E. Ratcliffe Anderson, Jr., MD
Executive Vice President
American Medical Association

Welcome. I’m Andy Anderson, Executive Vice President of the American Medical Association.

Thanks for joining us at this Breakout session for “Hot” State and Federal Issues.

What I’d like to do first is to introduce to you the other members of the team who form the panel for today, representing the various areas within the Federation.

After they’ve all been accounted for, I’ll fill you in on the AMA perspective on what’s happening in the other Washington.

First up, D. Brent Mulgrew, Executive Director of the Ohio State Medical Association. Brent will be presenting the work of the Advocacy Resource Center, on whose Executive Committee he has served as Chair since its inception in 1997.

Next, Susan G. D’Antoni, Executive Director of the Orleans Parish Medical Society in New Orleans, Louisiana. Susan will be speaking about the AMA House Call campaign and the tremendous grassroots support it received in the primary states during this all-important election year.

And last but not least, Katie Orrico, JD, Director of the Washington Office of the American Association of Neurological Surgeons/College of Neurological Surgeons. Katie will be sharing information about the work groups that the specialty societies and the AMA have formed around specific legislative and regulatory issues in Washington.

And now for the “hot” Federal issues. You’ll see that we’ll have to keep adding fuel to the fire to keep them boiling while Congress goes out for its annual August Recess and the Conventions start up.

Patients’ Bill of Rights

For six years we’ve worked to pass the common-sense provisions in the patients’ bill of rights. And the insurers have fought us every step of the way.

The Norwood-Dingell bill – which received a groundswell of grassroots support throughout the Federation – earned sweeping bipartisan support in the House.

And was overwhelmingly passed – a victory celebrated throughout organized medicine.

Because the House bill actually protects patients – and hold insurance firms accountable.

While what the Senate passed could only be called the HMO protection bill.

And the resulting Senate-House conference committee is locked in a stalemate.

But we – together with our Federation partners – are determined to continue our work for real patient protection.

Protecting all 168 million Americans covered by managed health care plans.

Holding health plans accountable when they make decisions that harm patients.

Providing an independent and timely appeals process if patient care is delayed or denied.

And in the past 2 – 3 weeks, we’ve been trying everything we can to work with all sides on a bill to break the deadlock without compromising our key principles.

No matter what happens in the time left after our legislators return from their August recess – the AMA will remain focused – disciplined – and aggressive – in getting these patient protections passed.

And as for those insurance plans who banded together in the Coalition for Affordable Quality Health Care to capture the headlines with their late-breaking concern for the patients they’ve been putting through their mills.

Sure, actions speak louder than words. But all we have right now are their words.

Remember a year ago, when the airlines said they would work to be more flyer-friendly?

Have you flown lately?

Let’s see how the health insurers follow through.

If they really want to prove that they care about patients, they’ll support the common-sense provisions of the patients’ bill of rights.

So then we can all focus on the real priority – the health of all Americans.

And I hope your organizations will stay the course with us to make that happen. Campbell bill

We also found broad, deep bipartisan support in Washington for the Campbell bill, H.R. 1304, the Quality Health-Care Coalition Act of 2000.

The House of Representatives approved the Campbell Bill by a wide margin – voting to allow collective bargaining by self-employed physicians.

Since 1994, there have been 275 mergers and acquisitions of health plans. Now, just seven powerful plans – and the Blues – control the cost, access and quality of care for more insured Americans.

We all know that these powerful health plans intimidate and threaten physicians with antitrust violations in order to bar them from talking to one another – and to insurers – about patient care.

We need legislation at the federal level to offset the enormous advantage insurance companies have in dictating terms – dictating what the underwriters think is appropriate patient care – and appropriate levels of quality.

What happened in the East Coast Washington was this: The House acted. The Senate slept. And now the summer recess is upon us.

So, I would urge all of you and the organizations you represent – to act now in urging support for a Senate version of H.R. 1304.

And, like the patients’ bill of rights – if they don’t act on it, I can assure you, we won’t back down. We will persevere in Washington – and back home – until Congress does the right thing.

Medicare BBA Fix

On Tuesday, we gave testimony to a subcommittee of the House Committee on Commerce concerning how the Balanced Budget Act of 1997 – the BBA, as it’s known – impacts on physicians and their patients.

This subcommittee on Health and Environment is taking a look at amendments to the BBA.

As you know, the BBA cut deeply into Medicare payments for some medical services. And allowed HCFA to burden physician and their patients with massive amounts of regulatory requirements – which could prevent access to Medicare and threaten the quality of such care.

So, we’re urging the Subcommittee to “fix” the BBA by addressing four issues of importance to physicians and their patients:

First of all, to approve an amendment to reform HCFA by making sure it supports physician education concerning Medicare coding, billing and documentation requirements and restore “due process” for alleged overbilling.

All this unnecessary red tape is pushing physicians to discontinue seeing Medicare patients – or even to retire early – rather than deal with such hassles.

Threatening access to care – especially in rural area – which, in turn, affects quality of care.

Even worse, forcing physicians to pay back the government, based on “extrapolation” is just plain unacceptable.

To add a second amendment to make the Department of Health and Human Services show some accountability for regulatory costs.

Physicians’ medical practices are forced to absorb all the compliance costs of the many regulatory requirements forced upon them.

We believe the cost of compliance should be calculated and that HHS and HCFA should increase Medicare physician payment rates each year to account for these costs.

As well as improve HHS’s methodology for calculating these regulatory costs.

Thirdly, more work is need on physician practice expenses. We’re looking for provisions that will ensure that HCFA’s current practice expense methodology will more accurately reflect physicians’ actual practice costs.

In conjunction with 40 other physician organizations, teaching hospitals , medical schools, and clinics, we support the 50/50 formula for determining practice expense relative value units.

A fourth change we propose is to improve the formula for determining whether medical residents can qualify for student loan deferments during residency.

The BBA made it even more difficult for medical residents to make ends meet, especially when they have to repay their student loans during their residency.

If the BBA would readjust the formula for “economic hardship,” residents could obtain deferments while they continue their education through internship and residency.

Sometimes, when lawmakers make laws to help – the after-effects of those laws often hinder what they originally set out to do.

It’s the role of the AMA as advocates for the profession and for the patients of America – to act as a reality check for such laws.

And to work through the process, as we are doing so with the proposed BBA amendments, to improve upon what is envisioned up there on Capitol Hill.

Patient Safety Legislation

The Institute of Medicine’s report on medical error has generated a great deal of media coverage and emotion.

But the issue comes down to no disagreement –

No debate or argument – over whether medical error exists or whether we can learn from mistakes and move on.

We have to keep in mind that this report doesn’t undermine or attack physicians themselves –

But instead points the finger at the systems we’re using that set us up to have problems in patient care.

AMA policy is to be part of the solution, not the problem.

In fact, long before the IOM report the AMA helped launch the National Patient Safety Foundation –

With the avowed purpose of adapting airline and aerospace industry practices to error detection and correction.

That approach creates a culture of cooperative learning and mutual improvement – as opposed to a culture of blame and trial lawyer enrichment.

And that’s what we’re urging on Congress now.

Calling for a central role for the Agency for Healthcare Research and Quality.

And incorporating the NPSF approach into whatever system evolves.

At each step while Congress studies the problem and designs a new system – our work is aimed at improving – not punishing.

Reporting and disseminating lessons learned – not blaming.

Finding prevention strategies and promoting them and helping implement them.

And doing so confidentially and securely.

All in the interest of our patients – the patients of America.

Patient Prescriptions

Concerning the drive to have Medicare fund patient prescriptions – we physicians understand how important it is for our patients to have their medications.

But we think this must be brought about in a fiscally responsible way.

Any proposed Medicare outpatient prescription drug benefit should be funded separately from Parts A and B of Medicare.

Requiring a new infusion of dollars into the Medicare program -- something that is certainly possible in this era of economic plenty.

But this benefit should be targeted to reduce hardship for those who need it – those whose incomes aren’t adequate to cover it and those with catastrophic drug costs.

We will be following the debates that take place on the issue of Medicare prescription benefits.

And carving out a position based on for what’s best for our patients – and for the profession.

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