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New AMA President Talks Tough on SGR

 |  By jfellows@healthleadersmedia.com  
   June 12, 2014

The new president of the American Medical Association, Robert Wah, MD, says he is "beyond frustrated" that the sustainable growth rate formula has not yet been repealed, and says finding a way to pay for it is the job of Congress.



Robert Wah, MD

Robert Wah, MD, inaugurated this week as the 169th President of the American Medical Association at the organization's annual House of Delegates meeting in Chicago, is a busy man.

Wah teaches and is a practicing reproductive endocrinologist and obstetrician-gynecologist at the National Institutes of Health and the Walter Reed National Military Medical Center, both located in Bethesda, Maryland. He is also chief medical officer for Computer Sciences Corporation, a Falls Church, Virginia-based technology company.

Nationally recognized for his technology expertise, Wah was the first deputy national coordinator for the Office of the National Coordinator for Health Information Technology (ONC) at the Department of Health and Human Services. He also served as a captain in the U.S. Navy Medical Corps for 23 years.

The first Chinese-American president of the AMA says one of the biggest challenges ahead of him is the same one that his predecessors also had: repealing the Medicare sustainable growth rate physician payment formula. He spoke with me this week about the work ahead.

Q: What concerns have you heard from physicians at this year's AMA House of Delegates meeting?

Overall, there is some trepidation about change; change is always a challenge for people. I personally like to look at change as an opportunity as opposed to a challenge. I would also say that we're very interested, as physicians, in making sure that we craft a delivery system that leads to better care for our patients in a more cost-efficient, cost-effective way.

I'm a little frustrated sometimes when we spend so much time talking about payment reform. We don't talk enough about delivery reform.

There is a clear intersection between delivery and payment, but we need to move the needle a little bit more and talk more often about how to deliver better care for our patients earlier in the conversation because oftentimes it leads to us just tinkering with the payment system and then seeing what happens on the delivery side.

Q: There is frustration that the SGR has not been repealed and is still a temporary, so-called "doc fix" Can you comment?

First, I'm on a one-person campaign to stop the phrase, "doc fix." I believe Medicare needs fixing, not doctors. All physicians and Medicare patients should be frustrated that Congress is not taking action definitively on the problem we have with the Medicare payment system, particularly with the SGR. It's been with us for many years. They just passed the 17th patch, and yes, we are beyond frustrated.

Q: The Florida delegation lined up significant support to have the House of Delegates take over control of the lobbying efforts of the AMA. Ultimately, that resolution failed. But do you believe the move reflects frustration that nothing permanent has come out of AMA's longstanding efforts to repeal the SGR?

It's important to note that the AMA has made progress on this [SGR]. Obviously, we're still frustrated that we haven't gotten the final goal of repeal, but there has been significant progress. We were encouraged by the fact that for first time in many years, we had bicameral support.

Both the U.S. House and the U.S. Senate worked together to craft a plan that had bipartisan support. The legislative process is very challenging, and so to navigate both sides of the aisle and both houses is a significant achievement.

We believe we have momentum this year, partly because the Congressional Budget Office has given us a better score in terms of lowering the overall cost of repeal. We also galvanized the federation of medicine. We had 600 organizations sign on to letter to Congress asking for repeal this time.

Q: The AMA has maintained that its role in repealing the SGR is from a policy perspective only, and it will not intervene in how to fund an SGR repeal proposal. Will the AMA continue to remain silent on how to pay for the SGR?

We will continue to expect Congress to do its job. And its job is to make those choices.

We believe they have many choices to make to pay for this. We also believe they haven't taken that step and they need to. It's their job to fix that part of Medicare.

We understand they have many challenges, but that's what they're hired to do, and we also believe they do have choices to find the funding, to make this happen. We'll work with them in any way we can, but ultimately it is the job of Congress to make those budgetary choices.

Q: As the first deputy national coordinator for the ONC, you're more than qualified to be the messenger for increasing the use of technology among physicians. How do you plan on using your background and expertise in health information technology in your role as AMA president?

A: I do have a background that is a little bit different than many physicians. I've had the privilege and opportunity to see HIT at a large scale. But, I can also talk from the perspective of a practicing physician. That's what I hope to do. I am very aware of the issues physicians face in their offices with technology, but I also know how large scale deployment of HIT can work.

I see an opportunity to have a rich conversation across policy makers, vendors, and physicians to make sure we're getting what we all want. Sometimes we get too focused on the close-up problems, and don't keep in sight the top goal, which is using technology to take better care of patients. I'm a big believer in consensus and then moving forward.

Q: What do you hope to accomplish during your term?

I hope we make significant advances in our advocacy agenda, and the SGR is certainly at the top of that. I am still optimistic that we will be able to take that momentum that we created over the last 9-12 months and get the SGR repealed finally this year. That's a huge aspiration, but I hope it's obtainable during my term.

I also really want to make sure we continue the robust conversation in the use of technology to take better care of our patients. I have a background in HIT, have had great opportunities in the Department of Defense, Health and Human Services, and see the power of how technology can improve patient care for my physicians.

I am also excited to talk about physician satisfaction. This is a great profession. We've been frustrated, certainly. There are a lot of challenges, but I'm still very optimistic about the profession of medicine. We shouldn't see change as such a challenge. It should be seen as an opportunity.

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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