Palm Beach Gardens Marriott
West Palm Beach,
May 10, 2000
Thank you, Dr. (Clay) Baynham.
And thank you, ladies and gentlemen, for that warm welcome.
It is a pleasure and an honor for me to represent the AMA
at your annual meeting.
I’ve been asked to discuss with you some of the aspects of
the on-going reform of health care in America – and the
legislative issues that surround it.
Now, that’s a very large order – and one that we could talk
about – literally – for days.
So I will only cover some of the highlights.
And doing that – I should begin by saying all of the issues
and actions are cooperative in nature – as all great
It’s ironic that – on this very day back in 1869 – that
famous golden spike was driven into the railroad tie at
Promontory Point in Utah – completing the transcontinental
That, too, was a massive, complicated undertaking. But at
the heart of the matter were literally thousands of
individuals – working together to make it happen.
From that point of view, you and I have been driving some
golden spikes of our own lately – welding our societies
together in an effective instrument for positive change.
And, we’ve seen some definite signs of progress.
PATIENTS’ BILL OF RIGHTS
One of the more encouraging signs has been the broad,
national, bi-partisan support for our continuing battle for
meaningful protections of the rights of patients in this
Specifically, in the last 6 years, the AMA has worked to
pass a Patients’ Bill of Rights that both protects patients –
and holds insurance firms accountable.
The House of Representatives gave overwhelming support to
our approach last year -- passing the Norwood-Dingell bill.
Unfortunately the Senate caved in to the insurance
industry’s $100-million-dollar propaganda campaign and passed
what I would call the insurance company protection bill.
Now a joint Senate-House conference committee is working to
resolve the wide differences between these bills.
The AMA is running ads right now in states represented by
key members of the conference committee – calling for real
Those ads started running last week in the
seven states whose U.S. Senators are members of the conference
committee – a committee that is making decisions now that will
affect the health of our patients for years to come.
- Like protecting all 168 million Americans covered by
managed health care plans;
- Like holding health plans accountable when they make
decisions that harm patients;
- Like providing independent, timely appeals process if
patient care is delayed or denied.
Meanwhile, the American Association of Health Plans began a
scare campaign that blame medical errors on physicians and
call them the real problem with health care today.
The AMA yelled “foul” and wrote an open letter to the AAHP
saying, “Your recent ad campaign sets a new low.”
“The AAHP is only interested in patient safety as a tool to
block enactment of meaningful patients’ rights legislation.”
We’re hopeful – today – that whatever emerges from the
conference committee does what it should do – protect the
patients of America not the insurance companies of
AMA’S NATIONAL HOUSE CALL
We’re keeping the full-court press on for more than
patients’ bill of rights.
It is one of the themes of the new AMA National House Call
– a grassroots, state-by-state, city-by-city effort to make
sure each presidential candidate takes a strong, positive
stand on health care issues.
Not just patients’ bill of rights.
But meaningful Medicare reform, adequate coverage for the
44 million Americans not insured today, proper use of the
tobacco settlement funds –
And other issues that poll after poll show are the number
one or two or three top issues in the minds – not of the
politicians – but of the American people.
And the grassroots approach is paying off. A few weeks ago,
The Wall Street Journal reported the words of a GOP
strategist who said – and this is her quote – “You cannot be a
majority party unless you talk about issues that the majority
of people care about.”
And she was talking about health care issues.
One of the issues the presidential candidates and all
Americans should be talking about is the Quality Health Care
Coalition Act of 1999 – the Campbell bill.
It would allow self-employed physicians the right to
negotiate collectively with health plans.
It would offset the enormous advantage insurance companies
have in dictating what the underwriters think is appropriate
patient care – and appropriate levels of quality.
The bill overwhelmingly passed the House Judiciary
Committee in March – and soon will be voted on by the House of
Now is a good time to contact your representative and
remind them of how essential it is to level the playing field
There isn’t much time left – the Summer Recess is
approaching. So I would act now, if you already haven’t.
PHYSICIANS FOR RESPONSIBLE NEGOTIATION
An issue that is no longer in doubt is the new vehicle for
physician advocacy named Physicians for Responsible
Negotiation – or PRN.
It is up and running independently of the AMA.
And right now, it is working on its first contracts to
represent physicians who – until now – had little or no voice
in dealing with their big, managed care firm employers.
PRN has its first bargaining assignment – representing
physicians working for the Medicaid HMO in Detroit named
Those physicians had feared they would have no say in the
And we physicians are men and women who have very critical
stakes in the futures of any plans – especially where patient
care and quality of care issues are concerned. It’s our job.
And PRN will help us do it.
And PRN will do it without strikes, without shutdowns or
slowdowns, without any of the abuses its critics screamed at
the time PRN was formed – criticism that tried to scare a
public that is more fearful of HMO abuse than physician
PRN is a simple, direct, American way to settle disputes –
and fight back again unjust abuse of power.
We are fighting back – also – against a potential unjust
abuse of power in the wake of the Institute of Medicine’s
report on medical error.
For all of the media coverage and emotion generated by the
report, the issue comes down to no disagreement –
No debate or argument – over whether medical error exists
or whether we can’t learn from mistakes and move on.
The debate, the disagreement, the argument has to do with
the extent to which mandatory report of errors will result –
not in learning and improvement – but in blame and lawsuits.
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 the Congress now.
The NPSF approach needs to be incorporated into whatever
The AMA will be involved at each step as the Congress
studies the problem and designs a reporting and measurement
system aimed at improving – not punishing.
Aimed at reporting and disseminating lessons learned – not
Aimed at finding prevention strategies – promoting them and
helping implement them.
All in the interest of our patients.
PRIVATE SECTOR ADVOCACY
Let me depart from legislative and labor issues at the
national level and talk for a minute about direct, local
actions the AMA has been taking.
We have partnered with 49 state medical societies to form
the AMA Litigation Center.
It currently is pursuing 22 cases – in state and federal
courts – on behalf of physicians and their patients.
And the list goes on – but the message is the
- The AMA and the Medical Association of Georgia sued
Aetna/US Healthcare for money damages under Georgia law –
because of late payment of physician claims;
- The AMA and the Medical Society of the State of New York
sued United HealthCare Corporation and Met Life – accusing
the two firms of knowingly using flawed, invalid data to
reduce their payments for medical services;
- The AMA prompted an investigation of anti-competitive
practices within two Pennsylvania Blue Cross and Blue Shield
The Litigation Center advocates in the one way our
adversaries understand – in the courtroom.
There’s a second private sector initiative you’ll be
It’s the AMA Model Managed Care Contract – now updated and
to be unveiled next month at the AMA Annual Meeting in
The revised model contract speaks to such emerging contract
issues as “all products” policies, reimbursement issues and
plan bankruptcies – as well as strategies you can use to
challenge health plans.
All designed to help you in your practice.
And speaking of help – that’s just what the AMA did in
forcing HHS to update payment systems in last fall’s Balanced
budget Refinement Act.
We went after HCFA to increase Medicare physician payments
– to catch up with reality – and HCFA announced a 5.8 percent
target growth rate for this year’s Medicare physician payments
– a record level for them.
The original Sustainable Growth Rate would have been 2.1
percent. Now it’s 5.8 – more than double and more rational, in
And more in your pocket in the days ahead.
The next step AMA is taking is pressure to force HCFA to
update the methodology that produced the imbalance in the
Last December we sued them – and we’ll keep advocating – to
replace fuzzy thinking with real-world data and inclusion of
new technologies in the backward-looking SGR process.
One very vital tool – and a last area I’ll touch today – is
the Internet and its potential for impacting health care
You’ve probably seen all the hype and heard all the
predictions of the info-enthusiasts out there.
But the AMA is taking the initiative in directing Internet
technology in very practical ways.
Not only does the AMA have a very busy web site – whose
popularity is growing every month – but we’ve adapted Internet
technologies to solving very specific challenges.
For example, you may already be a customer of the AMA
Grassroots Action Center.
If not, try it. All you need to do is log on through the
AMA home page, and you can communicate directly with your
senators and representative.
You can also access our new CITS system – the Compliance
Interactive Tutorial System.
CITS offers you a wealth of practice information on current
fraud and abuse regulations – how to respond when the Medicare
carrier storm troopers claim billing errors or seek repayment
for alleged over-payment.
What are the health care reform and legislative issues at
the national level?
At heart, they are all issues of concern for our patients.
And they are issues of constant, continuing advocacy.
In each of these issues – in those we’ve discussed and
others that come along – I cannot predict when or what will
I can assure you, however, that –
And we will do that –
- The AMA will continue to work for a meaningful patients’
bill of rights;
- The AMA will continue to work for equitable negotiations
with health care employers and managed care organizations;
- The AMA will work with your association and others to
fight injustices and imbalances wherever they are;
- And the AMA will use the Internet and any other tool at
its disposal to make certain the physician’s voice is heard
in Washington and the 50 states.
Not only because it is the right thing to do – for it
certainly is the right thing.
And not because it is the appropriate way under our form of
government – for it certainly is the appropriate way.
We will do it because our patients need it.
We will do it because our patients have no voice like ours.
We will do it because our patients have – for 153 years –
learned that the AMA –
And the county associations and the state medical groups
and the specialty societies –
All are caring, committed, resourceful and persistent
For those Americans – for your patients – I congratulate
you for what you have done.
And I thank you for what you will do – working with your
colleagues all over America – in the days to come.