside read, “Congratulations, you have been accepted for admission to the Emory University Medical School.”</p><p>And thus continued an association with Emory that started in college and has brought so much pleasure and sense of achievement in my life.</p><p>In medical school, I -- as did many of you in this room -- benefited from being educated by a superb faculty -- nationally recognized -- and by associating with fellow classmates who added to the richness of the experience.</p><p>And if the coin of the realm -- the measure of value -- then was excellence in education, a quest for knowledge, an understanding of the importance of questioning -- of seeking proof -- and a concern for caring for others, that coin has continued to grow in value over my life in practice and what I am doing now as president of the American Medical Association. </p><p>The value I received in my education at Emory has continued to grow as Emory has achieved greater and greater heights as a world renown institution, and I have been and continue to be proud to be associated by saying I graduated from Emory.</p><p>So tonight I am proud to receive this award named after another alumnus of Emory, Dr. Arnall Patz, and humbled by this honor. </p><p>Thank you very much.</p><p>Do you have a question or a concern you would like to have heard? If so, AMA members can join me for my next “Office Hours” at 7 p.m. Eastern time on Wednesday, Oct. 6. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=mt40duzyupkf" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Value of education and knowledge, and desire for caring for others grows stronger over time-09-27-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:37f13c35-cafd-45b4-8ca0-809405c83077 One doctor’s achievements offer inspiration to the medical community http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a765519f4-dd8e-4556-905e-56d6ba8d70f5&plckScript=blogScript&plckElementId=blogDest Fri, 24 Sep 2010 17:08:00 GMT <p>Last night I participated in the Future of Medicine Summit IV, sponsored by the Palm Beach County Medical Society, in Boca Raton, Fla. This is an outstanding community forum that looks at health care and how it impacts the citizens of Palm Beach. My role was to share the AMA’s plans for being actively involved in the implementation of the Affordable Care Act.</p><p>This evening I will be in Atlanta to receive a lifetime achievement award from my alma mater, the Emory University School of Medicine. This is a signal of honor for me of which I am most appreciative.</p><p>Perhaps, however, the more salient fact is that the award is the Arnall Patz Lifetime Achievement Award, named after another graduate of Emory. Dr. Patz grew up in Georgia and, after graduating from the Emory School of Medicine, served in the Army at Walter Reed Army Medical Center and subsequently became an ophthalmologist.</p><p>Dr. Patz is best known for his pioneering research that prevented blindness in countless premature babies. Before his discovery about two-thirds of all cases of childhood blindness were caused by an overgrowth of blood vessels or retinopathy of prematurity (ROP).</p><p>Dr. Patz believed that giving premature infants high doses of oxygen (a recognized treatment at the time) could cause blindness. This was considered a dangerous idea in the late 1940s. He applied for a National Institutes of Health grant to study that hypothesis but was turned down for ethical reasons. One grant reviewer wrote that “these guys are going to kill a lot of babies by anoxia to test a wild idea.”</p><p>Dr. Patz later borrowed money from his brother to run a study, which found that seven of 28 babies who received high doses of oxygen experienced severe ROP. None of the group receiving low oxygen doses had damaged eyesight. He was able to design a trial involving 18 hospitals—the first controlled trial in ophthalmology—and its data changed the course of treatment for premature babies. When the old treatment of ROP was dropped, the number of blind children in the Unites States immediately fell by 60 percent.</p><p>Dr. Patz’s story reflects well on him and Emory—and U.S. medicine. I am honored to be associated in this way by receiving an award named after him. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=One doctor’s achievements offer inspiration to the medical community -09-24-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:765519f4-dd8e-4556-905e-56d6ba8d70f5 Alzheimer's—raising awareness, managing a widespread disease http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a6a994fd5-fe40-4bc0-acce-0d520517b53a&plckScript=blogScript&plckElementId=blogDest Tue, 21 Sep 2010 20:54:00 GMT For the first time in more than 25 years, medical experts are updating the diagnostic guidelines for Alzheimer’s disease. I read this update last month in an <a href="http://www.ama-assn.org/amednews/2010/08/09/prl10809.htm"><em>American Medical News</em> article</a> that depicted <a href="http://www.alz.org/research/diagnostic_criteria" target="_blank">the possible changes</a>. They aim to help physicians diagnose patients with the disease who do not always “fit the definition” and know what signs to look for early on.    <br /><br />More than 5 million Americans have Alzheimer’s disease—the majority of those cases being the elderly. And that number is expected to reach 13.5 million by 2050. What’s more, Alzheimer’s is the seventh leading cause of death in the United States. <br /><br />With numbers of that magnitude and an outcome so serious, this is one topic that deserves a lot of attention—particularly from physicians.<br /><br />Yesterday was <a href="http://www.alz.org/news_and_events_world_alzheimers_day.asp" target="_blank">World Alzheimer’s Day</a>. As many of my regular blog followers know, I’m a big advocate for exercise and physical health. Therefore, I was pleased to see that one main event surrounding the “day” was the culmination of a 67-day, 4,500-mile cross-country bike ride by researchers from San Francisco to Washington, D.C., to help raise awareness of the disease. <br /><br />But more importantly are the people—the caretakers, the patients, their families—who were touched by this outreach of knowledge. And while awareness is absolutely critical, the need for more education, support and research among the medical community is just as important. And that’s where the AMA comes in. <br /><br />In March, the AMA launched an online program specifically for physicians—“<a href="http://www.ama-assn.org/ama/pub/education-careers/continuing-medical-education/cme-credit-offerings/therapeutic-insights/management-alzheimers-disease.shtml">Management of Alzheimer’s Disease</a>”—which features an overview of evidence-based treatment guidelines combined with an insightful look at current pharmacotherapy based on data from more than 1 million Alzheimer patients. The program is part of <a href="http://www.ama-assn.org/go/therapeuticinsights">AMA <em>Therapeutic Insights</em></a>, a free online quarterly newsletter featuring a different disease in each issue. And as an added bonus, every issue offers continuing medical education credit to physicians.<br /><br />The AMA also has an entire program focused on “aging and community health,” which offers resources on <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/older-driver-safety.shtml">older driver safety</a>, <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/dementia.shtml">dementia</a> and <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/geriatric-health/caregiver-health.shtml">caregivers</a>. The program looks to make sure patients have access to safe, high-quality medical management and oversight. It also aims to ensure that physicians are proficient in geriatric care principles and practices when caring for their patients. <br /><br />Alzheimer’s presents many challenges for physicians, for patients, for the caretakers. Let’s do our part—learning, public outreach, educating others—to help these patients help themselves. <br /><br />Do you have a question or a concern you would like to be heard? If so, AMA members can join me for my next “Office Hours” at 7 p.m. Eastern time on Wednesday, Oct. 6. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=mt40duzyupkf">Register today</a>.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Alzheimer%27s,%20raising%20awareness,%20managing%20a%20widespread%20disease-09-21-20102009" target="_blank">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:6a994fd5-fe40-4bc0-acce-0d520517b53a Tell me what you think: Register for my next “Office Hours” October 6 http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a81dae7ff-7fa8-4b90-b012-c8771dcdab62&plckScript=blogScript&plckElementId=blogDest Tue, 21 Sep 2010 13:57:00 GMT <p>Nearly 200 people, about 30 questions and a mere three hours later, I am preparing for my <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=mt40duzyupkf" target="_blank">fourth “Office Hours” conference call</a> with physicians from across the country. This is the number of people who have registered and the number of questions that I have been able to answer—all in, what I view, a short amount of time—during my “Office Hours with Dr. Wilson.” </p><p>Being able to talk directly with AMA members, hear their concerns and pass those concerns on to the AMA Board of Trustees and staff has proven absolutely invaluable to me and AMA leadership in gaining a sense of what physicians think, the questions they have and the information they need. </p><p>From private contracting and the cost of medical education to tort reform, scope of practice and physician work force issues, we’ve covered more in my first three calls than I could have ever done in a trip to a state medical association, in one post on my blog or in a speech to an audience full of physicians and students.  </p><p>Months ago—when I set out to do this—I wanted AMA members to be able to provide input into what and how the AMA was doing things. That goal has not changed. </p><p>The bottom line is this: I want to hear from every single one of you. I want the total number of people participating on these calls to grow exponentially over the next few months, because until I hear from all AMA members, my job is not done.</p><p>This is your opportunity to tell me what you think. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=mt40duzyupkf" target="_blank">Register for my next “Office Hours” call</a> at 7 p.m. Eastern time on Wednesday, October 6. I look forward to listening to what you have to say.  </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Tell me what you think: Register for my next “Office Hours” October 6-09-21-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:81dae7ff-7fa8-4b90-b012-c8771dcdab62 Growing number of uninsured reminds us that reform law is a first step -- not the last http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3acc7e08c7-5290-4ad4-bb18-3f9a5d7ae922&plckScript=blogScript&plckElementId=blogDest Mon, 20 Sep 2010 17:24:00 GMT <p>Last week, we were reminded why this country spent so much time over the past year struggling with the imperative for and ultimately enacting legislation that represents the first step in health system reform. </p><p>The U.S. Census Bureau reported that in 2009 the number of uninsured in this country had risen to an all-time high of 50 million, or almost one in six U.S. residents. This compares with 46 million in 2008.</p><p>The increase is related to multiple causes, including the decrease in employers offering insurance for their employees and especially the increasing cost of medical care. The latter means that workers pay 47 percent more now than they did in 2005 and employers pay 20 percent more. And all of this has been compounded by the recession with families losing their jobs and going without health care coverage to cut costs.</p><p>The Affordable Care Act is expected to provide help by increasing coverage to 32 million who are currently without, and protecting those with insurance by prohibiting denials of coverage due to pre-existing conditions or lifetime caps. This relief, however, will phase in over the next four years, and we can expect things to get worse before they get better.</p><p>These numbers are a timely reminder that our focus going forward should be to ensure that the measures in the Affordable Care Act are implemented in a timely, careful and expeditious way.</p><p>As the AMA has said, the law is not perfect; but it is a significant first step. There are things in the law that need to be changed, such as the Independent Payment Advisory Board. And there are other issues that are not in the law but urgently need to be addressed, such as the egregious Medicare physician payment formula that is threatening access to care for seniors, families of our active duty military and baby boomers who will start entering Medicare next year.</p><p>Do you have a question or a concern you would like to be heard? If so, AMA members can join me for my next “Office Hours” at 7 p.m. Eastern time on Wednesday, Oct. 6. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=mt40duzyupkf" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Growing number of uninsured reminds us that reform law is a first step -- not the last-09-20-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:cc7e08c7-5290-4ad4-bb18-3f9a5d7ae922 “Not every difference of opinion is a difference of principle” http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aba855644-b19c-46df-9925-bf9628d462ec&plckScript=blogScript&plckElementId=blogDest Fri, 17 Sep 2010 14:19:00 GMT <p>Last weekend I left the confines of Central Florida, where we are still “enjoying” sunny, hot and humid weather (temps in the 90s), to attend the annual meeting of the Maine Medical Association (MME) in Bar Harbor. It was sunny in Maine but the temperatures were delightfully cool and comfortable. And considering much of the rhetoric that surrounds discussions about health system reform in some parts of the country, the discussions were remarkable for demonstrating qualities of civility and thoughtfulness.</p><p>A highlight of the meeting was a forum attended by all five gubernatorial candidates in Maine. This was the first time during the campaign all five have been assembled in one room. The MME had prepared a list of questions that each of the candidates was asked to answer. </p><p>The questions were focused exclusively on health-related issues, such as smoking prevention, prenatal care, health care for children, prescription drugs for the disabled, dental care for low-income persons, substance prevention and treatment, and comprehensive school health and nutrition programs.</p><p>In addition, there were questions on environmental issues and the health effects of global warming, dealing with the epidemic of obesity, increasing physical activity in schools, risks of suicide among high school students and attracting physicians to serve in rural areas of Maine.</p><p>The candidates were asked to say how they would address such public issues if elected governor. Their responses were thoughtful, responsive to the questions and devoid of demagoguery and attacks on each other.</p><p>It was Thomas Jefferson who said, “Not every difference of opinion is a difference of principle.” Based on the experience of my weekend in Bar Harbor, Maine’s doctors, candidates for governor and citizens understand that very well. It would be good if that attitude could go “viral” across the country.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Not every difference of opinion is a difference of principle-09-17-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ba855644-b19c-46df-9925-bf9628d462ec Women physicians: Thank you for your contributions to the profession http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3af1f0349d-c0e3-4280-b944-a7a1640f03d2&plckScript=blogScript&plckElementId=blogDest Thu, 16 Sep 2010 17:10:00 GMT <p>Ever since Elizabeth Blackwell became the first woman to graduate from medical school—dating back to January 23, 1849—women have played an integral role in medicine. </p><p>Having said that, I would like to take a moment to commemorate these influential leaders as part of <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-congress/women-medicine-month.shtml" target="_blank">Women in Medicine Month</a>. The AMA has been celebrating women in medicine every September now for more than 30 years. This time is dedicated to recognizing the growing number of women physicians in the profession and their communities and the endless commitment they have shown to help enhance the health of the public—not only this month but throughout the year. </p><p>On an individual level, the AMA Women Physicians Congress hosts its <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-congress.shtml" target="_blank">Physician Mentor Recognition Program</a> each year. This program allows men and women to nominate someone in their lives, either a man or a woman, who has been a “mentor” for them and say “thank you.” Regardless, they are all giving back to the profession in countless ways and making a difference in the lives of so many.</p><p>Speaking of making a difference, the <a href="http://www.ama-assn.org/go/wpc" target="_blank">AMA-WPC</a> now represents more than 64,000 women and men who are working on real issues and challenges that face women physicians and medical students every single day. If you would like more information, or if you would like to nominate your mentor, <a href="mailto:wpc@ama-assn.org" target="_blank">e-mail the AMA-WPC</a>. </p><p>And before you leave your office today, take a moment to say thanks to those women physicians who have selflessly dedicated their lives to the art and science of medicine and making this world we live in a healthier, happier place. </p><p>We certainly could not do it alone—just another example of how together, we are stronger. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Women physicians: Thank you for your contributions to the profession-09-16-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:f1f0349d-c0e3-4280-b944-a7a1640f03d2 Breaking ground on delivery and payment reforms: get educated and involved and take time to assess http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a5ea1a3d2-e0a0-428d-a33e-70eb2b524dcc&plckScript=blogScript&plckElementId=blogDest Tue, 14 Sep 2010 16:11:00 GMT <p>Accountable care organizations (ACOs), bundling, gainsharing, the patient-centered medical home—these reflect the current mantra related to health care delivery reform. These terms have been gaining visibility over the past few years. The Affordable Care Act contains provisions that will accelerate the process of determining whether they offer an avenue to a health care delivery system that responds to the needs of physicians and patients for a high-quality, more rational and efficient system.</p><p>It is critically important that physicians be active participants in determining how these alternative delivery models are formed. It is not clear, for example, as to what the formula for ACOs will be. It is clear, however, that there should be a diversity in structure that reflects the needs of a variety of geographic and clinical settings around the country. And physicians and patients will not be well served if the only model is one that is hospital-dominated. Physicians should be leaders.</p><p>Here is my prescription for all physicians who are looking at these changes:</p><p>First, <a href="http://www.ama-assn.org/go/paymentpathways" target="_blank">look to the AMA</a>. The AMA is developing resources for physicians to help turn challenging new payment models into opportunities for physician-led patient-centric care, improved practice efficiencies, better coordination between specialist and primary care, and better margins. Read the AMA’s white paper, “<a href="http://www.ama-assn.org/ama1/x-ama/upload/mm/399/payment-pathways.pdf" target="_blank">Pathways to Physician Success Under Healthcare Payment and Delivery Reforms</a>,” written by Harold Miller, a nationally recognized expert on ACOs. And stay tuned to the AMA’s weekly electronic newsletters, <a href="http://www.ama-assn.org/go/amawire" target="_blank"><em>AMA Wire</em></a> and <a href="http://www.ama-assn.org/go/insight" target="_blank"><em>HSR Insight</em></a>, for the latest developments and AMA events on new payment models. </p><p>Second, be engaged. The AMA is conducting webinars and regional seminars specially for physicians, featuring leaders on this topic. The next one—“Pathways to success: What physicians need to know about the coming revolution in payment practices”—will be held from 10 a.m. to 3 p.m. Eastern time September 28 in New York. There’s still time and space, so <a href="http://www.ama-assn.org/ama/pub/about-ama/2010-strategic-issues/payment-model-resources/payment-pathways-cme.shtml" target="_blank">register today</a>. </p><p>In addition, a workshop will be held October 5 at the Centers for Medicare & Medicaid Services’ (CMS) headquarters in Baltimore that focuses on the issues surrounding ACOs. This will be hosted by the Federal Trade Commission, CMS and the Department of Health and Human Services. This developed as a result of recommendations the AMA made to FTC Chairman Jon Leibowitz during the Annual Meeting of the AMA House of Delegates in June. I will be participating in one of the stakeholder panels at the workshop.  </p><p>Third, take time to evaluate your own situation. The AMA provided advice on ACOs in an August 12 <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/ama-letter-cms-acos.pdf" target="_blank">letter</a> to CMS and during a June 24 listening session on ACOs convened by CMS.</p><p>Harold Miller pointed out during his July 12 presentation that no single organizational structure is inherently better able to deliver accountable care or manage new payment structures than any other. The key, he said, is whether there is clinical integration, leadership and adequate management skills. I could not agree more.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Breaking ground on delivery and payment reforms: get educated and involved and take time to assess-09-14-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:5ea1a3d2-e0a0-428d-a33e-70eb2b524dcc We must fix the broken formula in order to then fix the system http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a123a861f-7cf5-4947-836b-f498cd857452&plckScript=blogScript&plckElementId=blogDest Fri, 10 Sep 2010 16:17:00 GMT <p>In an August 23 <em>Annals of Internal Medicine</em> article, titled “<a href="http://www.annals.org/content/early/2010/08/23/0003-4819-153-8-201010190-00274.1.full?aimhp" target="_blank">The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges</a>,” the authors— Robert Kocher, MD, Ezekiel Emanuel, MD, and Nancy-Ann DeParle (members of the Obama administration)—describe in some detail the component parts of the health system reform law.</p><p>I believe they accurately report the ACA by stating that it “…is a once-in-a generation change to the U.S. health system.” They also point out that economic forces put in place by the act will likely “accelerate physician employment by hospitals and aggregation into larger physician groups.” </p><p>The reality, as practicing physicians know, is that these changes have already been under way. The acceleration of the change means it is even more important that physicians prepare themselves to be leaders, not the objects of change.</p><p>What I take strong exception to in the article is the part where authors state: “The uncertainty surrounding the sustainable growth rate policy is a distraction and potentially a barrier for some physicians to embrace the Affordable Care Act. But physicians should not let their frustration over the sustainable growth rate distract them from the improvements that health care reform delivers to their patients and the profession.”</p><p>This statement is breathtaking in its lack of knowledge of medical practice and understanding of the importance of stable federal programs (Medicare and Medicaid) to successful health system reform. </p><p>It is more than a distraction when Medicare physician payments are the same as in 2002 while inflation has increased the cost of providing care by 22 percent. </p><p>It is more than a distraction when physicians are unable to make plans for their business because they are threatened yearly by cuts in pay—23 percent December 1 if Congress does nothing and another 6.3 percent January 1. </p><p>It is more than a distraction when seniors are increasingly finding it difficult to find a doctor who can afford to take new Medicare patients because Medicare only pays 52 percent of the direct costs of running a practice—and the first wave of baby boomers entering the program in 2011 will accelerate problems with issues of finding access to care.</p><p>Medicare is the driver for many of the health care delivery changes in the new health system reform law. The current payment system erodes Medicare’s physician foundation and harms seniors’ health care. Fixing the broken payment formula is essential to the success of health system reform.</p><p>The disparaging tone expressed toward physicians in the Annals article did not advance the goal we all look toward: improving our health care system so it works better for physicians and the patients in their care.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=We must fix the broken formula in order to then fix the system-09-10-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:123a861f-7cf5-4947-836b-f498cd857452 We need tort reform—not a tax deduction for lawyers http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a66e6acdc-899d-4d69-aa08-74a30c06bc7a&plckScript=blogScript&plckElementId=blogDest Thu, 09 Sep 2010 14:16:00 GMT <p>This is another one of those “what in the world are they thinking?” discussions. </p><p>In late July, the AMA became aware of reports out of the U.S. Treasury Department that the IRS is considering a change in tax policy to allow attorneys to deduct certain litigation costs as business expenses. </p><p>In current contingent fee cases, lawyers’ up-front costs are considered loans to clients and not deductible unless the lawsuit fails (meaning there is no award to the plaintiff) and the loan is not paid back. While a 1995 decision by the Ninth Circuit Court determined that lawyers should be allowed to deduct those expenses in the year incurred, this ruling applies only to a few Western states.</p><p>It is not clear if, how or when such a policy change would become effective, but the IRS could issue guidance to its field agents without going through any formal rulemaking procedure. This would mean there would be no opportunity for public comment.</p><p>The AMA has been in contact with the Treasury Department, starting with a July 28 meeting, at which time the Treasury staff acknowledged that a change in policy was being considered. Last week, the AMA issued a <a href="http://www.ama-assn.org/ama/pub/news/news/oppose-tax-changes.shtml" target="_blank">press release</a> and, along with 90 other medical organizations (including state and specialty societies), sent a <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/attorney-tax-deduction-sign-on-letter.pdf" target="_blank">letter</a> to Treasury Secretary Timothy Geithner expressing strong objections to the proposed change.</p><p>If we change the tax policy, allowing trial attorneys to deduct court costs and other expenses, it will cost taxpayers $1.5 billion and increase the cost of health care in our nation. So in the end, this change would only encourage trial attorneys to file more lawsuits.</p><p>We will not be well served as a nation by creating new incentives for attorneys to bring lawsuits. A recent <a href="http://www.ama-assn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf" target="_blank">report</a> by the AMA found 95 medical liability claims were filed for every 100 physicians. Currently 65 percent of medical liability claims are dropped,  dismissed or withdrawn. And of claims that go to court, 90 percent result in no finding of liability on the part of the physician. In addition, average defense costs range up to more than $100,000 and take physicians away from patient care.</p><p>Those who are injured should be compensated expeditiously and fairly. The current tort system does neither. And the fear of going to court forces physicians to practice “defensive medicine” to protect themselves from meritless lawsuits—a practice that the U.S. government estimates adds $70 to $126 billion annually to the cost of health care.</p><p>What is needed is not another tax deduction for lawyers. What is needed is reform of the tort system to better serve those who have been injured and to protect physicians from being faced with meritless claims. </p><p>As our nation works to reduce the growth in health care costs, it is clear that medical liability reform must be part of the solution. The Obama administration must keep this on its agenda for change. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=We need tort reform—not a tax deduction for lawyers-09-09-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:66e6acdc-899d-4d69-aa08-74a30c06bc7a Collect your share of $350 million; start filing your claim now http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a79dcc061-98ff-4549-b428-657187366412&plckScript=blogScript&plckElementId=blogDest Tue, 07 Sep 2010 20:39:00 GMT While the deadline for physicians to file for their portion of the $350 million UnitedHealth Group settlement is Oct. 5, the <em>time </em>to file is now. This is one of the largest, if not <em>the </em>largest, settlement ever involving a single health insurer. <br /><br />My colleague, AMA Immediate Past President J. James Rohack, MD, wrote an excellent synopsis of how the settlement transpired in one of his <a href="http://www.ama-assn.org/ama/pub/news/newsletters-journals/ama-evoice-weekly-newsletter/evoice-04jun2010.shtml">final columns</a> as AMA president. Dr. Rohack’s summary recounted the efforts of <a href="http://www.ama-assn.org/go/litigationcenter">the Litigation Center of the AMA and State Medical Societies</a> to stop UnitedHealth’s scheme of artificially low payments on what should have been usual, customary and reasonable, or UCR, reimbursement rates for out-of-network services.<br /><br />That brings me to where we, as physicians, are—or should be—today. Hopefully you have already determined or at least thought about whether someone is going to file on your behalf. You’ve decided if you are eligible. <br /><br />A key step at this stage in the game is asking the settlement claims administrator for a copy of the defendant’s report. This report indicates the covered out-of-network services and supplies provided to patients from Jan. 1, 2002, to May 28, 2010. It’s a starting point for the claims filing process and can save a tremendous amount of time that would otherwise have to be invested in compiling all of the information from scratch. <br /><br />Receiving the report may take a number of weeks. That’s why it’s so important to start <em>now</em>. <br /><br />This process is not a piece of cake. And it’s not something with which physicians have had much experience. The AMA can help with its “<a href="http://www.ama-assn.org/ama1/pub/upload/mm/368/uhg-step-by-step.pdf" target="_blank">Step-by-step guide to maximizing your recovery from the UnitedHealth settlement</a>.” It details the entire process from determining eligibility and requesting the report to documenting and submitting a claim. <br /><br />The guide is part of a collection of resources that can help in filing claims. In addition, the <a href="http://www.ama-assn.org/go/ucrsettlement">AMA’s Practice Management Center</a> offers an educational webinar and a comprehensive list of <a href="http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/health-insurer-settlements/unitedhealth-ucr-settlement/frequently-asked-questions.shtml">frequently asked questions</a> to help physicians navigate the course. <br /><br />Time is running out to be part of the settlement. My prescription: don’t miss the boat!<br /><br />AMA members who need additional help can call the AMA Practice Management Center at (800) 621-8335. <br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Collect your share of $350 million, start filing your claim now-09-07-2010">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:79dcc061-98ff-4549-b428-657187366412 Office Hours recap: We must work together to protect interests of patients, physicians http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a3b95bf52-ba33-4937-ad41-0d7b5e44656c&plckScript=blogScript&plckElementId=blogDest Tue, 07 Sep 2010 15:31:00 GMT <p>Last week, on Sept. 1, I was in Washington for a meeting at the Centers for Medicare & Medicaid Services and that evening participated in my third Office Hours with Dr. Wilson. As has been the case in the first two of these calls, I found the hour a very helpful opportunity to talk to AMA members about what they find important.</p><p>During the first part of the session, I provided brief descriptions of the AMA’s amicus brief in support of the American Bar Association lawsuit against the so-called “red flags” rule and the Current Procedural Terminology® (CPT®) program initiated in 1966 by the AMA, which has since become the code set of choice for insurance claims filing in this country. </p><p>I also gave an update on the status of the work by two AMA-convened task forces: the SGR strategy development group and the group working on draft private contracting legislation called for by the AMA House at its June meeting. Each of these groups includes representatives from state and national specialty societies.</p><p>Questions from those on the call reflected what I hear from physicians across the country. There is continued concern about the lack of significant medical liability reform and the need for a permanent fix to the Medicare physician payment formula (SGR) within the Affordable Care Act. Success in addressing each of these issues is essential for meaningful health system reform, and they remain high priorities for the AMA.</p><p>A number of physicians had questions about how planned changes in the delivery system for health care will affect them. These included concerns about the future of private practice, especially solo and small groups, physician profiling, credentialing, fee-for-service, accountable care organizations, the patient-centered medical home, bundling payments, gain-sharing and the move toward health information technology, particularly the implementation of electronic health records.</p><p>Additionally, some questions reflected an understanding that the current work force shortage in this country will be exacerbated by the need for access by those 32 million who over the coming four years will have health insurance as a result of the ACA. Concerns in this area relate to how we expand the physician work force by increasing the number of medical students as well as residency positions; how that will be financed; and how these issues affect internationally trained physicians in the United States.</p><p>I provided answers to each of these questions; the AMA will be working to protect the interests of physicians and their patients. The takeaway message from such a list, however, should be that we as physicians must be leaders in bringing our expertise and leadership (after all we take care of patients) as these changes are planned and put in place. To do that effectively we must be united—working together. To do less means others will divide us—not for our own good—but for theirs.</p><p>If you are an AMA member and would like to participate in one of my "Office Hours" conference calls, I strongly encourage you to do so. The next one takes place at 7 p.m. Eastern time Wednesday, Oct. 6. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=mt40duzyupkf" target="_blank">Register today</a> for the call. I look forward to hearing from you.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Office Hours recap: We must work together to protect interests of patients, physicians-09-07-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:3b95bf52-ba33-4937-ad41-0d7b5e44656c Communication leads to endless road of possibilities http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a81bd3aed-a39e-4147-b79f-9cdf5a0511d5&plckScript=blogScript&plckElementId=blogDest Fri, 03 Sep 2010 14:29:00 GMT <p>If someone would have told me years ago that I would one day be blogging, I probably would have laughed. Of course, years ago there was no such thing as a blog. But here I am—nearly three months into my AMA presidency—writing to you, to physicians and to the entire medical community nationwide.</p><p>And I have to say, I am first pleased that I was willing and able to take a leap of faith into this social media craze that generations—much younger than mine—have been talking about and mastering for years. But second, and most importantly, I’m pleased about the impact that something as simple as a blog can have on one very significant component of humanity: communication.</p><p>From telegraphs, telephones and radios, to newspapers, TVs and computers, and to today’s smartphones and iPads, the methods we use to communicate are varied. But regardless of the means, the most important piece is that we are, in fact, communicating.</p><p>Physicians and those within the medical profession probably realize this need better than anyone. As those who care for patients, it is such a vital component of our day-to-day lives. And it is essential that in these roles, we remain informed, engaged and updated on news and happenings in the medical profession and the health care realm. That’s why the AMA has made physician communication and engagement such a priority.</p><p>In fact, next week—on Wednesday, Sept. 8—the AMA will launch its new weekly electronic newsletter, <em>AMA Wire</em>. Readers can scan the week’s top stories, AMA resources and a weekly blog message from me. If you receive AMA eVoice now, you’ll get <em>AMA Wire </em>starting next Wednesday.</p><p>Also this month, AMA members—physicians and medical students alike—should watch their mailboxes for a new print publication, <em>AMA Advantage</em>. Specifically for AMA members, this resource guide puts products, services and information about the business of medicine, medicine and public health, legal and health policy and professional development in the hands of physicians and medical students to help them move their careers and practices forward.</p><p>As always, physicians can read the latest in clinical science each week from <em><a href="http://www.jama.com/" target="_blank"><em>JAMA</em></a></em>, the most widely circulated medical journal in the world. Check out the top medical stories twice monthly in print from <em>American Medical News</em><em>,</em> the AMA’s award-winning newspaper, and daily at its website, <a href="http://www.amednews.com" target="_blank">amednews.com</a>. Get a daily dose of health policy, medicine and pharmaceutical news all in one e-mail news briefing, <em><a href="http://www.ama-assn.org/go/morningrounds" target="_blank"><em>AMA Morning Rounds</em></a></em>. </p><p>And stay engaged by following the AMA on <a href="http://www.facebook.com/AmericanMedicalAssociation" target="_blank">Facebook</a> or <a href="http://www.twitter.com/AmerMedicalAssn" target="_blank">Twitter</a>, or by joining me in one of my monthly Office Hours with Dr. Wilson conference calls. I held my third one earlier this week. Look for a recap of what happened on the call in my blog next Tuesday, Sept. 7. And, AMA members, I hope you’ll join me for the next “Office Hours” at 7 p.m. Eastern time Wednesday, Oct. 6.</p><p>Communication: without it, society as a whole would not be able to function; with it, the possibilities are endless.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Communication leads to endless road of possibilities-09-03-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:81bd3aed-a39e-4147-b79f-9cdf5a0511d5 Health reform law supports quality, patient safety http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aab60397f-be00-4820-be9e-5c356dee7653&plckScript=blogScript&plckElementId=blogDest Thu, 02 Sep 2010 16:01:00 GMT <p>The Affordable Care Act passed into law in March represents a significant first step toward meaningful health system reform. However, as the AMA has consistently pointed out, it is not perfect and there is work to be done to make it better serve the American people. In the coming months, the AMA will be hard at work to make those changes. </p><p>However, some criticisms of the law do not stand up well under the microscope of truth. In a <em>Wall Street Journal</em> op-ed yesterday, Hal Scherz, MD, asserts that the law “politicizes medicine and in my opinion destroys the sanctity of the doctor-patient relationship.” He further states that the law “effectively makes [doctors] government employees. ...” These are recycled arguments we have heard frequently during the health reform debate.</p><p>In his claims, Dr. Scherz makes reference to Section 1311 of the law as the culprit. This section actually includes the provisions for establishing state health insurance exchanges and establishing minimum criteria for the certification of qualified health plans. These include requirements that health plans implement a quality improvement strategy that provides for:</p><p>1. Improving health outcomes through the implementation of activities that include quality reporting, effective case management, care coordination, chronic disease management, and medication and care compliance initiatives through the use of the medical home model.<br />2. Implementation of activities to prevent hospital readmissions through a comprehensive program for hospital discharge planning.<br />3. Implementation of activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence-based medicine and health information technology.<br />4. Implementation of wellness and health promotion activities.<br />5. Implementation of activities to reduce health and health care disparities through the use of language services, community outreach and cultural competency training.</p><p>Dr. Scherz clearly believes that these quality improvement provisions represent a threat to the traditional patient-physician relationship.</p><p>The AMA comes to a different conclusion. We are committed to the development of quality improvement initiatives that increase the quality of care provided to patients and are actively involved in this arena, through legislative and regulatory advocacy, the <a href="http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/physician-consortium-performance-improvement.shtml" target="_blank">Physician Consortium for Performance Improvement</a> and the <a href="http://www.standforquality.org/" target="_blank">Stand for Quality Coalition</a>. And, as I noted, we continue to work to ensure that this law serves the best interests of physicians and their patients.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Health reform law supports quality, patient safety-09-02-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ab60397f-be00-4820-be9e-5c356dee7653 Report about AMA involvement in health reform events is untrue http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aded0c859-ac8c-4442-9ea2-ebd2f81cc4e5&plckScript=blogScript&plckElementId=blogDest Fri, 27 Aug 2010 19:40:00 GMT I have been told on more than one occasion, “don’t believe everything you read.” I had to remind myself of that sentiment earlier this week when I read an item in the beltway publication Politico stating that the AMA is working with the White House to plan events next month to mark the six-month anniversary of the passage of health system reform legislation.<br /><br />The report is 100 percent false and has no merit. The AMA is planning no such events. Our efforts have been and will continue to be focused on <a href="http://www.ama-assn.org/ama/pub/health-system-reform/resources/insight.shtml">educating physicians and patients</a> about the new law and what it means to them.<br /><br />The <em>Politico </em>piece was based on an earlier story appearing in the <em>Los Angeles Times</em> that reported a nationwide multimillion-dollar ad offensive being organized in consultation with the White House and aimed to support vulnerable Democrats in swing districts who backed the health system reform legislation. The article could lead one to believe that the AMA is involved in these efforts—we are not.<br /><br />In fact, when contacting the White House to inquire about the story, officials there said they were not coordinating any big ad campaign and that “outsiders” were the source of the story.<br /><br />The AMA contacted both publications to set the record straight, but inaccurate information about the AMA’s efforts has already been disseminated. It’s unfortunate that health system reform remains so politicized, but it’s a fact not likely to change anytime soon. I will continue to use this blog to try to set the record straight.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Report about AMA involvement in health reform events is untrue-08-27-2010">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:ded0c859-ac8c-4442-9ea2-ebd2f81cc4e5 CPT: the gold standard for coding http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3aa757867e-1593-4bc2-a003-472f47124e96&plckScript=blogScript&plckElementId=blogDest Thu, 26 Aug 2010 21:02:00 GMT Physicians know that three simple letters -- CPT® -- describe a code set and that <em>Current Procedural Terminology</em> (CPT®) makes it possible for communication between physicians and insurance companies about services rendered. Using a CPT® code, physicians can file an insurance claim and identify that an appendectomy was performed or Strep pharyngitis was treated and the insurance company knows what services to pay for.<br /><br />The CPT® code is to the health care industry what a dictionary is to the publishing industry.<br /><br />What is not known and what is surrounded in mystery and sometimes misperception and falsehood is where CPT® codes came from and how they are maintained.<br /><br />In 1966, the AMA established CPT® codes and they were subsequently and voluntarily adopted in the United States as the code set of choice for insurance claims filing. This meant that physicians could use one code set regardless of the insurance payer. In 1983, the AMA House of Delegates voted to have CPT codes adopted as Medicare’s official terminology. <br /><br />The association later finalized an agreement with the Health Care Financing Administration, now named the Centers for Medicare & Medicaid Services, to adopt CPT® for reporting physician services under Medicare and related programs. This agreement is not exclusive (CMS could sanction other code sets) and not binding on private insurance companies. And the AMA derives no income from the federal government for the agreement.<br /><br />The CPT® codes are physician developed and maintained. A CPT® Editorial Panel made up of physicians from different specialties guides the process, and an advisory panel that includes 90 physician specialty societies and 16 non-physician health care societies assures that the codes are up to date and new codes are developed as needed. Code change proposals are submitted by the physician and non-physician societies and by individual physicians around the United States. Codes for the H1N1 influenza vaccine last year are an example of new codes and modifications of old codes that are made every year.<br /><br />The financial resources invested in the development and maintenance of the CPT® codes has been provided solely by the AMA. The AMA in turn sells and licenses the CPT® codes for use in other publications, and uses the funds received to assist important programs in support of the medical profession. Physicians using CPT® codes are employing a tool that is essential for filing claims and supporting the work of the AMA in advocating for physicians.<br /><br />CPT® -- physician-developed, physician-owned, physician-maintained -- is supporting physicians in their practices.<br /><br />We should all be proud.  <br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=CPT:%20the%20gold%20standard%20for%20coding-08-26-2010">e-mail</a>.<br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:a757867e-1593-4bc2-a003-472f47124e96 Smoking still kills http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad239b28e-24e1-4a9b-8019-23a3da3dbc40&plckScript=blogScript&plckElementId=blogDest Wed, 25 Aug 2010 17:27:00 GMT <p>We have come a long way in this country in recognizing and responding to the threat of cigarette smoking to one’s health. </p><p>In 1964, when most of the country including many doctors smoked, the Surgeon General issued a report that identified smoking as a health hazard. In 1984 legendary Surgeon General C. Everett Koop called for a smoke-free society by 2000.</p><p>As a result, smoking is now rare among doctors and has decreased by half among the American population. However, roughly one-fourth of Americans still smoke. Smoking-related illnesses are still the major cause of deaths in the United States and account for 400,000 deaths annually. Tobacco companies still blatantly market their products to entice young people to become addicted to tobacco and to convince current smokers that they care about their health. </p><p>That is why the AMA last year <a href="http://www.ama-assn.org/ama/pub/news/news/obama-tobacco-regulation.shtml" target="_blank">supported passage of the Tobacco Control Act</a> which authorized the Food and Drug Administration (FDA) to regulate tobacco. On June 22 -- a date that coincided with the one-year anniversary of the passage of the Tobacco Control Act -- the FDA implemented new restrictions on tobacco advertising and sales. </p><p>The AMA issued a joint statement with the American Academy of Pediatrics, the American Academy of Family Physicians, the American Congress of Obstetricians and Gynecologists and the American College of Physicians highlighting the health and social benefits of the new restrictions and calling for the FDA to aggressively endorse them. </p><p>The new rules: </p><p>• Prohibit the sale of cigarettes or smokeless tobacco to people younger than 18.<br />• Prohibit the sale of cigarette packages with less than 20 cigarettes.<br />• Prohibit distribution of free samples of cigarettes.<br />• Restrict distribution of free samples of smokeless tobacco.<br />• Prohibit tobacco brand name sponsorship of any athletic, musical or other social or cultural events.<br />• Prohibit the advertising or labeling of tobacco products with the descriptors “light,” “mild” or “low” or similar descriptors.<br />• Require new, larger health warning labels for smokeless tobacco products.</p><p>We have come a long way, but we still have a long way to go. Integral to successful health system reform that will control the rising costs of health care is properly addressing the major causes of increased morbidity and mortality in this country caused by <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/smoking-tobacco-control.shtml" target="_blank">tobacco</a>.</p><p>I would like to know what you think about the issue of tobacco use in this country. Do you have something to add or another topic you would like to discuss? Join me for my next Office Hours with Dr. Wilson at 7 p.m. Eastern time Sept. 1 and let’s talk. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=ybzgr0u8j21" target="_blank">Register</a> today.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Smoking still kills-08-25-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d239b28e-24e1-4a9b-8019-23a3da3dbc40 It's up to Congress to fix the flawed SGR formula, keep its promise to seniors http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ac011c9e0-833c-41cd-a06e-90c0a19a3cfc&plckScript=blogScript&plckElementId=blogDest Tue, 24 Aug 2010 21:03:00 GMT “What makes you think you can fix the SGR formula when you have not been able to do it for the past eight years?”<br /><br />This was the anguished question I received from a very angry physician at an AMA forum during a state society meeting a week ago. The questioner was lamenting the fact that the Medicare physician payment formula, the sustainable growth rate (SGR), has resulted in threatened cuts in physician payments every year for the past eight years.  <br /><br />And every year physician payments fall behind the cost to provide care;  they currently are 22 percent behind inflation and are being paid only 52 percent of the fixed costs of a medical practice.<br /><br />Increasingly, physicians are finding it necessary to limit the number of Medicare patients they see in order to keep their practices open, thus decreasing access to care for seniors.<br /><br />Every year Congress recognizes that the formula is flawed and applies a temporary patch, but it does not have the intestinal fortitude to provide a permanent fix to pay the cost of providing care and protect seniors’ access to care.<br /><br />The nuance the physician missed in his question is that it is Congress -- not the AMA -- that has the responsibility to fix the formula and keep its promise to seniors and the families of active-duty military who depend on TRICARE for their insurance. And it is up to not only the AMA but also that physician and thousands more like him to keep the pressure on Congress to do what it was elected to do -- serve the interests of the American people.<br /><br />My promise to that physician is that the AMA will continue to press Congress to live up to its responsibility to fund Medicare. My ask of that physician is that he likewise take responsibility to insist that his own members of Congress do their duty. <br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=It's up to Congress to fix the flawed SGR formula, keep its promise to seniors-8-24-2010">e-mail</a>.<br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:c011c9e0-833c-41cd-a06e-90c0a19a3cfc Eliminate doubt, build patient trust, get vaccinated http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a5d8cbc0e-eb6c-46e3-b6ae-dd04eaebeddd&plckScript=blogScript&plckElementId=blogDest Thu, 19 Aug 2010 14:10:00 GMT <p>While there are some things we can reliably predict this time of year—summer turns to fall, kids head back to school and NFL season gets under way—there is one recurring trend we can’t predict: influenza. </p><p>August has been designated <a href="http://www.cdc.gov/vaccines/events/niam/default.htm" target="_blank">National Immunization Awareness Month</a> to heighten awareness of the importance of all vaccinations during the “back-to-school” season, including vaccination for the flu. Influenza season typically runs from October through April, but summer cases of the flu are no longer new to the radar screen. </p><p>That was certainly the case with last year’s flu season, It brought some interesting challenges with the appearance of the 2009 influenza A (H1N1) virus in early April. Despite an aggressive public health effort to vaccinate the nation against this influenza strain, about half of the U.S. population remains without immunity to the H1N1 virus. That strain has been added to this year’s seasonal flu vaccine. </p><p>Both the new 2010-2011 seasonal vaccine and leftover 2009 H1N1 monovalent pandemic vaccine will be available to providers. However, since the new trivalent seasonal vaccine provides protection against 2009 H1N1 influenza as well as two other seasonal strains of influenza, it is preferable to use it to immunize patients. </p><p>This year, it is expected that more than 160 million doses of seasonal vaccine will be available and all the manufacturers have begun shipping vaccine. A number of physicians have already started to receive the vaccine. </p><p>For the first time, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has developed a universal recommendation that all persons six months and older receive influenza immunization. However, there have been data from Australia about fever and febrile seizures being associated with the 2010-2011 seasonal vaccine made by CSL Biotherapies (and sold in the U.S. by Merck Vaccines) when given to children through 8 years of age. Thus, the ACIP has recommended that for this season, CSL Biotherapies’ flu vaccine Afluria® not be given to children ages six months through eight years and that another seasonal vaccine from a different manufacturer be used. </p><p>In addition, Sanofi Pasteur’s inactivated trivalent vaccine Fluzone High-Dose can be given to adults ages 65 and older instead of a standard flu vaccine and data indicate that this vaccine results in a higher serologic response in those over 65 years of age. </p><p>There are data to show that the immune response to vaccination given early in the influenza season (as early as August) does not wane, so there is no need to wait to start vaccinating patients. Additionally, data show that it is still medically appropriate to immunize later in the season, and the ACIP recommends vaccinating into March and beyond.</p><p>A physician’s recommendation is the number one reason why someone accepts influenza vaccination, and with the new universal recommendation, the physician’s voice is even more important in assuring that people seek out and receive immunization. But another important point is that we—the physicians—need to get vaccinated too.  </p><p>Last flu season, 62 percent of health professionals got seasonal flu shots by mid-January, and 37 percent received H1N1 shots. </p><p>Physicians, and all health care professionals for that matter, are a critical component in trying to reach and immunize all patients in the United States. And our own immunization is vital to our patients’ health and preventing further spreading of the virus. </p><p>Lewis Cass, the American military officer and politician, once said, “People may doubt what you say, but they will believe what you do.” </p><p>I agree.</p><p>What do you think about ACIP’s recommendation? Do you have questions or comments about this year’s flu season? Join me for my next “Office Hours with Dr. Wilson” at 7 p.m. Eastern time Sept. 1 and let’s talk. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=ybzgr0u8j21" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Eliminate doubt, build patient trust, get vaccinated-08-19-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:5d8cbc0e-eb6c-46e3-b6ae-dd04eaebeddd Medicare fix, tort reform needed for long-term success of health care http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ac5b09f7a-2781-48fe-9ef9-af1e2a9b54c2&plckScript=blogScript&plckElementId=blogDest Tue, 17 Aug 2010 16:10:00 GMT <p>I attended the annual meeting of the Florida Medical Association this past weekend in Orlando during which the association installed its second female president, Madelyn Butler, MD, a Tampa ob-gyn. Dr. Butler outlined her work for the coming year on dealing with the implementation of the health system reform law, attracting more members to the association and advocating for sound health policy in the state legislature.</p><p>As I talked with physicians who attended the meeting, it was clear that many of them are unsure that health system reform will bring changes that will be helpful as they see patients. And more than a few feel that their interests as practicing physicians were given short shrift in the law that was passed. </p><p>They find it unconscionable that health system reform did not permanently fix the Medicare physician payment problem or enact meaningful tort reform. They look at the major changes included in the law -- such as expanding health insurance coverage to 32 million Americans who do not currently have it and health insurance reforms that include getting rid of denials due to pre-existing conditions -- and do not see themselves in that picture.</p><p>I agree that the absence of a Medicare payment fix or significant tort reform are grievous omissions and that the success of health system reform in the long run will depend on rectifying both.</p><p>However, I disagree with the assessment that expanded health care coverage and health insurance reform is not good for doctors as well as patients.</p><p>When patients who currently do not have health insurance are covered, they can seek the medical care they need, and the physician who provides that care can be paid for the service and can witness his or her patient get better.</p><p>When patients who currently have health insurance are protected from losing it because of loss of a job or pre-existing conditions or lifetime caps on coverage, the physician who cares for them can continue to provide needed care, be paid for the service, and again, watch his or her patients get well.</p><p>Ultimately, when Congress finally realizes that adequate funding for Medicare is not a “doctor fix” but a responsibility it has to preserve access to care for seniors by paying for the care, then physicians will be able to continue to see Medicare patients and keep their offices open. And when common sense medical liability reforms become the standard across the nation, we will achieve more of the health care cost savings that our economy needs. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Medicare fix, tort reform needed for long-term success of health care-08-17-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:c5b09f7a-2781-48fe-9ef9-af1e2a9b54c2 Being a physician -- despite its challenges -- provides a sense of reward and gratification http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a6f566f47-e532-4c01-9948-692874310954&plckScript=blogScript&plckElementId=blogDest Mon, 16 Aug 2010 14:50:00 GMT <p>It was a pleasure to drive a couple hours north of Winter Park, Fla., last week to Gainesville -- the home of the University of Florida College of Medicine. I understand they play a little football there but that was not the purpose of my visit. </p><p>Following a day of presentations to the local Rotary Club and the school faculty about what the recently enacted health system reform law means to them and its implications for the academic community, I met with the incoming class of freshman medical students that evening during a reception that’s held annually on the first day of the school year.</p><p>As always, I find this type of event rewarding and uplifting. It is reassuring to see so many bright, dedicated young people entering the profession to provide needed medical care for all of us in the future (a little enlightened self-interest here). I also find this a good opportunity to talk about being a doctor now and in the future.</p><p>Medical students rightly have questions about the future. They know the changes in the health care system codified into law in March will have a major impact on their careers. And, the cacophony of noise, the partisanship and conflict that surrounded the debate, make them wonder if it will result in a better world. </p><p>Students also have concerns about not only the challenges of entering a very demanding profession, but also about the high cost of medical school that results in an average debt of more than $156,000 for each student on graduation.</p><p>My response, and what I told them the other night was this: </p><p>“The path you have chosen will require dedication and perseverance. And it will not be without some challenges. But let me assure you -- it will be incredibly rewarding. To heal, to comfort, to relieve pain -- to be trusted with this most sensitive part of people’s lives -- is a great privilege. After more than 30 years of practice, I can honestly say that I love being a physician. And over the years the sense of gratification I get from helping patients now is just as strong as it was when I first started out some years ago.”</p><p>And you can quote me on that.<br /> <br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Being a physician -- despite its challenges -- provides a sense of reward and gratification-08-16-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:6f566f47-e532-4c01-9948-692874310954 Remembering the lives of the brave souls providing care in Afghanistan http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ae55918cd-fed3-414d-8dba-ab83f9b8b26a&plckScript=blogScript&plckElementId=blogDest Fri, 13 Aug 2010 14:07:00 GMT <p>Physicians are bound by a code of ethics for access to care for all people. It was in the realization of that responsibility that the AMA in March gave its qualified support of the Affordable Care Act.</p><p>The recent wanton killing of a team of medical personnel in Afghanistan was a grim reminder that access to care for all incorporates, even in times of conflict, care for all regardless of which side of the conflict they may be on. This case includes treatment of noncombatants, as well as risk to those providing care.</p><p>The medical team was part of a Christian charity, the International Assistance Mission,  that has been working in Afghanistan since 1966. They have worked alongside the Afghan people providing care for the poor at great risk -- a risk that for them meant the ultimate sacrifice of their lives.</p><p>Recognizing the importance of caring for those who are suffering, nations across the globe have entered into agreements such as the Geneva Conventions and World Medical Association (WMA) resolutions that state the importance of maintaining medical neutrality in times of conflict. </p><p>Our hearts go out to the families of those who lost their lives and to the poor and needy in Afghanistan who because of the tragedy will not have access to the care they need.<br /> <br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Remembering the lives of the brave souls providing care in Afghanistan -08-13-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:e55918cd-fed3-414d-8dba-ab83f9b8b26a Make your health a priority, just as you would for your patients http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a0f263309-4216-42bb-a699-fa7d37531ac0&plckScript=blogScript&plckElementId=blogDest Thu, 12 Aug 2010 14:03:00 GMT <p>As physicians, we prioritize the health of others. Our patients’ health comes first. It takes precedence. It’s the foremost thing on our minds. It’s the epitome of what we accomplish each day as physicians and why we chose our work in this profession.  </p><p>But what about us—the health of physicians? Unfortunately, this tends to get lost in the shuffle. This is not a criticism but an observation. And I know this firsthand. </p><p>While I make a valiant effort to practice what I preach, it’s hard to find the time for my morning walk and a little life reflection. Throw family, friends, the life of being AMA president (or the life of practice), a BlackBerry, maybe a social life, and some personal interests into the mix, and the focus on one’s personal health becomes a challenge. </p><p>This could be one of the most difficult tasks we face as physicians. However, there is help. For three days this fall, one can focus on striking a healthy balance between caring for patients and <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health.shtml" target="_blank">maintaining one’s own personal health</a>.  </p><p>The AMA, in collaboration with the Canadian (CMA) and British Medical Associations (BMA), will host the AMA-CMA-BMA International Conference on Physician Health 2010, “<a href="http://www.ama-assn.org/ama1/pub/upload/mm/433/icph-brochure.pdf" target="_blank">Physician Health and Resiliency in the 21st Century</a>,” Oct. 3–5 at the Swissotel Chicago. </p><p>The conference is focused on improving the wellness of physicians. It’s for residents and medical students too. In fact, they get a discounted rate for attending.  </p><p>The <a href="http://www.ama-assn.org/ama1/pub/upload/mm/433/icph-agenda.pdf" target="_blank">lineup</a> is particularly impressive in a setting with diverse representation from the international community. From new and innovative thinking about how physicians can attain an appropriate work-life balance to endless opportunities to share strategies for advancing physician well-being, this conference offers more than 40 oral and workshop presentations with chances for continuing medical education and more then 40 posters for exhibition.  </p><p>To keep everyone physically active, refreshed and engaged, there will be a special “Walk the Doc” session—walking tours of various Chicago sites each morning—not to mention the city’s beautiful lakefront and spectacular shopping and museums. In addition, “mindfulness” and “small group reflection” sessions will be available. </p><p>Families have a significant impact on physician resiliency. That’s why the conference will offer a special workshop for spouses/ life partners on the “21st century medical family” with Wayne Sotile, a well-known researcher on medical family life and stressors, and Susan Todd, president of the AMA Alliance.  </p><p>Register for the AMA-CMA-BMA International Conference on Physician Health 2010 online at <a href="http://www.ama-assn.org/go/physicianhealth">www.ama-assn.org/go/physicianhealth</a>. Those who do so before Sept. 1 will get a special rate on registration. Special room rates are available for bookings before Sept. 6.  Information about spouse/ life partner registration is available online as well.</p><p>If you can’t make the AMA-CMA-BMA International Conference on Physician Health 2010, you can check out the <a href="http://www.amaalliance.org/" target="_blank">2010 Medical Families Summit</a>, hosted by the AMA Alliance Sept. 25–28, in Chicago, where the entire medical family, including children, will network with other families, gain resources, contacts and opportunities for work/life balance. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Make your health a priority, just as you would for your patients-08-12-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:0f263309-4216-42bb-a699-fa7d37531ac0 “Office Hours” gives members a chance to express what’s on their minds http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a794e175a-007d-4d9b-a08b-b994da04667b&plckScript=blogScript&plckElementId=blogDest Mon, 09 Aug 2010 16:10:00 GMT <p>Last Wednesday I hosted the second “Office Hours with Dr. Wilson” conference call. My plan is to hold these calls monthly over the coming year to hear from AMA members about questions they have related to the work of the AMA -- and suggestions for how to do it. It is already clear to me that these will be very valuable opportunities for me to hear first-hand from our members. My hope is that AMA members will also find this mode of communication helpful.</p><p>The calls last week covered a panoply of issues, including: </p><p>• How to provide end-of-life care education for physicians and patients.<br />• The potential impact the AMA’s stance on <a href="http://www.hsreform.org/" target="_blank">health system reform</a> may have on membership.<br />• A recent report by the U.S. treasurer which looks at increased tax breaks for lawyers.<br />• Support for the Mental Health Parity Act.<br />• The AMA’s <a href="http://www.ama-assn.org/go/pdrp" target="_blank">Physician Data Restriction Program</a>.<br />• Balance billing and private contracting.<br />• <a href="http://www.ama-assn.org/go/hit" target="_blank">Health IT</a> and the recently released “meaningful use” regulations. <br />• Work force shortages and how the AMA will respond.</p><p>In addition, some members expressed concerns regarding the health system reform debate, including the myth of  “death panels” and how they may adversely effect provisions of palliative care, the AMA’s plans for dealing with the Medicare physician payment/SGR problem, draft private contracting legislation called for by the AMA House of Delegates in June, whether the AMA is seeking repeal of the health system reform legislation (no), and scope-of-practice issues especially as they relate to work force shortages. </p><p>As previously, questions I was not able to answer on the call that had been submitted in advance will be answered through e-mails to those who asked. </p><p>My thanks to everyone who participated and I look forward to the next “Office Hours” on Sept. 1.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Office Hours gives members a chance to express what’s on their minds-08-09-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:794e175a-007d-4d9b-a08b-b994da04667b The "truth" is in the training—make it known http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a8e1060fa-101e-4a0e-b6bd-1f4b4b5dcf29&plckScript=blogScript&plckElementId=blogDest Fri, 06 Aug 2010 14:38:00 GMT Anyone can call themselves a "doctor". But not just "anyone" can be one. <br /><br />What I mean by that is being a medical doctor or doctor of osteopathic medicine means going through four years of medical school, three to seven years of a residency and/or fellowship, and 12,000 to 16,000 hours of patient care training in order to obtain the needed skills, possess the necessary qualifications and perform the specific duties that we, as MDs and DOs, have been rigorously prepped to do.<br /><br />Quite frankly, patients are confused. Titles and definitions matter to them because these act as an influence in their decision making. A survey conducted by Global Strategy Group in 2008 found that 54 percent of patients believe optometrists are MDs or DOs. In addition, 49 percent of patients think psychologists are MDs or DOs, 38 percent think doctors of nursing practice are MDs or DOs, and even 26 percent think physical therapists are MDs or DOs.  <br /><br />But patients deserve to know the truth when they are being seen by an MD or DO and when they are being seen by another health care professional who uses the "doctor" title. And they must be able to rely on what their health care providers tell them. <br /><br />Eliminating confusion and bringing clarity and transparency to these misunderstandings is absolutely essential. All health care professionals—physicians and non-physician providers alike—should accurately and clearly disclose their training and qualifications to every one of their patients. And when advertising services, health care providers mustn't promise more than what they are prepared and licensed through their training and education to do. <br /><br />That's exactly what the AMA and state and specialty society partners are asking for via our <a href="http://www.ama-assn.org/ama/priv/advocacy/centers-engaged-advocacy/advocacy-resource-center/state-advocacy-campaigns/scope-practice/truth-in-advertising.shtml" title="Truth in Advertising">Truth in Advertising</a> campaign, which launched earlier this year. And that's what patients want. In fact, according to the survey, 96 percent of patients want all health care professionals to clearly state their level of training and licensure. <br /><br />The AMA developed model legislation to help medical societies introduce legislation in their own states. In fact, Illinois just enacted a "truth in advertising" law—the "Truth in Health Care Professional Services Act"—on July 27 based on the AMA's campaign. <a href="http://www.ama-assn.org/ama1/x-ama/upload/mm/378/tia-az-bill-summary.pdf" target="_blank" title="Arizona Bill Summary - S.B. 1255 - Health Professionals, Advertising and Disclosure">Arizona</a> passed a similar bill earlier this year, and <a href="http://www.ama-assn.org/ama1/x-ama/upload/mm/378/tia-ok-bill-summary.pdf" title="Oklahoma Bill Summary - H.B. 1569 - Professions and occupations, disclosure requirements">Oklahoma</a> last year. And my home state of Florida enacted such legislation, the "Truth in Medical Education" law, in 2006. <br /><br />We all have an important role to play as members of a health care team. But to ensure optimal care and patient safety, we must stick to those roles and make sure our patients know exactly what those roles entail. <br /><br />The goal is simple: Give patients the necessary information to make informed decisions about who's providing their health care. Then the next time they're asked "who is a doctor?" they'll know the answer. But most importantly, they'll get the care they need in a safe, effective manner. <br /><br />If you or your state medical society is interested in learning more about how your state can be part of the "Truth in Advertising" campaign, <a href="mailto:amaprezblog@ama-assn.org">send me an e-mail</a>.  <br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:8e1060fa-101e-4a0e-b6bd-1f4b4b5dcf29 Even after more than 160 years, our quality-driven focus perseveres http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a38ac58d4-f689-4713-8ce3-c22d017f827b&plckScript=blogScript&plckElementId=blogDest Wed, 04 Aug 2010 17:54:00 GMT Having now reported on meetings last week with <a href="http://bit.ly/9VHn6x">Pfizer</a> (in New York) and the <a href="http://bit.ly/9VHn6x">National Medical Association</a> (in Orlando), I would be remiss not to mention that my travels also took me to Washington, D.C., where Friday I attended the executive committee meeting of the <a href="http://www.ama-assn.org/ama/pub/physician-resources/clinical-practice-improvement/clinical-quality/physician-consortium-performance-improvement.shtml">Physician Consortium for Performance Improvement</a> (PCPI). <br /><br />The PCPI, an AMA-convened group, is in its 10th year and is a shining example of the profession of medicine responding to the imperative to take a leadership role in providing quality care and making science-based information available to physicians to make that care possible.<br /><br />The PCPI now has 170 members including almost all medical specialty societies and state medical associations, the Council on Medical Specialty Societies, the American Board of Medical Specialties, specialty boards, the Agency for Healthcare Research and Quality, the Centers for Medicare & Medicaid Services, private health plans, experts in methodology and data collection, as well as a purchasers and consumer advisory panel.<br /><br />PCPI’s work product to date includes 270 measures across 43 topics. And there are more to come. It has become a recognized leader in the field of quality measure development; 56 percent of the measures adopted by CMS in its 2010 PQRI program are from the PCPI.<br /><br />Work is under way on measure development to help physicians respond to requirements for maintenance of certification programs by specialty boards, as well as maintenance of licensure requirements by state licensing boards. In addition, measures are being adapted to integrate into electronic health records.<br /><br />As I travel across the country, I am commonly asked the question, “when is the AMA going to do something about quality?” <br /><br />My answer, my talisman, is that the AMA was founded in 1847 with a focus on education, ethics and quality -- a focus that has not diminished. And the PCPI is the latest evidence of that.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Even after more than 160 years, our quality-driven focus perseveres-08-04-2010" target="_blank">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:38ac58d4-f689-4713-8ce3-c22d017f827b Transitions, passing the reins of leadership http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a2d22810a-362f-4ca0-b2fa-be2618fd2d2f&plckScript=blogScript&plckElementId=blogDest Tue, 03 Aug 2010 16:10:00 GMT One of the special times in the life of any organization is that transition meeting when leadership changes -- when those who have had the responsibility of stewardship pass the baton on to those who will be entrusted with preserving the organization, keeping it safe and on course, and subsequently passing the reins of leadership to those who will follow.<br /><br />This past weekend it was my privilege to attend such an event here in central Florida (note, no plane to ride, just my car) and be a part of the opening ceremony of the <a href="http://www.nmanet.org/" target="_blank">National Medical Association</a> convention at the Gaylord Palms Hotel and Convention Center.<br /><br />The highlight of the event was the keynote address given by U.S. Surgeon General <a href="http://www.surgeongeneral.gov/about/biographies/biosg.html" target="_blank">Regina Benjamin</a>, MD. Dr. Benjamin’s presence was all the more special in that she is a member of the NMA as well as the <a href="http://www.ama-assn.org/" target="_blank">AMA</a>. She has shown a lifelong commitment to reducing disparities in health and health care. <br /><br />In her new role, Dr. Benjamin will focus on the nation’s epidemic of chronic disease, the majority of which is secondary to health behaviors such as obesity, smoking, alcohol abuse and a sedentary lifestyle.<br /><br />The NMA, founded in 1895, is the largest and oldest national organization representing African American physicians and their patients in the United States. Its mission is to advance the art and science of medicine for people of African descent through education, advocacy and health policy; and to promote health and wellness, eliminate health disparities and sustain physician viability.<br /><br />The AMA, the NMA and the National Hispanic Medical Association are co-sponsors of the <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities/commission-end-health-care-disparities.shtml">Commission to End Health Care Disparities</a>. The commission was formed to address disparities in health care and in response to the Institutes of Medicine’s report “<a href="http://www.iom.edu/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx" target="_blank">Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care</a>.”<br /><br />The work of the commission takes on increasing importance based on an understanding that addressing health care disparities will be an essential part of <a href="http://www.hsreform.org/">health system reform efforts</a> -- the success of which will depend on expanding access to health care to those who have not previously been able to participate.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Transitions, passing the reins of leadership-08-03-2010" target="_blank">e-mail</a>.<br /><br /> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:2d22810a-362f-4ca0-b2fa-be2618fd2d2f Transparency and collaboration are keys to physician-pharmaceutical interaction http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ac6dcb7d6-7fd6-46a5-88e4-dc613c3f1926&plckScript=blogScript&plckElementId=blogDest Mon, 02 Aug 2010 21:34:00 GMT Last Thursday, Ardis Hoven, MD, chair of the AMA Board of Trustees, and I spent the day at Pfizer’s corporate headquarters in New York. I was privileged to speak at Pfizer Grand Rounds and talk about the health system reform legislation passed in March. <br /><br />My remarks focused on the implications of the Affordable Care Act for patients, physicians and the pharmaceutical industry, and the work that will need to be done over the coming years in implementing the law.<br /><br />Following my remarks, Dr. Hoven and I responded to questions from employees (primarily doctors, scientists and researchers) present at the meeting and those who participated by teleconferencing from Pfizer offices around the world.<br /><br />The remainder of the day was spent meeting with Pfizer officials about the AMA and the pharmaceutical industry’s priorities, insights and vision for American physicians and their patients.<br /><br />We also talked about some of today’s hot button issues and how to address them, such as the costs of medications, research and development for new medications, direct-to-consumer advertising, and potential conflicts of interest that can occur around the interaction between those who produce medications (the pharmaceutical industry) and those who prescribe them (physicians). <br /> <br />There are those who prefer that the interaction between the pharmaceutical industry and physicians be kept at a minimum or eliminated altogether. I disagree. It would be damaging to our health care system and reprehensible to build a firewall that would exclude physicians from interacting with those who, having produced lifesaving drugs, know a lot about them.<br /><br />An analogy that comes to mind is the misguided direction that occurred in the failed health system reform effort of 1993 that excluded those who actually practiced medicine (physicians) from input on what changes needed to be made.<br /><br />There are arguments on all sides about how far we should go to safeguard against conflicts of interest, but everyone agrees on one thing: Transparency is absolutely crucial -- transparency in terms of publishing clinical research findings, transparency in terms of compensation for doctors outside of industry, and transparency in terms of advertising that doesn’t just sell, but also educates the patient.<br /><br />That will inform patients about both the drug and the disease -- the risks and the benefits.<br /><br /><strong>What do you think?</strong> Join me for my second “<a href="http://www.ama-assn.org/ama/pub/ama-president-blog.shtml?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a091f3672-abea-4d51-a099-2a99d56eedfc&plckScript=blogScript&plckElementId=blogDest">Office Hours with Dr. Wilson</a>” at 7 p.m. Eastern time on Wednesday, Aug. 4. This call will be held on the first Wednesday of every month for all AMA members. You talk, and I listen. <a href="http://mailview.custombriefings.com/mailview.aspx?m=2010072201ama&r=1768045-7ae9&l=00b-7f8&t=c" target="_blank">Register today</a>.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Transparency and collaboration are keys to physician-pharmaceutical interaction-08-02-2010" target="_blank">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:c6dcb7d6-7fd6-46a5-88e4-dc613c3f1926 An all-inclusive team constitutes a healthy population http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a17858dd5-5d7c-4659-acd8-90f4c1779bdb&plckScript=blogScript&plckElementId=blogDest Thu, 29 Jul 2010 18:33:00 GMT <p>Health system reform, Medicare physician payment cuts, “meaningful use” regulations and the “red flags” rule—these were all top of mind for me and many other physicians when the calendar turned this year. One thing may have been overshadowed. </p><p>While many of these issues were heating up, the Centers for Medicare & Medicaid Services (CMS) had implemented a new policy on consultation codes. </p><p>Based on a decision that was finalized on Oct. 30, 2009, CMS decided to eliminate the use of all outpatient and inpatient consultation codes on Jan. 1. </p><p>The trouble is that this policy fails to adequately recognize the time and effort involved in these consultations and limits our ability, as physicians, to work together as a comprehensive health care team for patients.</p><p>I’m an internist but that doesn’t mean I can help every 70-year-old patient with a heart condition. For some I need to consult with a cardiologist. Typically, the patients I refer for a consultation have very complex problems and in addition to sorting out those problems, the cardiologist is going to report back to me with advice on the patient’s condition and future treatment. Based on the new policy, however, Medicare will not pay any more for this consultation and report than it pays for a regular office visit. But 20 percent of patients ages 65 and older need them. </p><p>Consulting specialists have been forced—much like the situation with Medicare’s flawed sustainable growth rate formula—to cut back on services. As a result, care coordination and access to care for the 20 percent of patients age 65 and older who need a consultation have suffered. </p><p>Is anyone else feeling a bit of déjà vu here? This is among the issues that have taken center stage in my book—and in the AMA’s. In fact, the <a href="http://www.ama-assn.org/ama/pub/news/news/medicare-consultation-codes.shtml" target="_blank">AMA and 11 medical specialties</a> released results of a survey on this problem on July 16. </p><p>Of the approximately 5,500 physicians who completed the survey, three out of every 10 had already reduced their services to Medicare patients or are contemplating cost-cutting steps that will impact care. And one-fifth of them had already eliminated or reduced appointments for new Medicare patients.  </p><p>This is simply unacceptable. The AMA sent a <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/consultation-codes-sign-on.pdf" target="_blank">letter</a>, signed by 33 specialty societies, to CMS in June highlighting these results and asking the agency to take the necessary steps to prevent further deterioration of care coordination between physicians. </p><p>While this issue has yet to be resolved, the conversation is not over. The AMA will continue to aggressively work to revise the current Medicare consultation payment policy. Because particularly in the profession of medicine, teamwork is critical. </p><p>Just as Helen Keller once said: “Alone we can do so little; together we can do so much.” And remember, whom we’re doing this for—our patients.  </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=An%20all-inclusive%20team%20constitutes%20a%20healthy%20population-07-29-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:17858dd5-5d7c-4659-acd8-90f4c1779bdb The AMA continues to plan, set a course for the future of medicine http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ab062b6f8-f929-4dce-816b-5b2072d134b3&plckScript=blogScript&plckElementId=blogDest Mon, 26 Jul 2010 15:55:00 GMT <p>As many of you may know by now, one of the joys for me of living in Florida over the years has been the opportunity to indulge in a passion for sailing. And it is the case that sailing, at least out of sight of land, requires setting a course, calculating speed, considering wind direction and strength -- in short -- planning.</p><p>This past weekend I was in Chicago attending the strategic planning session of the AMA Board of Trustees. This annual event in the life of the AMA provides the board the opportunity to evaluate the work of the previous year, assess the challenges that face the association and in the context of AMA policy set a direction for the coming year.</p><p>I confess that over the years I have participated in a lot of strategic planning sessions that involved an eyes-glazing-over repetition and mind-numbing focus on detail that made one wonder about the value of the process. But this is not so for the AMA Board. In a process that has been refined over the past five years, the discussions are focused, lively and participated in with the serious purpose of plotting a course for the future to achieve the goals that have been set for the association.</p><p>There are three major components of the AMA’s annual plan, which include:</p><p>1. The major strategic issues that will be the focus of efforts for the coming year<br />2. Centers of Expertise to preserve the core competencies (skills) of the AMA that assure our ability to respond to the broad array of issues that arise in which the AMA representing physicians needs to be involved <br />3. Institutional strategies to assure that there are financial resources to support the mission of the AMA.</p><p>The major strategic issues that will be the focus for the coming year are a reflection of what we see as the needs for improvement in our health care system. They are in some ways a microcosm of issues that were a part of the health system reform debate over the past year. They are:</p><p>• Access to care and work force shortages<br />• Prevention and wellness<br />• Quality of care<br />• Next generation physician payment models<br />• Cost of health care</p><p>Next steps in this process will be to develop the budget needed to support these goals.</p><p>As with sailing, if we fail to plan -- if we let outside forces plot our course and set our speed -- we will ultimately drift, powerless, without direction or purpose.<br /> <br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=The AMA continues to plan, set a course for the future of medicine-07-26-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:b062b6f8-f929-4dce-816b-5b2072d134b3 Preparedness: a critical component to effective response, a prescription for disaster http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ad174c429-8adb-4907-990a-db085dff04c8&plckScript=blogScript&plckElementId=blogDest Thu, 22 Jul 2010 15:24:00 GMT <p>In 2004, during the course of six weeks, Hurricanes Charley, Frances and Jeanne roared through central Florida, bringing wind and rain, felling large oaks in our yard, removing part of our roof and flooding the interior of our house. This was the first hurricane we had experienced since moving to Winter Park 25 years ago and a reminder that none of us is immune from experiencing disasters.<br /> <br />With that in mind, today’s focus is disaster medicine, or more importantly <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response.shtml" target="_blank">public health preparedness</a>. </p><p>With the disasters and public health challenges we’ve faced recently, from last year’s <a href="http://www.ama-assn.org/ama/pub/h1n1/index.shtml" target="_blank">H1N1 influenza virus</a> outbreak and this year’s <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/haiti-earthquake.shtml" target="_blank">earthquake in Haiti</a> to the <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/gulf-oil-spill.shtml" target="_blank">Gulf oil spill</a>, I think it’s fair to say that disaster can strike any time, any place, in just a moment’s notice. </p><p>Due to globalization, overpopulation and climate change, the trend and impact of natural disasters—earthquakes, hurricanes, landslides, tornadoes—has increased significantly over the last 30 years. </p><p>But according to a 2006 <a href="http://www.amrresearch.com/research/reports/images/2006/0605AMR-A-19413.pdf" target="_blank">AMR Research study</a>, only 32 percent of businesses actually have disaster preparedness plans in place. That means the remaining 68 percent could more likely become part of the problem, rather than the solution.</p><p>The onus isn’t just on groups. This is a personal matter too. More often than not, it’s the citizens who act as first responders to a community emergency. It rests on every single one of us to have a plan so when and if disaster strikes, we can be resilient in our response. </p><p>You’ve all probably heard the saying “practice makes perfect.” Well this is the very situation in which it applies. You can never be too prepared. </p><p>The newly revised <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/national-disaster-life-support/cdls.shtml" target="_blank">Core Disaster Life Support® course</a>, which the AMA launched earlier this year as part of its <a href="http://www.ama-assn.org/go/ndls" target="_blank">National Disaster Life Support</a>™ (NDLS) program, equips individuals, institutions and communities to prepare for and respond to disasters and public health emergencies. </p><p>It highlights key components of a disaster plan, including first aid and safety skills, family communication, emergency alert systems, disaster supply kits and coping strategies.  </p><p>The NDLS™ program also offers two other distinct educational training courses, including <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/national-disaster-life-support/adls.shtml" target="_blank">Advanced Disaster Life Support</a>™ and <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/center-public-health-preparedness-disaster-response/national-disaster-life-support/bdls.shtml" target="_blank">Basic Disaster Life Support</a>™, in an effort to standardize emergency response training nationwide and strengthen our nation’s public health system. </p><p>My family’s experience with three hurricanes pales in comparison to that of others along the Gulf coast over the years. But even for us, it was a full year before we had completely repaired the damage from Charley, Frances and Jeanne. </p><p>My prescription for all of us: in order to mitigate catastrophic situations, get ready to respond and recover with tenacity and wisdom. And be prepared—before disaster strikes. </p><p>What do you think? Join me for my second “<a href="http://www.ama-assn.org/ama/pub/ama-president-blog.shtml?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a091f3672-abea-4d51-a099-2a99d56eedfc&plckScript=blogScript&plckElementId=blogDest" target="_blank">Office Hours with Dr. Wilson</a>” at 7 p.m. Eastern time on Wednesday, Aug. 4. This call will be held on the first Wednesday of every month for all AMA members. You talk, and I listen. <a href="http://mailview.custombriefings.com/mailview.aspx?m=2010072201ama&r=1768045-7ae9&l=00b-7f8&t=c" target="_blank">Register today</a>.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Preparedness: a critical component to effective response, a prescription for disaster-07-22-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:d174c429-8adb-4907-990a-db085dff04c8 Moving toward a healthier society one step at a time http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3adaa9fa58-84ca-4340-924a-accee597d93e&plckScript=blogScript&plckElementId=blogDest Mon, 19 Jul 2010 15:59:00 GMT <p>I was  up at 6 a.m. on Saturday and headed out the door to be greeted by a temperature already at 79 degrees and headed for the mid-90s. It was another hot muggy Central Florida day (actually I like hot and muggy). </p><p>My walk took me to downtown Winter Park, Fla., and the Farmers Market. The vendors were already putting out their wares of fruits, vegetables and melons -- a reminder of the importance of healthy eating. Of course there were also places where one could purchase hot dogs, hamburgers, cakes, sweet rolls and breads of all sorts.</p><p>Healthy living is on everyone’s minds these days and for good reason. Most of the chronic diseases with which we in America are afflicted are preventable by modifications in our behavior. </p><p>In fact, studies have shown that the determinants of health -- what makes us sick or healthy -- are only 10 percent related to access to care. One’s genetic make-up accounts for 20 percent, and the environment (air, water, climate) 20 percent. That means that 50 percent is accounted for by what we call “health behaviors” -- alcohol abuse, cigarette smoking, obesity and a sedentary lifestyle.</p><p>The good news is that we all have it in our power to make a difference in our health and in the process to significantly decrease the cost of  health care in this country. The challenge is that our ability to put techniques in place to change behavior is rudimentary at best. And the reality is that this challenge is not something the physicians of this country can meet by themselves. It will require a societal commitment -- each and every one of us.</p><p>The <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/healthier-life-steps-program.shtml" target="_blank">AMA Healthier Life Steps™ toolkit</a> can help patients deal with four key health behaviors contributing to a majority of avoidable costs in health care: lack of exercise, poor nutrition, tobacco use and risky use of alcohol.</p><p>So back to walking. Study after study have shown the benefits of regular exercise in preventing chronic disease, decreasing the risks of falls and actually improving mental acuity. </p><p>For years now, my daily exercise routine has included walking four miles on weekdays and 6.5 miles on weekend days. Of course, not every one needs to walk 6.5 miles. In fact studies have shown benefits from routines of as little as 30 minutes of exercise five days a week.</p><p>I’m still waiting and hoping for the improvement in mental acuity. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Moving toward a healthier society one step at a time-07-19-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:daa9fa58-84ca-4340-924a-accee597d93e Easing into technology with the realities of practice and patients in mind http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a91e45eaa-c975-47a5-9438-8ee93005834b&plckScript=blogScript&plckElementId=blogDest Thu, 15 Jul 2010 15:38:00 GMT <p>I’m reminded today of a prominent American computer company that just a few years ago released a revolutionary new handheld phone. To get people to use the iPhone, Apple made it so intuitive and easy that even novices to the world of technology could make it work by reading as little as two or three pages of instructions. In addition, they made it a lot of fun to use. And as a result, millions of people across the world bought one. </p><p>The Centers for Medicare and Medicaid Services (CMS) released on Tuesday its 800-plus page final rule outlining the requirements for certification and how to become a “<a href="http://www.ama-assn.org/ama1/pub/upload/mm/472/arra-brochure.pdf" target="_blank">meaningful user</a>” for physicians who use <a href="http://www.ama-assn.org/go/hit" target="_blank">health information technology</a> (IT), such as electronic health records (EHRs). </p><p>Seven months ago, the proposed rule was first released for commenting. In contrast to the iPhone, these regulations were confusing and so utterly divorced from taking into account the realities of medical practice that if unchanged, they would stifle rather than encourage physician participation. </p><p>This participation, by the way, will also remain problematic as long as Medicare payments fail to cover the cost of providing care because Congress has not fixed the flawed Medicare payment formula.</p><p>The draft rule was “off the mark.” And that can be measured by the more than 2,000 comments CMS received. The AMA, along with 95 state and specialty societies, also provided extensive <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/meaningful-use-comments-15mar2010.pdf" target="_blank">recommendations</a> for realistic timeframes, reasonable reporting requirements and removing irrelevant criteria.</p><p>We want physicians in all practice sizes and specialties to be able to take advantage of federal incentives and adopt new technologies, so ultimately we can improve patient care and safety. <br /> <br />Now’s the true test. Did CMS listen? </p><p>Over the coming days the AMA will be <a href="http://www.ama-assn.org/ama/pub/news/news/ehr-meaningful-use.shtml" target="_blank">dissecting the final rule</a> and looking for the flexibility we so urged. In addition we will be looking for ways to help physicians understand the “meaningful use” requirements and how to make them work in their practices. This will include hosting a webinar in the coming weeks that will be announced shortly. </p><p>In conclusion, however, consider the following outcomes of the two scenarios I presented.</p><p>In the case of Apple, the desired outcome is selling a new phone. How was it done? Read my initial paragraph. </p><p>In the case of CMS, the desired outcome is for physicians to use health IT to help improve quality of care and patient safety. How can it be done? Read my initial paragraph.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Easing into technology with the realities of practice and patients in mind-07-15-2010" target="_blank">e-mail</a>.<br /></p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:91e45eaa-c975-47a5-9438-8ee93005834b Speaking with a clear, firm, constructive and trust-inspiring voice http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a9552d1dd-a5fe-41ce-abcd-a1f53135ae56&plckScript=blogScript&plckElementId=blogDest Wed, 14 Jul 2010 15:15:00 GMT <p>My daughter, hardly a disinterested observer, wrote to me in an e-mail that she is enjoying reading my blog, and said, “we are following the AMA on <a href="http://twitter.com/AmerMedicalAssn" target="_blank">Twitter</a> and <a href="http://www.facebook.com/AmericanMedicalAssociation" target="_blank">Facebook</a> and bookmarked ‘<a href="http://www.ama-assn.org/ama/pub/ama-president-blog.shtml" target="_blank">On the Road with Dr. Wilson</a>.’ She told me she became a fan of the AMA, by clicking on the “like” button.  </p><p>The AMA to date has 4,343 “likes” or “fans” as they used to be called. Clearly, that number leaves room for growth but is not surprising to me after the many challenges we have faced this past year in the debate over health system reform. The divisiveness that characterized that debate affected everyone, including -- and perhaps especially -- physicians. </p><p>In talking with AMA members around the country, I found most physicians did not dispute the <a href="http://www.ama-assn.org/ama/pub/health-system-reform/about-us.shtml" target="_blank">core principles of health system reform</a>.</p><p>Rather, physicians disagreed on the interpretation of those principles and the strategy and tactics used to advance reform.</p><p>Others sought a different destination. All were sincere in their views.</p><p>I do not want to dwell inordinately on the past. I believe we are better served looking to the future and focusing our efforts on making <a href="http://www.hsreform.org/" target="_blank">health system reform</a> the best it can be for physicians and patients. Now more than ever we need to focus on what’s best for our profession, our patients and our country.</p><p>However, I believe it is important to make note of where we have been. </p><p>I know too well that there are fences to mend, assurances to make, and wounds to heal.</p><p>And my hope for the coming year is that we, as members of the medical profession, bring to the challenges of improving our health care system the scrupulous requirement for action-based evidence that is the hallmark of the scientist and the compassion of the healer for those with whose care we are entrusted.</p><p>And my hope for the AMA is that it will bring to its role in the process a voice that is clear, firm and constructive -- a voice that in the end will inspire trust and will make all physicians want to exercise the “like” button.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Speaking with a clear, firm, constructive and trust-inspiring voice-07-14-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:9552d1dd-a5fe-41ce-abcd-a1f53135ae56 “Office Hours” conference call shows diverse needs of physicians http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3acf138f8c-2423-4502-83a6-9791edeee598&plckScript=blogScript&plckElementId=blogDest Mon, 12 Jul 2010 15:38:00 GMT <p>Last Wednesday, AMA member physicians from across the country called in to participate in “Office Hours with Dr. Wilson.” This was the first of what will be monthly opportunities for physicians to share their opinions about what the AMA is doing and should be doing in support of them and the patients they serve.</p><p>It is also an opportunity for me personally to talk with AMA members, hear their concerns and share those concerns with the AMA Board of Trustees and staff.</p><p>The variety of subjects covered during the call reminded me again that diversity, which is such a vital part of the strength of our country, is also found in the physician community. For example, here it is reflected by differences in geography -- practice in rural or urban areas; differences in mode of practice -- small group, solo or large group, hospital, academic centers, medical-surgery centers or private offices; and by difference in specialties practiced, of which there are more than 145 in this country.</p><p>This diversity means that what is important for one physician is not necessarily important for another. For the AMA it means that being responsive to the needs of our large membership requires sensitivity to and understanding of each segment of our association. It means there is no magic bullet, no single key to being relevant to each physician in his or her practice. </p><p>One of the callers last Wednesday illustrated this diversity with an observation about what is increasingly the practice across the country of hospitals buying physician practices and managing them with physicians as employees. The question is how does this (physician status as hospital employee) affect what services physicians need from a professional association such as the AMA. The answer in part is that we at the AMA will not assume we know, but will be asking these physicians what will be most helpful to them in their practices.</p><p>Some other questions related to why Congress does not fix the Medicare physician payment mess; how to help our patients become health care advocates for themselves; what is the future for solo practicing physicians in America; how to bring down the cost of health care; dealing with the shortage of physicians in a number of specialties especially primary care; the need for effective tort reform; service by retired volunteer physicians; the importance of environmental medicine; the future of the AMA as a membership organization; physician/patient private contracting; and antitrust obstacles to physicians working together  </p><p>I look forward to the coming monthly calls, and will from time to time share on this blog some of the discussions about questions raised by AMA members. Watch this space for details on the next “Office Hours,” scheduled at 7 p.m. Eastern time on Wednesday, Aug. 4.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Office Hours conference call shows diverse needs of physicians-07-12-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:cf138f8c-2423-4502-83a6-9791edeee598 Even in another country, health care challenges and priorities are similar http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a95efbe1a-22d2-4b33-9b9a-1c9a8a69d9e7&plckScript=blogScript&plckElementId=blogDest Fri, 09 Jul 2010 15:09:00 GMT Even in another country, health care challenges and priorities are similar<br /><br />Last week I had the privilege of attending the annual meeting of the British Medical Association in Brighton, England. Being there was a reminder that even in countries with markedly different health care systems, the challenges are much the same with access, cost, quality, continuity of care, work force deficiencies and medical student debt, to name a few.<br /><br />One of the highlights of the meeting was a speech by Andrew Landsay, secretary of state for health in the new British coalition government, during which he listed his five priorities:<br /><br /><ol><li>The patient is to be at the heart of everything and should be a part of shared decision-making -- a “no decisions about me without me” kind of mentality.</li><li>There should be a focus on outcomes -- not process -- using quality measures that are scientifically based.</li><li>Physicians, not the bureaucracy, should be empowered to make decisions.</li><li>There should be more effective integrated public health services.</li><li>There should be reform of social care to take care of the old and frail.</li></ol><br />The final comments were most telling and reflect the reality of the depressed economic condition of nations around the world, including the United Kingdom. Landsay said resources are far less, and ”there is no money.” Additional funds will have to come from efficiencies within the National Health Service.<br /><br />The BMA leaders were pleased by Landsay’s priorities and not surprised by his observations about funding.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Even%20in%20another%20country,%20health%20care%20challenges%20and%20priorities%20are%20similar-07-09-2010" target="_blank">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:95efbe1a-22d2-4b33-9b9a-1c9a8a69d9e7 Connecting medical liability reforms to quality and improved patient care http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a1f95b0f4-2e04-475c-a7f3-5c185458325d&plckScript=blogScript&plckElementId=blogDest Thu, 08 Jul 2010 17:34:00 GMT <p>In <a href="http://bit.ly/cAK0o2" target="_blank">my blog</a> on Tuesday, I mentioned the $2.4 trillion Americans spend on health care each year.<br />Today I would like to focus on one component of our health system that costs us between $84 and $151 billion.</p><p>I’m talking defensive medicine—the product of a tort system run amuck that drives up costs in our health system yearly and adds not one iota to the value of health care. </p><p>A solution to this problem is caps on non-economic damages in medical liability cases; it’s a solution that has worked for at least a generation in states like California, Texas, Louisiana and others.</p><p>In addition, there’s a way to potentially help alleviate this costly burden—by implementing <a href="http://www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/practice-management/medical-liability-reform.shtml" target="_blank">medical liability reforms</a> that reduce unnecessary health care costs and implement best-practices in patient care. </p><p>Last month, 20 different states and health systems were given the opportunity to start working toward making these initiatives reality. On June 11, the Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) awarded certain states and health systems medical liability <a href="http://www.ahrq.gov/news/press/pr2010/hhsliabawpr.htm" target="_blank">grants that totaled $25 million</a>. </p><p>The money will be used on programs that identify common medical errors, foster better communication, and ensure patients are informed of medical errors and offered early compensation. </p><p>Congress also appropriated $50 million to create a separate <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/hsr-3590-medical-liability-reform.pdf" target="_blank">medical liability grant program</a>—as part of the reform law—which allows for the resolution of disputes over injuries allegedly caused by health care providers or organizations. And it encourages collecting and analyzing patient safety data to reduce health care errors. </p><p>The AMA has been an advocate for comprehensive medical liability reforms since the beginning, and we’ve collaborated closely with state medical associations to implement such programs. We served as an advisor to the AHRQ for its new grant program. </p><p>Clearly, this is a topic we and physicians across the country have been talking about for years. Let me say emphatically the conversation is not over. As our nation works to reduce the growth in health care costs, <a href="http://www.ama-assn.org/ama1/pub/upload/mm/399/hsr-3590-medical-liability-reform.pdf" target="_blank">medical liability reform</a> must be part of the solution.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Connecting medical liability reforms to quality and improved patient care-07-08-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:1f95b0f4-2e04-475c-a7f3-5c185458325d United we stand http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ae1538656-6f99-4674-ba20-dcee0c034088&plckScript=blogScript&plckElementId=blogDest Wed, 07 Jul 2010 12:05:00 GMT <p>In the wake of this Fourth of July as we celebrate the independence and founding of our country, I am reminded of the words of Benjamin Franklin, who at the conclusion of the signing of the Declaration of Independence, said: “We must all hang together, or most assuredly we will hang separately.”</p><p>And more recently this Independence Day, on assuming command of NATO forces in Afghanistan, Gen. Petraeus gave voice to the image of unity when he said: “Civilian and military, Afghanistan and international, we are part of one team with one mission. …Your success is our success.”</p><p>The goal of unity in support of our patients and the physicians who care for them is critical if we are to be successful in making a health care system that better serves our country.</p><p>And just as I said in my inaugural address, this has been a challenging year. And on an issue as complex as health system reform it is inevitable that differences of opinion will arise.</p><p>Remember, the common ground we share is vast -- what divides us is not. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=United we stand-07-07-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:e1538656-6f99-4674-ba20-dcee0c034088 Adherence to medication saves billions of dollars and millions of people from pain and suffering http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a179c256e-b507-4256-ba9a-2039d1b5382a&plckScript=blogScript&plckElementId=blogDest Tue, 06 Jul 2010 13:35:00 GMT <p>Stating the obvious is not always a bad thing. Never stating the obvious puts us at risk that what should be obvious may no longer be.</p><p>Former U.S. Surgeon General C. Everett Koop, MD, once said, “Drugs don’t work in patients who don’t take them.”</p><p>This statement of the obvious has recently taken on new significance with the information that nearly three out of four Americans reported they do not always take their medication as directed. One in three never fills their prescriptions.</p><p>Between one-half and two-thirds of medication-related hospital admissions are linked to poor medication adherence. This is not just an individual problem. It affects all of us.  </p><p>The total cost of nonadherence amounts to at least $300 billion per year in America, which adds up to approximately 12 percent of the $2.4 trillion we spend on health care.</p><p>This is money we could be spending more productively. And it represents preventable pain and suffering for millions of people that must be dealt with by improved efforts to encourage patients to take their medications as directed.</p><p>With regard to medication safety, the AMA has resources for physicians to heighten awareness of the integral role of <a href="http://www.ama-assn.org/ama/no-index/physician-resources/medication-reconciliation.shtml" target="_blank">medication reconciliation</a>, and for patients to help them <a href="http://www.ama-assn.org/ama1/pub/upload/mm/370/medication-safety.pdf" target="_blank">become active partners</a> in their own health care by asking questions and sharing information with their doctors. Also, make sure that poor adherence is not caused by poor <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/health-literacy-program.shtml" target="_blank">health literacy</a> and that your patients understand the information you give them.</p><p>I want to hear what you think. Join me for my first “<a href="http://www.ama-assn.org/ama/pub/ama-president-blog.shtml?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a091f3672-abea-4d51-a099-2a99d56eedfc&plckScript=blogScript&plckElementId=blogDest" target="_blank">Office Hours with Dr. Wilson</a>” at 7 p.m. Eastern time tomorrow, July 7. This call will be held on the first Wednesday of every month for all AMA members. You talk, and I listen. Join me by <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=8n37a48splhf" target="_blank">registering</a> today. Registration closes Tuesday afternoon.  </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Adherence to medication saves billions of dollars and millions of people from pain and suffering-07-06-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:179c256e-b507-4256-ba9a-2039d1b5382a Join me next week for the first “Office Hours with Dr. Wilson” http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a2f188e15-29ef-43d7-a227-bf3202d58f2a&plckScript=blogScript&plckElementId=blogDest Fri, 02 Jul 2010 17:15:00 GMT Do you have a question you want to ask?<br /><br />Would you like to share your thoughts on a particular issue in medicine?<br /><br />Is there something you believe the AMA should be doing and we’re currently not?<br /><br />If so, then call. I want to listen. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=8n37a48splhf" target="_blank">Register</a> for the first “<a href="http://bit.ly/dvRjBm">Office Hours with Dr. Wilson</a>” at 7 p.m. Eastern time on Wednesday, July 7. <br /><br />This call will be held on the first Wednesday of every month for all AMA members. It’s a time to share your thoughts, concerns and suggestions with me. <br /><br />I hope you will plan to join me for the first call next week.  I am looking forward to this opportunity to hear your thoughts and concerns.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Join me next week for the first Office Hours with Dr. Wilson-07-02-2009" target="_blank">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:2f188e15-29ef-43d7-a227-bf3202d58f2a Coming together, keeping together, working together http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a375f6473-cc07-487a-8440-78265d91c4a7&plckScript=blogScript&plckElementId=blogDest Thu, 01 Jul 2010 14:24:00 GMT The great American industrialist Henry Ford once said that "Coming together is a beginning. Keeping together is progress. Working together is success."<br />That very teamwork is what Federal Trade Commission Chair Jon Leibowitz talked about during a session at the <a href="http://www.ama-assn.org/go/annual2010" title="2010 Annual Meeting of the AMA House of Delegates">AMA Annual Meeting</a> last month. He told physicians the FTC prefers "conversation and collaboration" with physicians rather than “confrontation.” Read about his visit in <a href="http://www.amednews.com/2010/prl20628.htm" target="_blank" title="American Medical News - amednews"><em>American Medical News</em></a>. <br /><br />The FTC plans to join forces with physicians through a <a href="http://www.ama-assn.org/ama/pub/news/news/ftc-chairman-antitrust.shtml" title="FTC payment policy workshop - Health care system">payment policy workshop</a> this fall. The workshop will clarify how we and others in the health care system can successfully participate and collaborate on new <a href="http://www.ama-assn.org/ama/pub/about-ama/2010-strategic-issues/payment-model-resources.shtml">health care delivery models</a>, like accountable care organizations, without breaking antitrust laws. <br /><br />This couldn’t come at a better time. Clinical integration has become a hot topic under the health system reform law. Leibowitz told physicians that working together to lower health care costs and raise quality is “applauded” by the FTC. But fixed prices, interference with competition and raised expenses would initiate FTC action. I'm pleased that the FTC heard our concerns, and I couldn’t agree more.  <br /><br />But that’s not the only concern we've expressed. The AMA <a href="http://www.ama-assn.org/ama/pub/news/news/lawsuit-red-flags-rule.shtml" title="AMA filed a lawsuite May 21 - FTC Red Flags Rule">filed a lawsuit</a> May 21 asking a federal court to prevent the FTC from extending the <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/practice-management-center/data-security/red-flags-rule.shtml" title="Red Flags Rule">“red flags” rule</a> to physicians. The FTC responded about a week later by <a href="http://www.ama-assn.org/ama/pub/news/news/red-flags-rule-delay.shtml" title="Red Flags rule delay">delaying the compliance deadline</a> until the end of the year.<br /><br />Liebowitz said the FTC wants Congress to fix the rule "sooner rather than later." Well so do we. For two years, we have been making the case that physicians are not creditors like banks and lenders, and this misguided rule should not apply to us. <br /><br />So we've "come together," we're making progress with the "keeping together" part, and I'm confident we can "work together" to enable the best outcome for physicians and patients. <br /><br /><strong>I want to hear what you think.</strong> Join me for my first "<a href="http://www.ama-assn.org/ama/pub/ama-president-blog.shtml?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a091f3672-abea-4d51-a099-2a99d56eedfc&plckScript=blogScript&plckElementId=blogDest" target="_blank">Office Hours with Dr. Wilson</a>" at 7 p.m. Eastern time on Wednesday, July 7. This call will be held on the first Wednesday of every month for all AMA members. You talk, and I listen. Join me by <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=8n37a48splhf" target="_blank">registering</a> today.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Coming%20together,%20keeping%20together,%20working%20together-06-02-2010">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:375f6473-cc07-487a-8440-78265d91c4a7 Let’s build more bridges through interactive conversation http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a091f3672-abea-4d51-a099-2a99d56eedfc&plckScript=blogScript&plckElementId=blogDest Wed, 30 Jun 2010 09:46:00 GMT <p>In my <a href="http://www.ama-assn.org/ama/pub/news/speeches/wilson-inaugural-speech.shtml" target="_blank">inaugural address</a> June 15 in Chicago, I gave prescriptions for the major problems facing our health care system and for the stakeholders responsible for implementing <a href="http://www.hsreform.org/" target="_blank">health system reform</a>.</p><p>I also gave myself a prescription, as president of the AMA, to help mend the divisions within our ranks. </p><p>Isaac Newton once observed that, “we build too many walls and not enough bridges.”</p><p>I plan to heed those words and act accordingly. </p><p>One way I intend to do this is through regular conference calls to speak with AMA members in what will be called “Office Hours with Dr. Wilson.” The goal of these calls will be in part to provide updates on the latest developments but primarily to hear from AMA members.</p><p>They will be interactive -- a two-way conversation to openly and honestly communicate with one another. I’m not just going to talk. </p><p>I’m going to listen.</p><p>“Office Hours with Dr. Wilson” will be held at 7 p.m. Eastern time on the first Wednesday of each month. The initial call is scheduled for July 7. <a href="https://cc.readytalk.com/cc/schedule/display.do?udc=8n37a48splhf" target="_blank">Register</a> today.</p><p>I hope you will join me to share your thoughts, concerns and suggestions about what the AMA is and should be doing.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Let’s build more bridges through interactive conversation-06-01-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:091f3672-abea-4d51-a099-2a99d56eedfc Reform makes lifelong impression for one patient -- and many more http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ade3778e9-af06-4194-9e73-75397b2857b6&plckScript=blogScript&plckElementId=blogDest Tue, 29 Jun 2010 14:27:00 GMT <p>Some of us, including me, remember the old TV crime series depicting life in New York City that ended with the line, “There are 8 million stories in the naked city; this has been one of them.”</p><p>I recently traveled to the Bays County Medical Society in Panama City, Fla., where members heard me describe what’s in the health system reform law and its implications for physicians and their patients.</p><p>During that meeting, my brother, a general surgeon in Panama City, also shared the following e-mail he had received from a friend who is a nurse practitioner:</p><p>“I just want to thank you and your brother for your efforts in <a href="http://www.hsreform.org/" target="_blank">health care reform</a>. My daughter, age 23, who is graduating from college this year was able to gain health care insurance through her father’s health plan (because of the new changes). She has a seizure disorder.</p><p>“Our son has a hereditary blood disorder and requires blood or iron transfusions a few times a year. He is in graduate school as well and we hope he will gain entrance into the high-risk pool as soon as they are in place. I just wanted to tell you how much this change means for me personally.”</p><p>It’s easy to spout statistics about the millions of people who now have insurance that previously did not; the billions of dollars health system reform will cost; and discuss the big-picture implications on congressional budgets, national debt and the economy. </p><p>Numbers with multiple zeros are hard to wrap one’s arms around. That’s why it is important to remember that in the end, it is individual people who will be helped.</p><p>And there are a million stories out there.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Reform%20makes%20lifelong%20impression%20for%20one%20patient%20--%20and%20many%20more-06-29-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:de3778e9-af06-4194-9e73-75397b2857b6 What it really means to be “On the Road Again” http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a6a4c7db3-acea-4245-9a97-91400d10f626&plckScript=blogScript&plckElementId=blogDest Mon, 28 Jun 2010 15:28:00 GMT <p>One of my all-time favorites on my iPod is Willie Nelson singing “On the Road Again” -- a song he made famous first as part of the soundtrack of a 1980 movie called “Honeysuckle Rose.”</p><p>This blog is titled “On the Road with Dr. Wilson.” So one may ask, what does that mean?</p><p>Last week it meant:</p><p>Monday – I spoke to the Emergency Department Management Association in Key Biscayne, Fla., then drove 250 miles back home to Winter Park, Fla.</p><p>Tuesday – I flew to Chicago.</p><p>Wednesday – I attended a meeting at the AMA headquarters between members of the leadership of the AMA and the American Pharmacists Association, the American Association of Colleges of Pharmacy, and the American College of Clinical Pharmacy. Then I was off to Washington, D.C.</p><p>Thursday – I joined Maryland Gov. Martin O’Malley at the opening session of the 25th annual meeting of the American Association of Physicians of Indian Origin. Then I flew back to Chicago.</p><p>Friday – I participated in the orientation session for <a href="http://www.ama-assn.org/ama/pub/news/news/bot-2010-2011.shtml" target="_blank">new members</a> of the AMA board who were elected during the <a href="http://www.ama-assn.org/go/annual2010" target="_blank">Annual Meeting</a> earlier this month, then flew back home to Winter Park.</p><p>Saturday – My wife Betty Jane and I flew to England, where we are attending the annual meeting of the British Medical Association in Brighton.</p><p>So, on the road again -- eat your heart out Willie.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=What%20it%20really%20means%20to%20be%20%E2%80%9COn%20the%20Road%20Again%E2%80%9D-06-28-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:6a4c7db3-acea-4245-9a97-91400d10f626 Raising the claims process benchmark http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ae3869cad-69f8-406b-b570-b2e794dd1b91&plckScript=blogScript&plckElementId=blogDest Thu, 24 Jun 2010 14:00:00 GMT <p>A reality of high school and college was the end-of-the-term ritual in which students received a report card that assessed their performance over the previous weeks. The hope, of course, was always that the outcome would be good. </p><p>With regard to today’s health insurers, though, that is not the case. They just received their <a href="http://www.ama-assn.org/ama/pub/news/news/2010-report-card.shtml" target="_blank">third annual report card</a> this month from the AMA. It ranks seven of the nation’s largest health insurers on how they can improve their claims processing performance. And while we didn’t give an actual letter grade on the report, I would venture to say an “A” would not have been reflective of their collective performance. </p><p>Here’s why. The <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process/national-health-insurer-report-card.shtml" target="_blank">National Health Insurer Report Card</a> found that, on average, one in five medical claims are processed inaccurately by health insurers. The industry as a whole has about an 80 percent accuracy rate for processing and paying claims. And if we eliminated all errors by health insurers, we could save at least $15.5 billion annually in unnecessary administrative costs. Need I say more?<br /> <br />On the other hand, the report card also provides reason for optimism. The performance of these health insurers has improved significantly on several metrics, especially the “contracted match rate.” This is the frequency with which the health insurer reports pricing the claim using the same contracted fee schedule amount the physician practice expected it would use.</p><p>This is an opportunity. By reducing administrative costs and creating a single transparent set of processing and payment rules, physicians and insurers can save both time and resources. </p><p>The National Health Insurer Report Card, a key component of the AMA’s <a href="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process.shtml" target="_blank">Heal the Claims Process</a>™ campaign, marks an important step in doing so. While some insurers are getting better, there’s a lot more work to be done. </p><p>I encourage all physicians to take the next step. Get involved in this campaign so we’re no longer forced to be at the mercy of a chaotic payment system.  </p><p>And let’s work together to make sure insurers set the grading curve high. So when report card time rolls around next year, health insurers can look forward to and anticipate glowing results. And we can focus on what we do best—caring for our patients.</p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Raising%20the%20claims%20process%20benchmark-06-24-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:e3869cad-69f8-406b-b570-b2e794dd1b91 The success of reform hinges on a stable, reliable Medicare program http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a9cdf587b-4094-4e22-bce8-dd42b51bfd9c&plckScript=blogScript&plckElementId=blogDest Tue, 22 Jun 2010 15:00:00 GMT <p>Over the weekend I was privileged to speak at the annual meeting of the Dade County Medical Association in Miami. In addition, yesterday I talked to the Emergency Department Practice Management Association in Key Biscayne.</p><p>On both occasions I talked about the truly historic legislation passed in March that is a start toward meaningful health system reform in our country. It is not, however, the end. It’s only the beginning. The legislation is not perfect and much work remains over the coming years.</p><p>One large gap in the law is the lack of a permanent fix for the flawed Medicare physician payment formula, the sustainable growth rate (SGR). This is a problem that dates back to legislation passed in 1997. But it has assumed greater importance as the cuts in payments -- called for under this formula -- are making the Medicare program unreliable. And much of the success of health system reform is going to be dependent on a stable, reliable Medicare program.</p><p>A surgeon I talked with at the DCMA meeting put a face on the payment issue. He indicated that last year he opted out of the Medicare program even though it accounted for 75 percent of his practice. His reasons were that Medicare payments for the past nine years have not kept up with the cost of providing care. </p><p>There is the annual threat of cuts in payments making financial planning impossible. Medicare now covers only 52 percent of the direct costs of providing care in a physician’s office, and the surgeon has lost hope that Congress will solve the problem. He elected to take what is a significant financial loss now in an expectation that without Medicare in his practice he will be better able in the long run to plan for a successful practice.</p><p>This story is being repeated across the country. We know that almost 25 percent of seniors who are looking for a primary care physician are having difficulty finding one. In addition, a recent AMA poll revealed that 17 percent of physicians have already limited Medicare patients in their practice. For primary care physicians, that number has reached 31 percent. And this was before the 21 percent cut went into effect on June 18. </p><p>Anecdotally -- at least in my community -- the conversations at parties, in the grocery stores and at the water cooler frequently include the question: “Do you know any doctors who still take Medicare?” Unfortunately the answer not uncommonly is “no.”</p><p>Members of Congress need to hear these stories from their constituents. </p><p>Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=The%20success%20of%20reform%20hinges%20on%20a%20stable,%20reliable%20Medicare%20program-06-22-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:9cdf587b-4094-4e22-bce8-dd42b51bfd9c A dereliction of duty -- what are they thinking? http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3ae1ab8598-7b60-46a1-a8af-ceea4559e5d7&plckScript=blogScript&plckElementId=blogDest Mon, 21 Jun 2010 17:33:00 GMT In a dereliction of duty that is astounding and breathtaking, last Friday <a href="http://www.ama-assn.org/ama/pub/news/news/medicare-cuts-begin.shtml">Congress abrogated its promise</a> to seniors to provide care through the Medicare program by allowing a draconian cut of 21 percent in Medicare physician payments to go into effect. This puts at risk access to care for seniors, baby boomers and military families who rely on TRICARE.<br /><br />This follows nine years in which the Medicare payment formula -- the sustainable growth rate (SGR) -- annually called for cuts in payments; and annually, at the last minute, Congress blocked the cuts but did not fix the problem. This time after a kabuki dance that postponed the cuts three times, the ball was dropped and the cuts are reality.<br /><br />It is likely, though not inevitable, that this week Congress will take action to reverse the cuts. But it is unlikely to take action to get rid of the formula -- the SGR -- that is the cause of the problem. So once again there will be a temporary “fix” that postpones resolution of the problem and makes future cuts deeper and the costs of a fix higher.<br /><br />Five years ago when cuts were 5 percent, the cost of a permanent fix was $48 billion. Today the cuts are 21 percent and the cost of a fix is more than $250 billion. In another five years predictions are for rates to be cut by as much as one-third or more and the cost of a fix would be in excess of $500 billion.<br /><br />Much of the rationale that one hears to explain the difficulty in reaching a solution revolves around the laudable, if for some, newfound goal of members of Congress to be fiscally responsible. But being fiscally responsible is about more that just not spending money. It is about spending wisely. I would submit that not resolving a problem now that will inevitably be much more expensive to fix in the future is neither wise nor fiscally sound. As the old adage goes, “you can pay me now, or you can pay me later.” And in this case, later will cost a lot more.<br /><br />America’s seniors and the physicians who care for them deserve better. They deserve a Medicare program that is reliable and that pays the cost of providing care.<br /><br />Editor's note: To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=A%20dereliction%20of%20duty%20--%20what%20are%20they%20thinking-06-21-2010">e-mail</a>. Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:e1ab8598-7b60-46a1-a8af-ceea4559e5d7 Navigating toward healing, unity http://www.ama-assn.org/ama/pub/ama-president-blog/road-dr-wilson.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=0b90b13b-8074-42d2-be9a-5d263dc8c945&plckPostId=Blog%3a0b90b13b-8074-42d2-be9a-5d263dc8c945Post%3a29b916bf-8b8b-4428-9d36-b650f17b441b&plckScript=blogScript&plckElementId=blogDest Thu, 17 Jun 2010 15:01:00 GMT <p>When my brothers and I would head out the door to school every morning, our father the Rev. Dr. Wilson, would always say: “Remember, you represent the whole family. Act accordingly.” </p><p>That simple statement has guided me through college, medical school and my service as a flight surgeon in the U.S. Navy. As I begin my term as AMA president, representing and providing a voice for all physicians -- starting today with my first in a series of blog posts as part of “On the Road with Dr. Wilson” -- I will use it to “act accordingly.” </p><p>I’ve found that life is really about opportunities and responsibilities. I think I speak for us all when I say that there’s no shortage of these within our profession.   </p><p>As physicians, we have the opportunity to heal and the responsibility to do no harm. We have the opportunity to care for those who are ill and the responsibility to deliver the best care possible. And we have the opportunity to assure that our country’s health care system bears the imprimatur of physicians and the responsibility to bring to that task a voice that is clear, firm and constructive. </p><p>I would compare the journey we’ve endured on health system reform to that of my love for sailing. We embarked upon it with a plan of action, and at times we diverted off course, at times we were becalmed, but ultimately we reached our destination—a first step toward a better health care system in this country.</p><p>The new law makes medical care more accessible, coverage more reliable and insurance companies more accountable. And it strengthens wellness and prevention. </p><p>Even when the sailing is smooth and the sun is shining, I still check the wind, the sea and my sails. I expect changes and I prepare for them. If physicians fail to plan and let outside forces plot our course and set our speed, we will ultimately drift powerless without direction or purpose. </p><p>Facing a defining moment in the history of medicine, remember, this is a tremendous opportunity for physicians. Let’s work together to bridge the legitimate differences that exist between us. And let’s keep in mind that we’re in this boat together. </p><p>We are the family of medicine. We represent our patients. We must set the course together. </p><p>Because together, we are stronger. </p><p>Until later…</p><p>Editor’s note: <a href="http://www.ama-assn.org/go/annual2010" target="_blank">View video</a> of Dr. Wilson’s inaugural address. To comment on this post, send us an <a href="mailto:amaprezblog@ama-assn.org?subject=Navigating%20toward%20healing,%20unity-06-17-2010" target="_blank">e-mail</a>.</p> Blog:0b90b13b-8074-42d2-be9a-5d263dc8c945Post:29b916bf-8b8b-4428-9d36-b650f17b441b