Chicago Hilton Hotel and Towers
Saturday, June 10, 2000
Ted Lewers, MD
American Medical Association
Thank you, ladies and gentlemen.
It is a privilege to meet with this outstanding group of
leaders from New England.
Someone reminded me that New Englanders cherish two things
above all else –
First, the honored memory of the Minutemen.
Second, speakers who don’t take much more than that.
So, to honor that tradition, I’ll get right to the point
and answer the question put to so many politicians this
election year – What have you done for me lately?
Well, the American Medical Association has done quite a bit
for you lately – as most of you already know.
PATIENTS’ BILL OF RIGHTS
We should all take heart in seeing the broad, national,
bipartisan support for the our continuing battle for
meaningful protections of the rights of patients in this
Specifically, we’ve had the best news in the more than 6
years that the AMA has worked to pass a Patients’ Bill of
Our aim is simple – both to protect patients – and to hold
insurance firms accountable.
The overwhelming support we found in the House of
Representatives -- the Norwood-Dingell bill – was never
matched by the Senate.
Unfortunately our Senators caved in to the
$100-million-dollar propaganda campaign by the insurance
And they passed what I would call the insurance industry
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 has
been running ads in their home states – calling for real
Meanwhile, the American Association of Health Plans began
its own campaign -- a scare campaign that blames medical
errors on physicians and calls them the real problem with
health care today.
The AMA yelled “foul.” We 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.”
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.
But – make no mistake about it – should Congress fail this
session, we’ll be right back there after bringing that failure
to the attention of every voter we can between now and
Congress may go away, but the issue will not.
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 healthcare 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.
Health care issues are front-and-center in this year’s
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
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.
It was all set for a floor vote in May – and the House
leadership got cold feet, postponing a vote until later this
Now is a good time to contact your representatives –
regardless of party -- and remind them of how essential it is
to level the playing field for physicians.
There is no doubt that the Campbell Bill is not a
Republican measure or a Democratic measure – it’s a patient’s
measure. And we need all the help we can muster to get that
point across in Washington – and around the country, for that
PHYSICIANS FOR RESPONSIBLE NEGOTIATION
One positive 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 – like many of our colleagues across the
country -- feared they would have no say in the plan’s future.
And we physicians have a very critical stake in the future
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.
Of course, PRN will negotiate without strikes, without
shutdowns or slowdowns, without any of the abuses its critics
Like so much of the criticism aimed at AMA issues – PRN
criticism tries to scare a public that really 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 Report.
I noted that -- long before the IOM report -- the AMA
helped launch the National Patient Safety Foundation –
Not alone – by a long shot – but with your help – with the
cooperation and teamwork of specialty societies from across
the whole spectrum of medicine.
And we did so with the avowed purpose of adapting airline
and aerospace industry practices to error detection and
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.
I urge you to read the column I’ve written in the current
AMNews on this subject. I think you’ll find it interesting.
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.
The list goes on – but the message is the
- 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 and Blue Shield
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
being unveiled this week.
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 influencing healthcare
You may already be a user of the AMA Grassroots Action
It’s fast, easy and effective – and available around the
clock through the AMA web site where 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 snoops claim billing errors or seek repayment for
If you haven’t visited the Internet displays in the lobby,
I urge you to do so before you leave town.
Well – I took more than a minute.
But there are many, many issues to discuss – many successes
to note – many signs of progress.
At heart, they are all issues of concern for our patients.
And we will continue to fight for our patients.
Because they have no voice like the unified voice of
Because – when our patients benefit, we benefit.
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 partners in organized medicine –
All are caring, committed, resourceful and persistent
In the days ahead – I urge you to complete what we’ve begun
We are heirs to a rich tradition – participants in a
worthwhile cause – and the best hope our patients have.