The former AMA delegate who predicted the physician group's membership would "drop like a stone" because of statements suggesting they oppose a public plan, now says he is somewhat relieved that the group's Wednesday resolution will "at least keep them at the table" of health reform debate.
"At least they realized that the first statement was a mistake," says David Priver, a San Diego obstetrician gynecologist and California Medical Association delegate.
AMA delegates this week spent several hours in an emotional debate–one member who was there called it "knockdown, drag out"–between left wing and right wing members who disagreed over how to weigh in their voice on President Barack Obama's push for a public plan. And support for "a public option" was language that was included in the wording of one of several proposed resolutions they agreed to consider.
"It broke down between the right and the left," says Robert Hertzka, MD, a moderate California delegate to the AMA. "The right outnumber the left, but people on the left are about as loud as the people on the right," he said yesterday in an airport bound for home.
Some were concerned that not supporting a public plan "makes it seem like we like Aetna, when we just filed three lawsuits against health plans," he says.
In the end, the delegates were tired and out of time, and outgoing president Nancy Nielsen, MD, took the microphone. They all want reform, she told the crowd, but she suggested they just stick with the language in place in a previous resolution. That resolution did not include mention of a public option.
They voted, just as the delegates were about to lose the conference hall, Hertzka says.
The new resolution says the following: The organization supports "health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice and universal access for patients."
"People on the left and right really felt like they had fought a war. They felt something dramatic had happened," Hertzka describes.
But other doctors are still disenchanted with the AMA for not specifically advocating a public plan as the Obama administration is pushing.
"The AMA has a large denial problem," says Joe Scherger, MD, vice president for primary care at Eisenhower Medical Center, near Palm Desert, CA. and an AMA member.
"They're not facing the huge healthcare cost problem, and that's the problem that's crippling America," says Scherger. "What is the AMA doing to respond to what is happening in McAllen TX, where a map of medical expenses finds them charging more than all but one other region of the country, apparently because physicians are giving too much care?
"Nothing," he said.
"There's nothing new in their new statement, at all," he said.
Kevin Pho, MD, who blogs from his internal medicine practice in Nashua, NH, said in an interview that younger physicians like himself, and more liberal ones in his specialty, tend to side more with the American College of Physicians than the AMA.
"The AMA only represents 30% to 35% of doctors practicing across the country," he says. "But they are still the most influential lobbying force for doctors in the country and they still hold influence and sway."
Now, he said, the AMA appears to realize that "they have to appear somewhat open to some sort of public plan because the president supports it, and if they don't they'll lose their seat at the negotiating table."
Pho says it's difficult for anyone to say how they feel about a public plan when the details of the president's proposal have not yet been revealed. In reality, the concept of a public plan may be different than anyone on the right or left side of the debate envisions today.
Priver, former president of the San Diego County Medical Society, echoes his comment. "They've got to start spelling out the details. I don't know whether they're holding up for a reason, or whether spelling out these details would mean more anxiety."
More than two-thirds of respondents say the government should provide more funding to expand services for emergency departments so they can hire additional physicians and other staff, according to a new poll commissioned by the American College of Emergency Physicians.
The Harris Interactive poll also found that 81% say emergency care benefits should be included as part of any government sponsored health insurance plan being designed by Congress and the Obama Administration.
"This is the strongest evidence yet that the public supports significant reforms to help emergency patients," says Nick Jouriles, MD, president of the 27,000-member ACEP. "Emergency physicians treat 120 million patients each year—nearly one-third of the national population—yet our policymakers are not focused on addressing emergency care in the healthcare reform discussions. This comes at a time when emergency departments are closing at rapid rates and overcrowding is increasing dramatically. Emergency care consumes only 3% of the nation’s $2 trillion in healthcare expenditures, but is a priceless public resource."
The poll of 1,012 adults, conducted June 3-7, also found that:
51% say emergency department care should be one of the top priorities for the Obama Administration and Congress when it comes to developing a government sponsored health insurance plan.
67% expressed concerns about the length of times people wait to see emergency physicians.
55% expressed concerns about the availability of staff and resources in the emergency department in their community, such as nurses, doctors and laboratory equipment.
55% are also concerned that general overcrowding in the emergency department is becoming a problem.
The poll has a margin of error of 3.1%
"You cannot solve America’s healthcare dilemma without also taking a long, hard look at the state of emergency care," Jouriles says. "In a year in which the first pandemic in 41 years has been declared (the H1N1 virus), it is shortsighted at best and dangerous at worst not to shore up our nation's safety net, the emergency medical care system."
Richard M. Scrushy, former chairman and chief executive of HealthSouth Corp., was found liable in a civil suit alleging he masterminded the massive fraud that nearly sank the rehabilitation company. A Birmingham judge awarded the plaintiffs $2.876 billion in damages and rescinded Scrushy's employment contract.
Physicians getting jobs out of residency reported an increase in median salaries from last year in emergency medicine, infectious disease, and hematology/oncology, according to the Medical Group Management Association "Physician Placement Starting Salary Survey: 2009 Report Based on 2008 Data." The survey also found that experienced physicians migrated to Florida and Texas, while those directly out of residency favored North Carolina and Illinois.
The AMA voted in its annual meeting to establish a dress code that would do away with the white coats that have distinguished physicians for years. The goal of the ban is to reduce the risk of infection from bacteria on unwashed sleeves.
Many providers received an alert message from CMS this morning informing them that scammers are sending fake faxes and posing as a Medicare carrier or Medicare Administrative Contractor (MAC) in order to obtain billing information.
According to Peter Ashkenaz, CMS deputy director of media affairs, the agency discovered the scheme when several providers called CMS after receiving the suspicious faxes. The faxes asked physician staff to respond to a questionnaire and provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The faxes may have included the CMS or MAC logo.
Ashkenaz says CMS wanted to get the word out to providers immediately. "At this time, we don’t know much more than what is in the release," Ashkenaz says.
Ashkenaz adds he could not speculate on what charges the scammer/scammers could face or what could be done with the information, but he did say possession of billing information could lead to fraudulent billing of Medicare or other insurance providers.
CMS informed physicians and non-physician practitioners that they should be wary of the request and check with their contractor before submitting any information. CMS added that Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov Web site found at http://www.cms.hhs.gov/MLNGenInfo/ or http://www.cms.hhs.gov/MedicareProviderSupEnroll.
Are your medical staff bylaws a help or a hindrance? If they resemble dusty archaeological documents, you can be sure they are hindering your medical staff's ability to function effectively while staying compliant.
Many medical staff bylaws were written in the distant past and are only occasionally dusted off and modified, either to accommodate a new accreditation requirement or to address a current controversy involving the medical staff. Individuals who participated in crafting bylaws language are often highly invested in the resulting document and sometimes resist attempts to modernize it. Thus, many medical staffs are organized and function much as they have for decades, despite the dramatic changes that have occurred in healthcare.
Today, the healthcare industry and society in general demand more of the medical staff than ever before, yet physicians have less time than ever to devote to medical staff activities. The challenge is to create an effective and efficient medical staff structure that burdens physicians as little as possible.
To accomplish this, physician leaders in hospitals nationwide are redesigning the way they tackle self-governance, credentialing, peer review, communication, and medical staff administration. As they do, they must revise their bylaws to reflect the changes they initiate because bylaws serve as a blueprint and a road map for the medical staff's exercise of the powers delegated to it by the governing board.
The Greeley Company cannot provide a model set of bylaws because each document must mirror the uniqueness of the medical staff for which it is written, but it can provide some helpful pearls. The saying "form follows function" applies here. Once a medical staff decides how it wants to function, it can incorporate appropriate changes into its medical staff bylaws.
When written well, bylaws and associated policies are user-friendly documents that:
Clearly define the purpose of the medical staff
Establish effective and efficient medical staff structures and processes
Recognize and protect physicians' rights to self-governance and due process
Promote good citizenship by specifying the obligations and duties of the medical staff
Enhance quality of care through excellent credentialing and performance improvement processes
Achieve excellent provider performance by setting unequivocal expectations for clinical care and professional behavior
Clearly delineate the investigation and fair hearing processes
Despite hospitals' best attempts, medical staff bylaws are rarely user-friendly documents. Physicians new to a medical staff are often required to sign a statement that they have read and agree to abide by the bylaws and associated medical staff manuals and policies. However, few physicians have the time or motivation to weed through the numerous pages of cumbersome language that often characterize these documents.
Hospitals spend significant sums of money, devote countless hours of physicians' time, and employ numerous attorneys and consultants in an attempt to perfect, refine, and improve their bylaws. Still, bylaws are often overrun with complex terms, definitions, and jargon that have little to do with the provision of quality patient care. For many physicians and medical staff leaders, the word "bylaws" is equivalent to "bureaucracy."
Medical staff bylaws also have legal implications for physicians and hospitals. If the medical staff does not follow governing documents meticulously, or if the documents contain ambiguous or sloppy language, disputes can eventually turn into lawsuits. When bylaws are poorly constructed, they can impede cooperation and disrupt the smooth coexistence of the hospital and medical staff. One benefit of well-written bylaws—like any good contract or compact—is that they provide clear guidance to all parties that must operate in compliance with them. In addition, carefully thought-out and drafted medical staff bylaws help organizations create an environment in which physician-hospital collaboration can be successfully maintained.
Undertaking a bylaws review
The importance of medical staff bylaws should compel every hospital and its medical staff leaders to ensure that bylaws are adequate, accurate, and compliant with applicable requirements. The medical staff should conduct a thorough review of these documents periodically to determine whether they:
Accurately reflect the medical staff's structures and processes
Incorporate recognized best practices for medical staff functioning and structure
Are organized into a user-friendly and flexible set of documents
Adequately address potential future conflicts
Comply with regulatory standards
Keep in mind that your organization should review the bylaws annually and whenever a regulatory body introduces a new standard or makes changes to an existing standard to ensure compliance. However, the medical staff can conduct a stem-to-stern assessment less frequently. For example, some medical staffs automatically conduct a comprehensive bylaws document review every three to five years. Others undertake this task only when they redesign, the medical staff structure and processes to ensure that they perform efficiently and effectively.
A general rule of thumb is to not allow more than three to five years to pass between rigorous assessments. Unfortunately, too many medical staffs neglect to commit to this time frame. Every year, the number of pages in the document grows as new additions are layered on top of old and often unnecessary provisions. During a casual read-through of the bylaws, one is likely to identify medical staff "fixes" that were added to address problems that last surfaced ages ago.
The result is an unwieldy and ossified document that hinders the effectiveness of a modern medical staff in a rapidly evolving healthcare environment. If this describes your bylaws, it may be time to consider a comprehensive review and potential top-to-bottom overhaul.
Responsibility for the bylaws review
A designated medical staff professional should keep the medical executive committee (MEC) up to date on changes to regulations and standards that might affect the bylaws. Some medical staffs have a standing bylaws committee, and this group can vet suggestions for appropriate bylaws revisions. However, medical staff leadership (with the endorsement of the MEC) can and should make the decision to undertake a thorough review of the medical staff's governing documents. Keep in mind that this activity will inevitably be tinged with organizational politics and should be carefully planned.
Also, keep in mind that bylaws committee members may have a vested interest in the old documents. In some organizations, the chair of the bylaws committee has held that position for many years and therefore may have an ownership mentality regarding the current bylaws; he or she may resist significant changes to the documents. At the same time, this individual likely has vast institutional knowledge and understands the reasoning behind why the medical staff chose to make certain additions to the bylaws. Finding the right balance between keeping what is valuable from the past and incorporating new best practices is one of the greatest challenges in any bylaws rewrite.
To avoid some of these issues, the MEC may want to consider appointing a special task force to undertake the bylaws review. Appointees can be chosen for their knowledge of medical staff affairs, ability to craft good bylaws language and to achieve medical staff buy-in, statesmanship, and other critical qualities.
Bylaws decision points
When crafting new bylaws, medical staffs are faced with many decision points. It would be impossible to discuss all of them in this paper, but the following is an example of one such decision point regarding potential sample bylaws language.
Determining the appropriate number of medical staff committees
Why do some medical staffs have up to 20 standing committees? Simply put, they rush to create a new committee every time The Joint Commission or other accrediting body publishes another standard that requires medical staff participation.
Originally, the MEC performed all of the functions required by the medical staff. However, as medical staff requirements and responsibilities grew, the MEC began to establish standing subcommittees to accomplish various tasks. If a streamlined infrastructure is the goal, a medical staff with a strong MEC, credentials committee, and interdisciplinary quality/peer review committee can carry out all the medical staff's work. However, various accreditation standards, regulations, laws, and professional organizations (e.g., medical societies) may require medical staffs to establish certain committees.
For example:
To be accredited by the American College of Surgeons as a trauma or cancer center, organizations must establish a trauma or cancer committee
To be able to grant category 1 continuing medical education (CME) credits, a facility must establish a CME committee
If a medical center educates and trains residents, it must establish a graduate medical education committee
If a facility is involved in research, it must establish its own, or leverage an existing, institutional review board
Although these are the most commonly required committees, some state laws may require additional committees (e.g., a safety or pharmacy committee). All other committees are optional, and you should consider keeping them only if they provide value to the organization.
Traditionally, medical staffs have appointed a nominating committee that only convenes to develop a ballot prior to electing medical staff officers and other leaders. Because the task of finding, educating, training, and retaining excellent medical staff leaders is becoming increasingly important, some medical staffs are now establishing an ongoing leadership and succession committee. This committee develops selection criteria, outlines a leadership training process, and works to create a pool of future leaders. This committee also periodically assesses the performance of medical staff leaders, provides feedback, recognizes good performance, and identifies opportunities for improvement when appropriate.
Below is some sample bylaws language to govern a leadership and succession committee:
1. Composition. The leadership and succession committee shall consist of five members of the medical staff, including the president and immediate past president of the medical staff and three others appointed by the president of the medical staff. The chair shall be the immediate past president of the medical staff. Except for the president and immediate past president, members will serve three-year terms, and one of the appointed members will rotate off the committee each year. All members should be active members of the medical staff for at least three years and be in leadership positions, such as a department or committee chair, medical staff officer, or MEC member, during at least part of their term on the committee.
2. Responsibilities. The leadership and succession committee shall:
Develop criteria for leadership positions that include tenure, leadership training, previous experience in leadership positions, and character
Provide an annual slate of nominees for the elected medical staff positions
Provide an annual list of potential leaders
Define a process for evaluating current leaders (e.g., department chairs, committee chairs, medical staff officers, and MEC members) and potential leadership candidates
Outline a plan and process for developing potential leaders
Submit recommendations for medical staff committee chairs based on the potential leaders' needs for development and readiness to serve (the president of the medical staff will consider these recommendations for committee chairs but will not be bound by them)
Develop position descriptions for the officers
Report twice per year to the MEC
Many committees that have been historically organized by the medical staff function just as well (or better) as multidisciplinary hospital committees with designated physician leadership or participation. Physician leaders are appointed by the president of the medical staff to fulfill the medical staff functions of the hospital-based committees. This seems to work well for committees that address blood usage, utilization review, medical records, ethics, pharmacy/therapeutics, and infection control.
For example, a medical staff ethics committee could become a hospital committee with physician representation. Under this structure, the MEC would no longer be directly accountable for that committee's functions, but physician representatives on the committee would keep the MEC abreast of important issues. Although the medical staff must play a role in a wide variety of hospital functions—such as blood-usage monitoring, participation in ethical decision-making, selecting formulary drugs, and adopting infection control policies—it need not manage a long list of committees to serve those purposes. Another alternative to medical staff or hospital committees is to enlist the services of designated physician liaisons, advisors, or experts.
For example, the medical staff could replace a long-standing medical staff infection control committee with a physician advisor who meets regularly with the hospital's infection control coordinator to address important issues. This individual would report periodically and as necessary to the MEC (or medical staff quality committee), eliminating the need for a group of physicians to take the time to attend regular committee meetings. Consider addressing functions such as blood-usage monitoring or utilization review in this way as well.
Other medical staff committees need not be standing committees. Instead, they could function on an ad hoc basis. A bylaws committee might be assembled whenever there is a perceived need to review or modify the medical staff governing documents. A physician advocacy/impaired physician committee could meet only as needed when a matter of physician health, well-being, or impairment arises. A joint conference committee of the medical staff and board might meet on an ad hoc basis only when the board is considering acting in a manner contrary to a recommendation made by the MEC or when a collaborative discussion of controversial topics is needed to reduce potential conflict between the medical staff, senior management, and the governing board.
The MEC is ultimately accountable for ensuring that all medical staff functions are achieved. It can accomplish its work through whatever committee infrastructure it deems most efficient. Given the extreme demands on physicians' time and the difficulty many staffs encounter trying to get physicians to attend meetings, less may be more when it comes to establishing a committee infrastructure.
What should be in the bylaws?
A battle continues to rage over what should be kept in the bylaws and what can be kept in associated manuals and policies. Some protagonists in this argument believe that physicians' rights are best protected by placing as much as possible in the bylaws. Many believe that the bylaws function as the contract between physicians and the hospital, and in many states, this is the law. The bylaws are the proper place, they argue, for all things that could affect physicians' practices, especially those items that might restrict their clinical activities or their ability to earn a living.
Although this approach is valid, it fails to recognize that the bylaws are difficult to change. They serve as the constitution of the medical staff, and they change infrequently and only when change is desired by a majority of those who are governed by the constitution. However, healthcare is changing rapidly, including regulatory requirements and evolving best practices for credentialing, peer review, and competence.
The goal for individuals drafting bylaws should be to strike the right balance between these two perspectives. Documents describing physicians' rights, including a physicians' bill of rights and the protections of due process, should be embedded in a document that is difficult to change. At the same time, rapidly evolving processes related to redentialing, privileging, and peer review should be in a document that can be changed with a vote of the MEC, without having to appeal to a majority of voting medical staff members.
The Joint Commission has appointed a task force to craft new language to address which documents should be kept in the bylaws, which is addressed in MS.01.01.01. The latest news from The Joint Commission is that the task force has reached a compromise and will share it with the public soon, with implementation planned for 2011. Stay tuned for more on this evolving issue.
Enable the create of new bylaws
Careful vetting of current bylaws and thoughtful rewriting or reorganizing are only the first steps along the path to developing new medical staff governing documents. The next challenge is overcoming resistance to change. Remember, resistance to change is typically greatest in volatile times such as those we now face in healthcare.
Once a committee or task force recommends change, it should create and fully explain the new draft document to medical staff leadership. Buy-in of medical staff leaders is essential, and every effort should be made to achieve consensus at this level. The committee or task force should then develop a campaign to educate and win the acceptance of the general medical staff. This campaign can and should include town hall meetings, newsletters, presentations by leaders at department meetings, and one-on-one lobbying of those physicians most likely to resist change. The ultimate goal, of course, is to win the acceptance necessary to ensure that the bylaws can be modified under the amendment procedure in the current bylaws.
Conclusion
The 21st century will demand that practitioners change the way they deliver healthcare to patients. Hospitals are likely to continue their rapid pace of change, and the nature of the organized medical staff will have to change as well. If your medical staff bylaws are outdated and cumbersome, they may hobble your institution and its practitioners.
In our consulting work with medical staffs, The Greeley Company has always been impressed to see that revising bylaws is much more of a change management and redesign challenge than a clerical chore. When striving to achieve effective bylaws, we are well advised to keep in mind the wisdom of Albert Einstein: "Any intelligent fool can make things bigger, more complex ... It takes a touch of genius—and a lot of courage—to move in the opposite direction." Einstein also gave us the insight that "Everything should be made as simple as possible, but not simpler." Together, these are words to live by for all of us who endeavor to improve medical staff bylaws.
Joseph D. Cooper, MD, CMSL is a Senior Consultant with The Greeley Company.
The Health Information Technology for Economic and Clinical Health (HITECH) Act, a portion of the American Recovery and Reinvestment Act (ARRA) passed in February, is creating a lot of buzz in the healthcare industry. Approximately $20 billion will be appropriated through the act to help physicians, medical practices, hospitals, states, and some healthcare vendors adopt information technology that will be used meaningfully. What does this mean for you and your practice?
What makes understanding and moving forward with the act difficult is that there are no directives for how all the changes are going to happen. What we do know is that the law states that this money will be available to physicians who can demonstrate "meaningful" use.
So, what does that specifically mean? Money will only be available if physicians can show meaningful use. "That's a big deal, and I think approximately 80% of the people that you talk to in the real world don't get that," says Kibbe. "What they are likely to say is, ‘If I buy an EHR, I'll get this money.' Wrong. That's not what the law says. It doesn't mention specific standards. It's very unclear how the certification will be done and by whom."
With those considerations in mind, it's a good time to formulate an information technology and business plan for your practice. "What we're telling people is that if you have a business plan for the adoption of a comprehensive EHR from company A, B, or C; if you have been working on the plan for a while; and if you can afford it, there's probably no reason to delay that purchase right now," says Kibbe. "On the other hand, though, these monies do not get paid until 2011, and we don't have clear guidelines or specifications with respect to the minimum [technological] requirements, in terms of the tech they need to have to qualify under the meaningful use clause."
That means there is a risk you could be investing in a system that is more expensive and complicated than you need. Once the terms of the bill are laid out, your system might not have the technological requirements needed for you to meet the bill's standards, and you might need to purchase expensive extras, updates, or even an entirely new system.
Physicians will also need to track disclosures from EMRs to a greater extent than is currently required to comply with the HIPAA privacy rule, meaning that whatever vendor you select will need to add the ability to track and report this in- formation, says Chris Apgar, CISSP, president of Apgar & Associates, LLC, in Portland, OR.
Consider accreditation
It's also important to see whether the EHR is accredited. The most well-known accrediting body is the Certification Commission for Healthcare Information Technology (CCHIT). "They have worked with a number of organizations; they accredit EHRs. It's a key in the stimulus package," Apgar says.
Medical professionals should begin looking at the way things are going to roll out. Some money will come to each state, but it's important to know how it's going to happen. "What I would anticipate seeing is that there is going to be a differentiation between rural versus urban," says Apgar. "The infrastructure for an urban [health information technology (HIT)] is usually well established, while it may not exist in some rural areas of states."
But what if you've already purchased a system? Or what if you've had one for some time? The first thing to do is to make sure your EHR follows the currently known guidelines of the act and has the aforementioned attributes. Is it able to e-prescribe? Does it follow the three guidelines defining meaningful use? If not, you will need to discuss upgrades and interoperability work with your vendor. In some cases, the way a practice customizes a system can compromise its interoperability, so upgrades need to be planned carefully, Apgar says.
"Another key thing the system should be able to do is to export quality reports in standardized formats in ways that are likely to be chosen by the Secretary of Health and Human Services," says Kibbe. If it can't, Kibbe suggests looking into an upgrade because it's a technological capability you will need to report and apply for the incentive when the time comes.
What should you be doing now?
Even though you may want to consider waiting to purchase a system, it's always a good time to be thinking about acquiring the healthcare application you need and to be educated and prepared for what you need to know and do in the future.
For example, few people realize that $2 billion has been set aside as discretionary funds for HIT exchange stations at the state and regional level. Why is it important? HIT extension offices will act as help desks and training facilitators for those in healthcare adopting and using EHR technologies.
This resource will help new users avoid the usual pitfalls that come from adopting EHRs, such as stress, decreased productivity, paper chart conversion costs, and a decreased number of patients that can be seen per day.
Although almost every state will have HIT exchange programs or projects, many are still in the planning phase. "Therefore, it would be wise for physicians to contact their local state and government offices to try to learn who will be responsible for receiving federal money that will provide resources to help them in the implementation of the HIT and EHR systems and to learn how to do that in a way that is very effective," says Kibbe.
This article was adapted from one that originally ran in the June 2009 issue of The Doctor's Office, a HealthLeaders Media publication.
President Barack Obama's nearly hour-long speech to the American Medical Association on Monday didn't contain much in the way of new policy proposals. But he made it clear that physicians may play a pivotal role in determining whether or not healthcare reform legislation moves forward smoothly in the coming months.
"I need your help, doctors," Obama said. "To most Americans you are the healthcare system. The fact is Americans—and I include myself and Michelle and our kids in this—we just do what you tell us to do … We listen to you, we trust you. And that's why I will listen to you and work with you to pursue reform that works for you."
Those comments are particularly interesting in the context of the AMA's fumbling last week over its position on the public insurance option that Obama favors.
An article in last Thursday's New York Times claimed for the first time that the nation's largest physician group opposed a government-sponsored insurance plan, and quoted a letter the AMA sent to the Senate Finance Committee that said, "The AMA does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70% of Americans."
That's pretty strong language that could have made for an awkward visit from the president and given ammunition to opponents of the public plan.
But not so fast. Before the day had ended, AMA President Nancy Nielsen, MD, issued a clarification, saying, "Today's New York Times story creates a false impression about the AMA's position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress."
So what's going on here? Why is the AMA sending mixed messages? Why did the organization immediately back away from its strong opposition to a public option?
The answer was in Obama's speech: It's because he needs your help, doctors.
A new poll from Gallup suggests that the American public trusts physicians more than any other stakeholder to recommend the right options for reforming the healthcare system. Seventy-three percent polled put their trust in physicians, compared to only 58% who are confident in Obama's recommendations.
That means physicians also have a unique power to sink healthcare reform. The AMA has a history of doing so, in fact. The AMA is credited with giving the phrase "socialized medicine" its current pejorative connotation; it campaigned against Medicare in the 1950s and 1960s, enlisting then-actor Ronald Reagan as a spokesman; and it helped defeat President Bill Clinton's attempt at healthcare reform in the 1990s, in part by endorsing House Speaker Newt Gingrich's alternative plan.
But this time may be different. Physicians need reform as much as anyone, and they have a lot to lose if the entire effort fails. Most doctors support many of the proposals that Obama mentioned on Monday—covering the uninsured, getting rid of the sustainable growth rate formula, paying more for prevention and primary care, and addressing malpractice reform. Although Obama explicitly said he wasn't in favor of caps on malpractice awards, he did tell the audience that he was willing to explore a range of ideas for dealing with malpractice issues and defensive medicine. That was the biggest applause line of the speech.
The AMA has to walk a fine line politically—it must use its influence to tweak the specifics of the reform package, but if the organization is too aggressive it risks torpedoing the entire process.
Most doctors don't want that to happen, so the AMA won't likely oppose reform as openly as in the past.
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The debate over an overhaul of the nation's healthcare system got off to a rocky start in the Senate as lawmakers delayed action on one key bill and engaged in partisan sniping over another. Senate leaders said they are still on track to put a bill on the floor by midsummer, but some Democrats privately acknowledged that piecing together a measure that will expand coverage to the uninsured is proving excruciatingly difficult, particularly if the goal is to pass a bill with Republican support.
