Harmon H. (Bud) Davis II, MD, FACP
Governor, Wyoming Chapter
Greetings, Claire and I recently returned from the Board of Governors Meeting and National Meeting at the American College of Physicians-American Society of Internal Medicine in Philadelphia. It was a very profitable week, both from an educational standpoint and from administrative standpoint. The Scientific Meetings were, as usual, quite interesting and educational with a broad spectrum of topics. I was particularly interested in the new sessions that were offered with regard to the history of medicine, and dealing with the pressures of medical practice.
Administratively, the Board of Governors dealt with several issues. We have recommended to the Board of Regents that the name of the College be returned to the American College of Physicians. This passed unanimously without alteration other than an amendment that the Board of Governors can change the name over time, in view of the expense engendered. We also spent a great deal of time dealing with recertification. The Board of Governors passed several resolutions with regard to this and hopefully over time, the recertification process will be improved. While mentioning this, I should note that one of our own is now on the American Board of Internal Medicine, Dr. Dan Klein from Laramie, and if you have any comments, I am sure that Dan would be more than happy to hear them. He was in Philadelphia at the same time for an American Board of Internal Medicine meeting. He also attended the College Scientific Meeting.
Several other topics were also discussed, including the fact that over the next three to four years there will be a significant reduction in Medicare payments, which will amount to approximately 28% when adjusted for inflation, as well as the geometric reduction that is forecast. The College is attempting to deal with this and understands the impact on American medicine in general.
I have enclosed a sample Op-Ed on page two that one could send to their local newspaper, adjusting it obviously to local circumstances, with regard to the significant reduction in health care services. Other additions to this newsletter are the response of the College to the American Medical Association regarding the SAGE Report, as well as, the pledge that is taken by Members of the College. I have included the oath because I feel that it, in and of itself, represents a reason for members to advance to fellowship. If you have any questions with regard to Fellowship or Membership, please feel free to contact me.
I look forward to seeing you at our Regional Meeting in South Dakota, September 12-14, 2002. John Beckman, Eric Wedell and I have been working closely with the South Dakota Chapter and I believe this is going to be a very interesting and educational scientific meeting.
Sample Op-Ed: Reduction in Health Care Services
ACP-ASIM's advocacy efforts to reverse this years' 5.4 percent Medicare cuts and to replace the SGR-based update formula in future years can be fought right here in Wyoming. To call constituents attention to this issue, the Public Affairs Department is encouraging members to submit editorials and letters to the editor in publications in each state capital and targeted congressional districts. These letters should incorporate key national policy messages, statistics specific to each state, and the experiences of local members. The following is a recent op-ed submitted on behalf of Dr Hall to the New York Times:
Sample Op-Ed- In my medical practice, a receptionist has been replaced by voicemail, to the dismay of my patients. Another chair sits empty in front of a blank computer terminal. Each time a patient asks why, I find myself explaining that the payments Medicare makes to health care professionals continue to decline in spite of rising costs of delivering care to my patients.
Medicare rates for physicians' services in 2002 are nearly equal to rates from 1990. When adjusted for inflation, payments have lagged 13 percent behind the rising cost of providing care to patients. Medicare is now projecting that reimbursements to physicians will drop nearly thirty percent between 2002 and 2005, after adjustments for inflation. This will force physicians and patients to make tough choices about how and even whether medical care is available to Medicare enrollees.
Medical practices are in effect small businesses. The simply economics of running a medical practice dictate that when reimbursements drop, costs must be cut. When an insurer pays less than the cost of services, you stop providing those services. With practices revenues down significantly in the last ten years, Medicare doctors must make tough choices about how to respond.
The areas where doctors can cut costs are those that will ultimately hurt patients: delaying medical equipment purchases, cutting hours to reduce staff time or cutting costs on medical and patient education materials. Although I would not stop seeing my current patients, I may have to make the difficult decision to limit the number of new Medicare patients coming into my practice.
In New York alone, over 2.5 million people participated in Medicare in 1999. Baby boomers will soon reach retirement age and that number will swell. At the same time, access to physicians will suffer as reimbursement drops dramatically. Physicians over fifty are more likely than ever to retire early because of economic pressures. Young physicians are less likely to enter medical specialties that serve older adults when they see that the nation's primary insurer of older adults is not adequately covering the cost of care.
For years, congressionally mandated systems for reimbursing physician services have ignored the rising cost of providing medical care to Medicare beneficiaries. Congress cannot legislate a change in the basic laws of economics. A business must be paid more than the cost of providing its services. Medicare can no longer ignore the consequences of current payment policies that deliberately under-fund medical care for beneficiaries.
Congress must find a rational, predictable method of paying for health care services. Congress' own advisory panel has recommended reforming the physician payment system to reflect the rising costs of care, as does the payment system for hospitals and long term care facilities. This solution must be implemented quickly, before large numbers of Medicare enrollees find themselves with an insurance card, but no doctor to honor it.
ACP-ASIM'S Response to the SAGE Report
The American College of Physicians-American Society of Internal Medicine (ACP-ASIM), the largest medical specialty society in the United States, is pleased to offer comments on the final report of the Special Advisory Group Extraordinaire (SAGE). The College supports the goal of the SAGE to streamline and transform the Federation based on the conceptual design of the Commission on Unity. Our response was necessarily delayed beyond the requested response date in order to allow full review by our Board of Regents on April 9, 2002.
ACP-ASIM applauds the effort that went into this thoughtful report. Many of the recommendations of the SAGE report would have a huge impact on the AMA and the component participating organizations of the federation. The report calls for a virtual reinvention of organized medicine. There are many issues that need to be explored further prior to implementation. It will require careful handling and a reassessment of relationships both internal and external to the Federation.
During our discussions, it became clear that our support of the proposed governance structure of CORE is contingent on a re-engineering of the AMA Board of Trustees that would foster trust in its stewardship of the Federation. There is additional concern that the proposal transfers too much power to the Board. ACP-ASIM feels the Congress should be specifically charged with setting policy direction for the core organization. ACP-ASIM also supports the exploration of ongoing electronic communication to continue the work of the Congress between sessions. Thus, ACP-ASIM can consider approval of Recommendation 1 only after major modification. ACP-ASIM supports the following aspects of the SAGE report:
- The creation of a yearly Congress to replace the House of Delegates.
- A staged change in the delegate allocation formula from 1:1000 to 1:3000 over the next five years.
- The creation of a National Collaboration Council.
- The establishment of an Advocacy Council consisting of 20 members.
- Recommendation 9 that outlines the framework for the annual advocacy planning process.
- The coordination a communications policy as outlined in Recommendations 10-12.
- A voluntary membership model that would transition the core entity to a organization of organizations.
ACP-ASIM does not support Recommendations 14-17 at this juncture and defers consideration of Recommendations 18-20. We are not interested in a centralized membership management system at present. We are unable to approve an affinity program clearinghouse until additional information on specific proposals are available.
The College agrees that the best way to redefine organized medicine is to build trust among the member organizations. ACP-ASIM appreciates that the report will be subject to further consideration and debate, and recommends that it be referred for further refinement and adjustment.
ACP-ASIM Membership Pledge
I affirm my belief in the mission of the American College of Physicians-American Society of Internal Medicine; To preserve and maintain the highest traditions and precepts of our professional calling; And I solemnly declare that I will conform to these ideals to the utmost of my ability.
I therefore reaffirm my dedication to the practice of medicine;
To act always in the best interests of my patients;
To respect the reputation and integrity of my colleagues;
To supplement my own judgement with the counsel of others when the occasion requires;
To render assistance to my colleagues in every way;
To extend my professional aid to the unfortunate;
To increase my medical knowledge and understanding by continuing study by association with physicians of the highest intellectual and ethical standards and by the free exchange of information and experience with all of my medical colleagues.
I hereby pledge to uphold the ethics of medicine as exemplified by the standards and traditions of this College.