What's a Consumer Advocate Anyway?

2002 has not been a good economic year for physicians. The 5.4% reduction in reimbursement from Medicare (mirrored by many insurers) combined with rising overhead has put the squeeze on medical practice. Rising malpractice rates combined with a managed increase in coverage to obtain the "free" second layer help narrow the gap between gross income and expenses, i.e., the physician's income. As these stresses increase, frustration with organized medicine increases. The question, "How did they allow this to happen?" put the blame for tough times on local, state and national medical societies and raises the more important question, "What is the current role of organized medicine in contemporary medical practice?"

Gone are the days when membership in the county medical society was a requirement for hospital privileges and a necessity for practicing in a community. Our county society has an active Peer Review Committee and Board of Censors that deal with patient (consumer) complaints and issues of professional responsibility. In reality, we often preach to the choir, since the majority of our members are decent practitioners who occasionally encounter difficult situations or issues.

Gone also are the days of camaraderie, where membership in the medical society was vehicle for a new physician to become known to colleagues. Most referrals are made either to physicians known to the referring physician from hospital medical staffs or to physicians chosen from a directory as required by managed care companies.

Do legislative and regulatory failures make medical societies irrelevant? Obviously, I don't think so.

As physicians we compete for a scarce resource, money, with various other constituencies. On the national level, we compete with farmers, displaced workers, the poor and other groups who want a greater share of federal funds. Although we did reasonably well with the sustainable growth target methodology for Medicare reimbursement over the last few years, when the economy turned, we were harmed by the very formula under which we previously did well. Clearly a national voice is necessary to lobby at the federal level to protect physicians economic interests.

Locally, our county society and Academy work with our Commissioner and Department of Health on a number of projects. We are a vital link in the communication between government and physicians.

Why have we failed to achieve our goals? We are up against formidable opponents competing for the same resource. Although it may not be realistic to expect a reversal of the Medicare reduction for 2002, we need a national voice to have input as the new reimbursement formula is developed. Tort reform has powerful enemies. The trial lawyers are powerful and give money, so do farmers, steel manufacturers, etc.

So what can we do to become more successful? First, we need a better message. In a recent Crain's HealthCare Daily report it was noted that "consumer advocates" (read good people) have determined that a cap on pain and suffering would be unfair to the elderly who get very little when strict economic loss is the only recovery available. We are no longer fighting trial lawyers, we are now against the old, ill and frail. It was also noted that access in New York State is not a problem since we have one of the highest number of physicians per capita in the United States (read the doctors are lying to us). We need to make our message more credibly patient centric and for this we need very sophisticated public relations assistance.

We also need people. Numbers count. When groups representing 1,000 people vs. 100,000 people vs. 1,000,000 million people speak, you can bet who will be heard best and loudest. To increase our influence we need more membership and we need to ally ourselves with other like-minded organizations in the community. We need more and stronger relationships of this type.

And finally, to paraphrase Flip Wilson, for this project to run, its going to take money! Money for PACs, and for public relations firms and programs. Again, in any coalition, other than the United Nations, the larger the contribution, the greater the voice in policy and direction. Some of this increase in funds available for our cause will come with increased membership. Some must come from voluntary contributions to our PAC. It is hard to imagine a worse time to increase spending than when revenue is down and expenses are up, but failing to act will intensify the downward spiral.

In summary, physicians are under extraordinary stress. Organized medicine has responded, with some measure of success and some significant failures. We do have established credibility on the local, state and national level. We need the membership, funds and expertise to leverage this credibility and to become more successful in battling for limited resources and relief.

A new legal analysis makes a compelling case for the Bush Administration to work with Congress to fix the Medicare payment problem. The AMA, working with a broad coalition of medical professionals released a legal analysis clearly showing that costly government errors now hurting the Medicare program can be legally corrected by the Bush Administration. "Congress and the Administration must work together to fix a growing Medicare payment problem that is threatening access for America's seniors," said Timothy T. Flaherty, MD, AMA Chair.

The Administration admits that errors were made in 1998 and 1999, including underestimating the gross domestic product (GDP) and leaving out the cost of medical care for one million people. In addition, the physician spending pool currently included outpatient drugs, the cost of which is growing faster than actual physician services. By fixing these two terms, the administration could restore about $62 billion to funding for Medicare services and help avert a series of sharp Medicare cuts.

Physicians are urged to learn more and contact both their Congressional representatives and the Bush Administration by logging onto the AMA web site at www.ama-assn.org/grassroots, or by calling 1-800-833-6354.