Randolph D. Smoak, Jr., MD
President
American Medical Association

Good morning.

For the past six months, I have had the privilege of traveling the country – and the world – on behalf of the American Medical Association. And I have been honored to address the men and women who represent our profession in all its diversity – physicians from different specialties, different types of practices, different states -- even different countries.

But whether I speak with pediatricians or neurosurgeons, Texans or New Yorkers, managed care employees or that rare find, a solo practitioner, physicians today all seem to ask the same question.

What is organized medicine doing to improve the practice of medicine?

In other words, what have you done for me lately?

My answers usually surprise them, because physicians are so focused on the care of their patients that they simply can’t keep up with all we are doing.

And if there’s one thing I’ve learned in my six months as the AMA President, it’s this:

My job – your job – our job is to let the physicians of America know just how hard we are fighting to create the best environment possible for their practice of medicine.

We’re fighting this battle on a number of fronts.

We’re fighting to win physicians relief from government hassles.

We’re fighting to prevent and to end managed care abuses.

We’re fighting to make sure that good solutions to tough health care issues, including the problem of the uninsured, get heard.

Let’s begin with an old favorite: HCFA.

As you may know, HCFA recently announced a 4.5 percent physician payment update for 2001. This follows the 2000 update of 5.4 percent. Thus over the past two years HCFA has increased the physician payment update almost 10 percent.

These increases come to you thanks to the efforts of your AMA. We advocated for -- and got – important provisions in last year's Balanced Budget Refinement Act. These provisions forced HCFA to correct errors in its projections of the Sustainable Growth Rate, and thus the spending targets that help determine physician payment updates.

While we still are suing HCFA for the three billion dollars they owe physicians due to previous errors in their projections, we’re pleased that – thanks to these changes in the BBRA -- HCFA won’t get away with making those mistakes any more. And we’re proud that the physicians who care for our nation’s elderly / will get the resources they need -- to continue to provide the very best care.

The physicians of this nation will also get more help -- and fewer hassles -- from HCFA this year.

Why?

Your AMA demanded that HCFA reinstall their toll-free lines so that physicians can talk to a real human being when they have questions about claims forms.

HCFA gave us back the toll-free lines.

Your AMA said “no” to the government’s use of proprietary coding edits.

On October 1, HCFA deleted these “black box” edits and today physicians can get the information they need to properly submit their claims.

Your AMA also earned a victory in terms of CPT.

This year HCFA published a series of regulations for the Health Insurance Portability and Accountability Act – and designated CPT as the HIPAA standard.

What does this mean to you?

You – and your staff – can rest assured that you’ll only need to know one coding system – not two or three – to submit your claims electronically.

And that system is the AMA gold standard: CPT.

These are just a few examples of how we’re slicing away at the red tape that keeps physicians tangled in paper work, phone calls – and even litigation.

And it’s not just HCFA we’re watching closely.

We’ve also been working to make sure that health insurance plans do right by physicians – and we’re suing when necessary.

The AMA, in conjunction with the Medical Association of Georgia and several physicians sued Blue Cross – Blue Shield of Georgia – and won. Because of our suit, the Appellate Court of Georgia has ruled that Blue Cross – Blue Shield must fully disclose their payment schedule and explain how they calculate that schedule. Thanks to our combined effort, the physicians of Georgia will soon be able to tell before they sign a contract -- whether they will be paid fully and fairly for the care they give.

We have made it part of our mission to make sure physicians sign contracts that are good for them – and for their patients.

That’s why we’re continuing to offer “Model Managed Care Contracts.”

These contracts not only provide physicians with examples of appropriate contractual language they also help physicians to recognize the language of unfair practices. Practices that can have a detrimental effect on the quality of our care. Practices such as all-products clauses, silent PPOs, hold harmless agreements, and health plan down-coding.

In the past year, two states -- Maine and Washington -- have succeeded in having provisions of the AMA Model Contract included as part of insurance legislation or regulation. And countless physicians throughout the nation have used these model contracts to negotiate better contracts or to throw out bad contracts altogether.

However, even the best-written contracts cannot protect us -- or our patients -- from a bottom-line imbalance of power in the negotiating process.

Which brings me to a legislative issue that will be of major importance in the 107th Congress: Anti-trust relief.

In the upcoming session of Congress, we will continue to push for legislation that would allow physicians in private practice to negotiate jointly with health plans – without fear of government reprisal.

As you know, the Campbell anti-trust bill swept the House of Representatives this past year – winning 276 votes. Next year, anti-trust legislation will be considered by the Senate Judiciary Committee, and the Chair of that Committee, Senator Orrin Hatch, has promised to work with us on next steps. We will keep on fighting for anti-trust relief until legislation passes.

And while we’re there, we’ll also keep fighting for patients’ rights.

This past year the patients’ bill of rights met with overwhelming bipartisan support in the House of Representatives only to stall in the Senate – largely because of partisan politics-as-usual.

Today, the winds of change are sweeping our nation’s Capitol, because today, no political party has won a clear and overwhelming mandate from the American people.

But one issue certainly has: Patients’ rights.

Almost ninety percent of all registered American voters believe our nation needs to pass a meaningful patients’ bill of rights. And to create legislation that would put medical decision-making back in the hands of physicians and hold health insurance companies accountable for their decisions to deny or delay care.

Like us, they’re sick and tired of congressional gridlock.

Our newly elected Congress should take heed – including our as-yet-to-be-named president. Because now is the time to show Americans that the elected leaders of this country are capable of working together for the common good.

I can think of no better vehicle for this than the passage of a real patients’ bill of rights.

And so I urge the elected representatives of this nation to seize this opportunity – and show us that they are bigger than the sum of their parts.

That’s what this new political climate demands.

That’s what our patients – and the physicians who treat them – expect.

And that is what we have been calling for since we put our National House Call on the road last year and started shaping the national health care debate.

Patients’ rights -- of course.

The uninsured?

We have a plan.

Recent studies have shown that limited access to care means big problems for uninsured Americans – such as advanced cancers, uncontrolled diabetes and dangerously high blood pressure. Uninsured people often wait until they are critically ill to seek medical attention – and they often seek care in the most expensive medical setting – the emergency department. Living without health insurance is a serious medical risk for uninsured Americans -- and it is a fiscal risk for all of us as well.

Because caring for the uninsured at the crisis stages of illness not only hurts them – it also drives up the cost of care for everyone, including those physicians who provide much-needed charity care.

I believe that the short-term political fix is no longer an option. It’s time for a long-term cure.

We know there are better ways to address this problem – ways that improve the practice of medicine instead of undermining it.

The AMA believes that every American should have access to quality, affordable health care. Our economists tell us that we could reach this goal by taking the tax breaks that currently subsidize employer-sponsored health plans and redirecting them towards refundable tax credits for everyone – especially those who need it most:

The working poor.

We want to put control of health insurance back where it belongs – in the hands of the people it covers. And we want to do so in a medically – and economically -- responsible way.

That is the very cornerstone of the AMA’s approach to health insurance reform.

These are big problems. They need big solutions.

But let’s not forget that – like politics – all health care is local.

This means that any physician in America can participate in this kind of work, with the AMA or in your own backyard.

Let me tell you about my own home state.

A few years ago, South Carolina had such a low immunization rate that the governor asked local businesses to help.

Local businesses responded with a plan. They would give the families of all children who received their shots --coupons for kiddie meals at local restaurants.

The governor loved the idea. So did local businesses.

Most importantly, so did families.

Immunization rates for the children of South Carolina skyrocketed.

And a major public health initiative was quickly and painlessly put into place.

These are the kinds of initiatives that the AMA supports, admires -- and emulates.

As we seek to create and recreate as necessary the best possible medical environment – for patients and for physicians.

I began this speech by saying that it would answer a question that physicians love to ask:

”What have you done for me lately?”

And I’ve given you some good answers to that question.

Now I want to turn the tables – and bring that question back round to you.

What have you done for your AMA lately?

And what have you done to improve the practice of medicine in this country?

I issue this challenge today because it is our challenge.

Because we can’t achieve all that we want to achieve unless we pull together with our colleagues and work for the good of physicians – and for the good of our patients.

Thank you.

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