Marriott’s Orlando World
D. Smoak, Jr., MD
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
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
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
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,
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.
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
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
That’s why we’re continuing to offer “Model Managed Care
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
And while we’re there, we’ll also keep fighting for
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.
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
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
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
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
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.