Philadelphia Country Club
Thursday, June 29, 2000
Ted Lewers, MD
American Medical Association
Thank you, ladies and gentlemen.
And let me add my congratulations to Dr. (Paul) Siegel on
becoming the 139th president of this prestigious group.
I want to briefly discuss with you this evening how much
progress is being made these days by the AMA and by you; some
of the issues our wonderful profession is facing right now.
And some of the news is quite good.
PATIENTS’ BILL OF RIGHTS
One example has been the broad, national, bipartisan
support for our continuing battle for meaningful protections
of the rights of patients in this country.
It’s the best news in the six years that the AMA has worked
to pass a patients’ bill of rights.
Our goal has been to both protect patients and hold
insurance firms accountable.
The House of Representatives gave overwhelming support to
our approach last year, passing the bipartisan Norwood-Dingell
Unfortunately the Senate caved in to the
$100-million-dollar propaganda campaign by the insurance
And, the Senate passed what I would call the insurance
industry protection bill.
Now, a joint Senate-House conference committee is working
to resolve the wide differences between these bills.
To bring pressure on some of those members, the AMA is
running ads in their home states calling for real patient
- 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
Today, I’m hopeful that the conference committee will do
what it should do protect the patients of America not the
insurance companies of America.
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.
Most recently, we barnstormed through Missouri, Michigan
and Washington to pressure Republican senators to approve a
patients' rights bill using pinpoint advertising and media
interviews to bring pressure to bear.
But, House Call is not just about patients’ bill of rights.
But also 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 of all Americans.
This 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 strategists and 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
So I would act now, if you already haven’t. Working
together we can have an enormous impact.
PHYSICIANS FOR RESPONSIBLE NEGOTIATION
One 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.
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 organization.
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 potentially 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.
Some of you might have seen the column I wrote in the
American Medical News back in January on the IOM
I noted that 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
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.
- And aimed at maintaining confidentiality and the
security of the data.
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.
- Sued Aetna/US Healthcare with the Medical Association of
Georgia for money damages under Georgia law resulting from
late payment of physician claims;
- Sued United HealthCare Corporation and Met Life with the
Medical Society of the State of New York accusing the two
firms of knowingly using flawed, invalid data to reduce
their payments for medical services;
- Fostered an investigation of anti-competitive practices
within two Pennsylvania Blue Cross/Blue Shield associations.
The list goes on but the message is the same:
The Litigation Center advocates in the one way our
adversaries understand in the courtroom.
There’s a second private sector advocacy initiative you’ll
be interested in.
It’s the AMA Model Managed Care Contract now updated and to
be unveiled next month at the AMA Annual Meeting in Chicago.
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.
HCFA’s SUSTAINABLE GROWTH RATES
And speaking of challenges 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.
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 reform.
You may already be a customer of the AMA Grassroots Action
All you have to do is log on through the AMA Web site and
you can communicate directly with your senators and
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.
The AMA just completed its Year 2000 Annual Meeting in
I was struck by the tone of the meeting a tone of real
optimism a feeling that we’ve turned the corner in the public
That the AMA and American medicine are once again held in
the highest regard.
I believe that is because we have kept the issues focused
and kept ourselves focused on the issues.
At heart, they are all issues of concern for our patients.
And we will continue to fight for our patients.
We will fight because our patients have no voice like ours.
We will do it because when our patients benefit, we
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 advocates.
We will do it for the same reason that young student will
be attending medical school this fall.
We’re doing because we care deeply.
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.