As the healthcare debate has unfolded and people's positions have hardened, I have tried hard to give physicians, in particular, the benefit of the doubt. After all, we have a common heritage and a common interest of providing the best possible care for our patients. Earlier this week, however, Dr. James Rohack, the current AMA President made one of his final blog entries for the year. I was completely taken aback.
The AMA President is Lying.
In the blog, Dr. Rohack tries to spin the fact that the AMA's failure to achieve their two biggest goals, tort reform and repeal of the SGR formula were in fact victories. On tort reform, Dr. Rohack claims that the $25-50 million that were included, respectively in the House and Senate versions of the bill for tort reform "pilot projects" was a major, major victory. He is not including two critical pieces of information:
- A last minute change in the House version of the bill included a small addendum. "Section 2531, entitled "Medical Liability Alternatives," establishes an incentive program for states to adopt and implement alternatives to medical liability litigation. [But] ... a state is not eligible for the incentive payments if that state puts a law on the books that limits attorneys' fees or imposes caps on damages." In other words, any states that adopt or attempt to adopt any meaningful malpractice/tort reform efforts are not eligible for the programs, in effect punishing the same states that Dr. Rohack says have led the way in tort reform effort.
On the SGR debate, Dr. Rohack dances around the fact that the AMA was not able to achieve an appeal of the SGR. What Dr. Rohack knows full well is the fact that the SGR fix cannot be included in any version if the reform bills because the only way the reform bill can be scored as budget neutral is by assuming the physician payment cuts do in fact go through and the SGR is left in place. Dr. Rohack also knows that the most likely outcome is that SGR repeal will not be passed by the Senate after the holidays, as he promises. Why does he know this? Because he is talking to the exact same people that I am speaking with in Washington, and he knows that there is no way, mathematically, that Congress can pass this bill while simultaneously addressing SGR. He also knows that the most likely outcome is that the rest of the country will follow the same trajectory as my home state of Massachusetts. Two years after enacting reforms that are remarkably similar to those now being considered by congress, the state is finally addressing the physician "question." There is a major effort to move all physician payments to capped payments (doing away with fee for service medicine once and for all) and making participation in the state insurance plan a condition of medical licensure.
A discussion with just about any practicing physician or a browse through the millions of comments on Sermo make it abundantly clear that our profession is in serious jeopardy. What is needed today is not hollow claims of victory, but a serious reassessment of our leadership to date and our goals moving forward. It leads me back to the original question; Why is Dr. Rohack lying?
Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.