Saturday, July 29,
Ratcliffe Anderson, Jr., MD
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
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
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
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
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
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
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
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
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
Physicians’ medical practices are forced to absorb all the
compliance costs of the many regulatory requirements forced
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
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
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
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
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
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
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.