It's not the fact that the AMA has gotten no where that frustrates me, it's the fact that it lies through it's teeth... sorta like a big corporation telling it's employees all is well but they go into firing people.... essentially, we are in their eyes a bunch of children who need to be calmed down.
He has no choice. Truth is seriously damaging to their image and claim of being assertive. AMA has been made a non-event by our elected politicians. AMA knows this and is very uncomfortable trying to cover this up as a positive. Logic and reasoning that Dr R gave are very stupid, immature and counter intuitive.
BTW, I could have tried making it budget neutral by raising tax on cigarettes, alcohol and oily foods.
The AMA must protect it's interests. They made their deal: we'll back the reform bill(s) as long as it includes the continued use of CPT as the sole medical coding platform.
Good to here from you Dan. The AMA is totally useless and they know it so all they can do is try to look tuff. Its kind of like the blowfish when if fills itself full of water to look big and bad.
I am really frightened about the movement towards forcing us to accept Medicare and Medicaid (or whatever the next iteration of these will be) in order to get licensed. This must come under restraint of trade, don't you think? And as such, it would be ripe for many lawsuits to challenge it.
The AMA's income comes mainly from CPT materials and not from membership dues. They have no incentive to "speak for us." From the AMA's standpoint it's probably good that the physician membership is dropping precipitously. Fewer dissenters and more "yes" men make life easier for those in control of the AMA.
Agree,good to hear from you Dan;seems like we will need to continue a media saturation campaign;that's what large corporations and the Feds do when they try to counter the truth with marketing.
Of course, when Congress returns and again puts a one-year band-aid on physician pay, the AMA will celebrate again their victory by blocking the 21% pay cuts so that we can do this nonsense again next year with a 30% pay cut looming!!
As far as making acceptance of Medicare mandatory for state licensure, this is what happened when Canada started their National health care. Most doctors opted out of Medicare. Patients were unable to find a doctor who took Medicare. The government made it mandatory and also made it illegal to charge more than the Medicare approved amount. The key difference is that in Canada, they are allowed to collectively bargain with Medicare. Each provincial Medical Society negotiates their rates with Medicare. I we cannot stop this boondoggle, we at least need to be able to collectively bargain.
The truth that President Obama thinks nothing of using people to achieve his agenda.
The truth that the Congress has used the statment made by the AMA to mean that ALL doctors suppor this reform
The truth That despite their best efforts the AMA has not succeeded in any of its major political objectives over the past 5-10 years (Rpeal fo the SGR and Tort Reform)
The truth thata physicians will become slave labor to the government
Recvoery is a twelve step process and until one can admit to the problem there is no recovery. The AMA as it stands now will not admit that there is a problem and therefore will nto recover. I forsee the future where the AMA will no longer exist and a new forces fills the gap left by their abscence.
How many of the AMA leadership do you think have ever been frivolously sued?
Do you think they have any idea what it's like to get that call from your friendly "risk management department" telling you a lawsuit has been filed on behalf of a patient you saw 2 years ago?
Do you think they've ever traveled to medical records to look at that chart, then realize in shock "I didn't do anything wrong"?
Do you think any of them have had to spend 4 years, thousands of dollars, thousands of hours, trying to defend themselves, being threatened with loss of assets, while some moron insults them, all the while knowing "I didn't do anything wrong"?
Do you think any of them understand, when seeing a patient, the thought of "well, I really like this patient, I want to do what's best for him, but the healthcare system has f-cked me, so now I have to order CT's, MRI's and consults to defend myself". Because it's no longer enough to say "I didn't do anything wrong"
This should make you feel better (right!) Rohack's AMA blog!
Medical liability reform, SGR repeal and the health reform bills Posted at 12/29/2009 7:17 AM CST Over the weekend I received an e-mail from a long-time AMA member asking how he and his fellow members would benefit from health system reform legislation the Senate passed on Christmas Eve. In his e-mail, he wrote that he found no mention in the bill of two issues that are of particular concern to many physicians: medical liability reform and permanent repeal of Medicare's SGR formula. I'd like to explain how both, which are among the AMA's seven critical elements for reform, are addressed in the Senate bill.
The Senate bill contains $50 million for medical liability reform funding for state pilots, and that is in addition to the $25 million President Obama already directed the Agency for Healthcare Research and Quality to provide in grants. The AMA has heard loudly from states that have caps on noneconomic damages—such as California and Texas—that they are opposed to any federalization of tort reform that puts their state reforms at risk. During the George W. Bush administration, when the majority in Congress was Republican, the starting bid for caps in the Senate was double that of California and Texas and was opposed. So scientific testing of alternatives to caps is valid and a move forward to reducing unnecessary costs of defensive medicine.
Medicare's flawed SGR formula predates all the discussion on health system reform. The Senate's original bill included a temporary fix to the SGR, but the AMA opposed it. As a result, the Senate removed the SGR from the reform legislation and included a provision in a Department of Defense appropriations bill that would avert a scheduled 21 percent Medicare physician payment cut on Jan. 1 by extending the 2009 conversion factor for 60 days.
Money originally allocated to the SGR then was instead used to remove from the reform bill a Medicare enrollment fee for doctors, a cosmetic surgery tax, and a provision calling for a primary care and rural general surgery bonus that would have been paid by taking from other specialists. Senate leaders have stated their intent to pass legislation to repeal the SGR formula after the holidays.
The Senate's action mirrors a similar move by the House, which pulled the SGR out of its reform package and did not include it in the total cost of health system reform. The House then passed separate legislation to permanently eliminate the SGR.
The AMA's support of the Senate bill and the House bill earlier this year came after careful consideration. There are some who have wanted the AMA to oppose this reform effort all along. However, I believe that without the AMA being constructively engaged, the result would have been devastating for physicians—and AMA members would have asked why the AMA was not involved in the reform process.
The AMA has been consistent with its goals and achieving as much as it can in spite of the toxic partisan nature in Congress. We are closer than ever to realizing a number of those goals, but we still have important work to do to secure additional changes in the final bill during the House-Senate conference committee. With your help, input and support we can continue to advance health system reform policies that will benefit patients and physicians. I encourage you to visit the AMA's health system reform Web site to learn more about the provisions in both the House and Senate bills and how they relate to AMA policy.
The AMA lies about their physician membership, too. In a previos post a few of us checked to see if we were correctly listed as nonmembers. Some were listed as members even though they had canceled their membership years ago. Some were listed as members that had never joined the AMA! I urge everyone to check their status to see if you are listed correctly. Just go to their website and they have a list.
This "health care reform legislation" isn't reform; it's regression. It isn't "budget neutral". It's outrageously expensive. It isn't even health care legislation; it's just health care cost manipulation. The industries win. The politicians win. "Organized medicine" wins. The ABA wins. The practicing physician loses. The patient loses. Small business loses. It's a travesty and potentially a tragedy. It makes me sick. I'd work for free if I could but it would only save about 10% of the total cost of caring for my patients. If my husband didn't get health insurance benefits, I wouldn't even be insurable much less able to afford my medical care. And I'm supposedly a "rich doctor." Malpractice reform should include NO payment for non-economic losses. (We're sorry you lost your husband. Go buy a Mercedes.) That's barbaric. I'm ranting but I'm upset, disgusted, disappointment, distressed, desperate. Our profession's going to hell in a hand basket and taking a lot of patients with it. I don't know what to do. Any suggestions?
The lying isn't new. The internet makes getting away with lying harder.
Today the N Y Times has an editorial saying the ENTIRE state government should be voted out of office, both parties, because of hopeless corruption and lying.
New Yorkers should be appalled at their failed state government, particularly their corrupt and clueless Legislature. Scandal and irresponsibility have been Albany's creed for decades. This year, the gang added another outrage to the list: complete fiscal incompetence.
The only solace is this: The entire Legislature is up for re-election in 2010. And unless there is a sudden turnaround — and, so far, we see few signs of it — New Yorkers have no choice but to vote out all the lawmakers and start over.
I had high hopes for Dr. James Rohack when he came to AMA. Former head of the TMA, I thought he would kick butt and restore the AMA to its rightful place. I stayed an AMA member but I had several emails with him and saw that he had followed the dark side and converted. I am no longer an AMA member. Is this a human nature thing, do we all give up our values when we change status and move into a bigger group? We all see this over and over, people that we respect join the "man" and all of a sudden start speaking for the "man". That is apparently what has happened here.
"It has been said the greatest volume of sheer brainpower in one place occurred when Jefferson dined alone..." John Kennedy
When we get piled upon one another in large cities, as in Europe, we shall become as corrupt as Europe.
Thomas Jefferson
The democracy will cease to exist when you take away from those who are willing to work and give to those who would not.
Thomas Jefferson
It is incumbent on every generation to pay its own debts as it goes.
A principle which if acted on would save one-half the wars of the world.
Thomas Jefferson
I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them.
Thomas Jefferson
My reading of history convinces me that most bad government results from too much government.
Thomas Jefferson
No free man shall ever be debarred the use of arms.
Thomas Jefferson
The strongest reason for the people to retain the right to keep and bear arms is, as a last resort, to protect themselves against tyranny in government.
Thomas Jefferson
The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants.
Thomas Jefferson
To compel a man to subsidize with his taxes the propagation of ideas which he disbelieves and abhors is sinful and tyrannical.
Thomas Jefferson
This is neither shocking nor surprising. The AMA is not a representative group nor are they "leaders" of the physician world. I canceled my membership years ago, with no regret.
I believe that the AMA and the ACP and AAFP and AAP all sincerely believe that by staying engaged with the politicians that they will still be able to affect the changes most of us feel need to be made... liability reform, compensation sanity.. I have spoken to several members of several of these groups at relatively high levels.
However, I have told them, said here, and I will repeat here, that health care reform that does not address the liability catastrophe we have, the mis/mal-payment issues and does not contain DIRECT, up front, explicit cost containing measures, will be doomed to failure - over the short term possibly, and certainly over the long term... I think Howard Dean is right here, and the whole kit and caboodle should be discarded, and a more incremental approach started... And I would start immediately...
I fear this will not happen, the current law, in much of its incarnation will pass (and much of it is very good), but the meaty, real issues that consternate so many of us, will continue to be swept under the carpet.
Oh, the Jeffersonian quotes are great, but the idea that he was smarter than the host of Nobel Laureates that Kennedy hosted is inane.
I worked with Dr. Rohack in Texas.. He is a smart, hard working guy. I also had high hopes when he surmounted the AMA throne... but it appears that he is as enthralled by the power structure as all who enter that arena... One begins to compromise to keep as many people happy as possible, and ones principles become diluted.
They dont need our dime (of subscription). They lie about their membership. They get leverage b/c of that lie. They get to get behind the closed door meetings and deal making. They expand and legalize their monopoly on CPT. They mint money on that.
In fact, I would not be surprised if they start paying their members for membership. I know if I were running AMA, I would pay doctors to join AMA. And make it up on CPT license fee.
If you really hate AMA and BO and HCR and .. and .. and ... and .... just about everything in current system, transition to a direct to pt care model. I know it is a piece of cake for PCPs in most areas to do that. Visit IMP group and you will realize how easy and relaxing it is to practice without insurance.
There is no CPT in cash practice. Stop buying CPT books.
I called him out on this when he first went on record as backing these bills. And then Peter Orszag went on MTP and said of course the SGR will go into effect, nobody thought we were really going to repeal SGR.
I will stay in the AMA and just like with our US congress, work to elect officials that reflect my opinions. Leaving the AMA will not make it stronger or our specialty societies stronger Approx. 23 state and county societies have written Congress and had the letter published in the Congressional Record opposing the stand of AMA leadership and opposing the present Senate bill. Non dues revenue such as publishing the CPT is the backbone of most professional organizations and keeps our dues down. I would rather have AMA (physicians) controlling CPT than someone else such as AETNA or HUMANA or the USGOVT. The members of CPT are physicians and appointed by specialty societies. The system in uniform and universally accepted. Yes, the AMA has lost its leverage with congress but the work of AMA is not just legislative. Science, Public Health, Education, Ethics and PAC are all area of significant AMA input and discussion. Don't leave the AMA, take it back!
We've apparently come to the point in our culture where "spin" somehow is NOT seen as one's attempting to have someone else believe something that is not the truth....i.e., a form of lying....deceiving....defrauding....purposefully misleading....
Sermo Doc 12, surely you are being sarcastic... yes?
Spin is lying....and we need to begin calling it what it is. It is a purposed attempt to mislead another, yes?
The AMA has merely been more willing than usual to show its true colors. What's new? Corruption at all levels....and resultant distrust at all levels.
The fine country we once knew.....the one where "telling the truth" was highly valued, where integrity was a character quality one was to be appropriately proud of, where cheating was thought of as a very bad thing, where trust was something one did not want to lose, where politicians were truly desirous of serving those they were sent to represent..... The United States of America.
"Change!" "Change this country as we know it!" "No more politics as we know it!"
Well.....those who voted for Obama and his camp are getting what they voted for! They have aided in the introduction of incremental socialism....and the medical realm is in no way shielded from "the change".
I HAD never given a cent to the AMA until 2 weeks ago when I went to apply for adjacent state reciprocal licensure and was REQUIRED, as the ABMS boards I hold have contracted with them as the sole verification source. What the H...?
Bless you Dr P for staying on top of the fine print. The moral of the story is-lawyers will protect their own. Doctors need to fend for the themselves, and the AMA has proven it is not capable of fending.
Ah Folks, do we really expect to be treated differently by our "Representatives" in Congress, I believe the majority of whom are attorneys? Tort reform or Caps won't happen as long as there is no incentive for the gang in DC to take a stand against their friends and colleagues on the "Trial Lawyer" side. What we seem to be fighting is a losing battle in the PR arena, apparently our "worth" to Society appears to be in a downward spiral with no positive end in sight. Somewhere along the line we lost the ability to practice Medicine and allowed ourselves to directed in our decisions by insurance companies and government, anyone sat in on a "Joint Commission Survey" lately?
It started in 1964 when a bunch of docs signed onto Johnson's "Great Society" and allowed the government to determine what their time was worth. Sure, those guys got rich when medicare paid whatever they charged, but that only lasted until the early 80's. It's really the same sellout that we see with the AMA. This time Rohack and his ilk have traded us in for a photo-op with his Obama-ness. They're whores, really cheap whores.
Rather, use the kinetic energy of AMA-bashing for smashing the Unholy Trinity of trial lawyers, the so-called 'consumah' groups & leftist Big 'Laybah'.
['consumah' & 'laybah' being NooYawker/Brooklynese for consumers & labor {unions}, respectively]
Ladies and Gentlemen of the Profession, hear this: This noble profession is over ... done ... finished ... beaten by the politicians and trial lawyers of America who are blind to what was created in America by entrepreneurial physicians in pursuit of excellence in medical education and practice. Even when we enjoyed the privilege of having a physician as President of the Senate and a Republican Congress, we were unable to secure meaningful tort or SGR reform; surely it will not occur now.
Until and unless the profession can speak with a sustained and meaningful voice or is willing to defy the law and undertake a meaningful work action nationwide in defense of its advocacy for excellence in patient care, there will be no change in the progressive loss of power and privilege that the Oath of Hippocrates once offered. The specialty societies and the AMA have so fragmented the underpinnings of our profession that the politicians can now simply ride roughshod over us in the process of destroying all that we have built. Shame on them, but more importantly, shame on us.
Government knows that Doctors will never stage a "Million Man" march on Washington or stage a massive walk out in American hospitals. Instead, they know that, like a flock of sheep, we will go quietly to our slaughter.
We need our own Abraham Lincoln and our own "Emancipation Proclamation." But we have lost the public to the demagoguery of the Congress and the media. We seem helpless in organizing ourselves and selling a reasonable position.
Go to the polls in November and re-elect no one. Then go to church and pray.
The acrimony directed at the AMA Prez. is understandable but misplaced and counterproductive. It still remains to be seen if the AMA strategy will produce some benefits for physicians or result in doctors getting screwed in every matter.
The issue is that the country elected a left-leaning democratic president and large democratic majorities in both houses of congress, with far-left "behind the scene" political operatives that engage in "take no prisoner", cut-throat, gutter politics. That puts the AMA in the same position as legislators like Senators Lieberman, Nelson, Landtrieu and others. They have serious concerns about the situations and many of the proposals but are acutely aware of the political reality.
AMA could have taken the "just say no" posture embraced by many republicans, when it became clear there were no intentions of crafting a "good faith" bipartisan bill. That would have producd '" feel good" accolades from many AMA members but substantive "squat", as it has for republicans. The AMA exercised a strategy much like that employed by the Senators noted above. By doing so they invited - and received - criticism, scorn, and ridicule by individuals on both sides of the issue.
If the legislation passes - and the political operatives honor their committments - these senators and the AMA will come out far ahead of those who just said no. If the legislation does not past and/or they get screwed by the political operatives (which would not surprise me in the least), they and their constiuencies will get screwed. However, this current group of politicians and operatives has no great love for physicians and would screw us worse if we just said no. I do not trust these politicians and fear we will get screwed in the end but certainly no worse than if we had just said no.
Viscerally I would feel better if we had stood up to this proposal and opposed a massive increase in the federal role within health care but pragmatically believe that posture woul have just hastened and intensified the takeover. I am not terribly optimistic that the AMA strategy will produce significant gains for physicians or the public but can not castigate them for trying to get something rather than nothing from this group of thugs. .
Dr Rohack and the AMA are deluded in believing that they can drive the political process rather than be used by those pushing their agendas and to whom physicians are just another group to be forced into submission and servitude. I believe trying to force self employed practitioners to take Medicaid or Medicare could be sucessfully challenged in the courts - involuntary contracts were one of the main complaints the Colonists had against the British, If it happens here being British also I will likely return to the UK, might as well have the real thing in the NHS than a quasi dysfunctional NHS set up here. The pension is at least good.
As Winston Churchill once said: « Sometimes truth is so precious, it must be attended by a bodyguard of lies.» Perhaps Dr Rohack likens himself to Churchill. I rather think he is more like Chamberlain.
It seems almost impossible for lawyers (politicians) to make decisions about medicine.
Unfortunately, the lawyers who are politicians outnumber the physicians who truly represent the interests of the majority of physicians. How will we ever be heard and acknowledged?
internal med(dying breed)
we must fight for ourselves since the organizations we trusted have let us down.Sermo has some of the most informed and concernd individuals ,probably because we actually treat patients and don't sit in ivory towers making outrageous salaries without a care in the world.We must organize and screw the AMA.We are the healthcare system!!!!!!!!!!
So Dr. Pasternak -
Consider starting a counter to the AMA. I would be the first in line. SERMO is the closest thing I have seen to a cohesive group of 'docs in the trenches' in the twenty years I have been in practice.
There must be enough of us who have had enough
Not that Dick Morris is the most trustworthy of politicos and he has been on both sides of the fence but.....he maintains on his site, Dickmorris.com, that members of both houses have their own insurance, which they keep upon retiring, as well as their present salary.
The way neutralize James Rohack and the AMA is to exploit the fact that it represents a minority of physicians. The AMA's cachet and place at the policy table are a legacy of a past era.
Not enough is being said about the divide between the interests of physicians at-large and the AMA's 'representation' of those interests.
The passage of the health bill through both House and Senate, without representing the majority of voters position of not supporting a bill that was not available to read until the weekend before is a disgrace to American politics. The next step is to dislodge the untrustworthy politicians and start fresh with a more conservative bunch. Then start over and fix the problems of present healthcare, with tort reform, allowing insurances to compete across the nation, and support a safety net for those who are Legal citizens who have the need for an affordable health plan. Deport the rest of the illegals.
I never thought I would say it but physicians have essentially zero clout financially compared to the insurance companies and pharmaceutical companies. The only answer to to use the power of collective bargain--unionize. Black ball an insurance company if they are cheating us. This is not easy to do, but our things will continue to deterioate as long as the insurance and pharmaceutical industry rule with with their financial whip.
Thanks so much, Dan, for vocally standing up for the truth. I agree with other commenters: we need a well-funded publicity campaign to 1) expose to the American public the lies and payoffs of both Congress and the AMA, and 2) present a rational plan to undo the damage already done to our healthcare system by Congress, CMS, etc., and to restore fundamental American principles of freedom, competition and charity to our healthcare system.
Regarding CPT and ICD codes: they comprise a "parallel universe" created for bureaucratic purposes. As such, they never can, could or will accurately reflect the realm of medical practice. If bureaucrats want to use them for bureaucratic purposes, that is their privilege. As physicians, we now all clearly have a responsibility to totally extract ourselves from any involvement with this time-wasting and resource-gulping parallel universe as quickly as possible.
Although some states might be foolish enough to try it, hopefully state or federal requirements to accept Medicare would not survive court tests. Also, it is very unlikely that any individual state(s) would enact such legislation, since it would surely result in a flight of physicians from that state.
In any event, we must never forget that we are free professionals practicing in a free land. But freedom only survives when it is nurtured and defended. For too long we have allowed our freedoms to be eroded around the edges. Clearly, it is now imperative that, both as individuals and as a group, we stand up for the rights of our patients and ourselves to associate freely in a free-market economy. Else we will all soon be salaried government stooges.
Maybe we should start our own "Sermo Lobbying Group" and support, in a very organized (and financial) way the candidates who we feel truly represent us, not to mention encouraging physicians in our own communities to run for office and help them get elected. The 2010 elections are coming soon, and just changing the balance of power in Congress will slow down this steamroller of a trainwreck.
Most of the "reforms" aren't due to start until a few years from now (except for the increased taxes to pay for them), so I believe we have time to stop or reverse these corporate and special-interest boondoggles and protect our profession and our patients from the idiots.
How can it be that doctors...a rich, smart, leader rich, rule following, ethical group of qualtiy people can't seem to compete with the slim-ball, lying, money grubbing, power hungry political might of our goverment? I for one have started talking honestly with patients. I dont use their time I wait til were all done professionally but if asked I let them know my opinions. I discuss my three lawsuits, my struggle seeing illegal alien patients at 3 AM knowing that will be a complete loss, how the aged would be shocked at how much their death is costing society, my work at charities, church, hospitals, clinics and our public school. Many say we should not bring religion nor politics into our professional life. I am blessed as my practice is long and strong and my patients are my friends. I have gotten very lucky with 20 yrs of practice. I work with a nice suburban midwest crowd who can stand to know the facts as we see them. Thanks to all with good thoughts and prayers for a fair and just solution. Happy 2010.
The AMA misrepresents doctors and is losing members rapidly and lying about membership numbers. Malpractice lawyers are the enemy and the worst form of humanity. Let's throw a wrench into the works and confuse everybody (probably including ourselves): what if every doctor who was misrepresented as being an AMA member files a class-action lawsuit (using, of course, a sleazeball billboard law firm) for defamation of character against the AMA? Not sure what it would accomplish but it would make this whole thing a lot more fun, and at least a bit satisfying that we as doctors were finally able to "stick it" to somebody rather than constantly getting punched in the face.
How about starting a National Doctors Association with web enabled interactivity and let AMA add a word to its title so it is called American Medical Insurance Association (AMIA)
I am ashamed Dr Rohack is from Texas..he, and the AMA are a disgrace and hated by every physician I know. I don't personally know a single physician that is a member of the AMA. Obviously though this is not enough to bring it down; instead, we must have an alternative organization that truly represents the interests of physicians and thus garners the full support of the overwhelming majority of US physicians. The subspecialty boards are not much better either with the grandfathering-in of older physicians and the test-out-the-wazoo-for-major-bucks of the rest of us. This ridiculously flawed system shows its not about patient care and preserving competent care,but about preserving the "old boy" network . Once the grandfathering is discontinued,we could respect the specialty board certification requirements...until then, they are a farce. This new physician organization should take on the AMA and also govern specialty certification to outlaw double standards in credentialing. signed, a 49 yo OB-GYN
Clearly, we must become better organized. I'm not sure starting a totally new organization is the best approach. The AAPS seems to be doing some good things. Creating an "organization of organizations" seems a better way to gain critical mass quickly.
We physicians are STILL the only providers of medical care and if a large percentage of us decided to maintain a cash-only practice, refused direct insurance reimbursement (making it the patients' responsibility) and opted-out of medicare, we could take back medicine. I have a cash practice and am busier than ever. Patients pay us directly even though they could pay only a few bucks to their in-network docs. However, with us, they get a two-hour initial consultation and true personalized attention. They are taught and inspired to change their lifesyles and therefore their health for the better. Our overhead is low because we don't have any billers or coders in the office, so our fees are still reasonable. Many of our patients are middle class and save up to see us. If they force us to accept medicare as a condition of licensure and still most of us refuse to comply, let them try to lock all of us up! I'd continue to fight the government. We could get a class action attorney and sue for restraint of trade. Are we going to continue being sheep?
Maybe he is learning from the politicians he consorts with. Barack Obama and George W. Bush are 2 of the biggest liars I've seen, and they have been the role models for the "free world" for the last 10 years.
Thnaks Dr Dan for exposing the lies and deliberate deception of the AMA.. The AMA is so corrupt that it will NEVER repesent the working physician. As one polotician put it "money talks and bs walks" I agree with the suggestions that everyone bail out of the AMA and a new grassroots organization be initiated and Dr Dan you are in the best position to decide how that should be accompished .
The AMA has irrevocobally BETRAYED all of us
That we (physicians) have a common heritage, is true; but to say we all have a common interest is an oxymoron, particularly within the same statement that assures us that "Dr. so and so is laying" (which is true).
One fundamental problem with the healht crissis, lets be honest, is that we have quite a few rooten apples within the barrel. Not to mention the mistrust that physician greed has sawn whithin the people that we are meant to serve. Healht Reform needs to start by purging the barrel...any thing else is hot air and self deception
I recently sent the following to our State medical association executive director:
While I appreciate some of the efforts of my union leaders in the AMA as well as the leadership in the American College of Surgeons and the Society for Vascular Surgery in representing my personal interests as a guildsman, I feel they have not represented the best interests of the society in which I live. In addition to rearranging the deck chairs on the Titanic, they and our legislators have brought on deck some newer chairs able to accommodate more passengers with increased seating options. But the hole in the hull is ignored and won't fix itself -- a hole caused by the iceberg of COST........I know, I know - we keep hearing from various bean counters about how overall costs are going to be contained - don't believe it! Our legislators have simply battened some hatches while opening and reconfiguring others while the sea water continues to sink the ship of American healthcare.......In order to contain costs, our society needs to undergo a fundamental cultural change regarding needs, wants and futility. Space prevents me from expounding in depth but the truths of health care reform have been branded heresy by the self-serving healthcare industry. The truths are: We don't need more doctors, we probably need less but with a different specialty mix and geographically redistributed with the addition of more physician extenders; We need to test, treat and prescribe based on scientific evidence and in the context of societal benefit as we appropriately attend to the needs of the individual; We need to (re)educate those (lay populace) who have been beaten into a state of fear by our industry, media and politicians playing loosely with facts, often for their personal benefit; We don't need more bureaucracy - commissions, panels, insurance overseers, forms and regulations - on the contrary, the process needs to be simplified and streamlined. And finally, we need tort reform that allows health care providers to do their best for their patients without fear ........Although I believe we will see changes in our healthcare system, it will take courageous and enlightened leadership to reduce costs and effect true healthcare reform and our current political system won't allow that to happen. Please, Save Our Ship.
Almost 7 months ago, after much soul searching and discussion with the team here at Sermo, we decided to end our relationship with the AMA. In July I states that I felt that the biggest risk to the US physicians was the AMA (click here for that announcement www.sermo.com ). Having been a strategic partner with the AMA for almost two years, there was just too much evidence that they were no longer working in the best interest of physicians. I am saddened to say that my deepest fears have in fact come true. I am further concerned that what we are seeing now is the very tip of the iceberg. To add to this conversation, I'd like to share three thoughts with the community. First, the way the AMA really works, second, what is about to play out, and finally what the real challenge. 1. The way the AMA really works I think, we as physicians make a common mistake of thinking of the AMA as a single, monolithic organization. The AMA is in fact two distinct organizations. On the one side is the elected physician leadership, which includes all the delegates, the presidents, etc. There is also a "professional" side of the organization that includes people mostly coming from the publishing and insurance industries that have built their careers within the AMA. This includes more Vice Presidents than you can count and enough people earning $300K+ salaries to make you sick. The first real clue you get that there is something odd at the AMA is their offices. You have never seen such opulence in your life. Having spent my share of time in the Goldman Sachs and Citi offices, I can tell that the "professional offices" at the AMA are FAR more opulent and the sanctum sanctorum is straight out of Hudsucker Proxy.
The professional side of the AMA looks down at the elected physician leadership with a mixture of disdain and pity. They know that the elected leadership is a revolving door and that the vast majority of people will do their time at the AMA and then "retire" as board members for large hospital systems or insurance companies. A very senior person at the AMA described it to me as "the mushroom treatment". The AMA professionals carefully keep the physicians in the dark and feed them bullshit. At the AMA, it is a matter of great contention, that the physicians are not given the actual membership numbers, nor are they "allowed" to understand the actual mechanics of how the business runs.
Whenever there are points of real contention, the strategy that the professional side of the organization uses is both simple and effective. Just wait. Invariably, the physicians start bickering over politics and/or hierarchy. Worse case scenario, the physician leadership rotates every few years and the problem goes away.
Above all, the professional side of the organization will protect their own income.
The AMA has been investigating the issue of declining membership for some time now. A few years ago, there was a "crisis of conscious", where the AMA had to decide if they would take the necessary steps to regain physician loyalty (which would invariably mean giving up a huge part of their revenue from insurance companies) or start plotting a new course.
The AMA decided to start plotting a new course.
In the near-term, that course has meant increasingly aggressive tactics to shore up their membership numbers (actual paying members is believed to be 80,00-110,00). There are a number of these efforts underway, but I am sure the one that you have seen are the "invoices" that you receive in the mail, but are actually HIGHLY EFFECTIVE ploys to trick physicians into becoming "members".
It is the longterm plan that physicians should be most concerned about.
The AMA is now actively transforming itself into a public health organization. The AMA will continue to cling to the physician brand only so long as it takes to establish themselves as a public health organization. As I am sure many of you have noticed, the AMA has removed most references to physicians from their branding. Beyond the caduceus, there is very little left that indicates that the AMA has anything to do with physicians. In the next few months you'll see the AMA start to take incremental steps to expand their membership to non-physicians. Mark my word, you'll soon see the AMA accepting PAs, NPs, and eventually RNs.
From a marketing standpoint, the AMA's new branding makes perfect sense. They have done the research and it clearly indicates that they have the most "brand equity" among non-physicians, especially the general public. The $40MM that the AMA spent on the "Campaign for the Uninsured" was the first public phase of this evolution and we will see that effort accelerate. These efforts will have two things in common. They will focus on the general public (read, patient population) and they will never mention physician interests. Right now, physicians are providing a convenient midwife (please excuse the pun) to a new organization, but make no mistake, as physicians, the AMA is actively trying to lessen their dependence on us.
All of this is important in the "new world order" for healthcare. Physicians will be functionaries among the many "providers". The government was able to easily "buy" the AMA's endorsement by simply hinting (not even threatening), that the CPT monopoly could be easily taken away from the AMA. They knew where the AMA was most vulnerable and used it to their advantage. Having achieved the "brass ring" they needed, a pretense that physicians supported the healthcare reform effort, the government has absolutely no incentive to publicly question the AMA's hegemony.
Believe it or not, it get's even more scary.
The real powder kegs, the ones that the insurance companies needed to make sure was kept out of the healthcare debate at any cost was the issue of off-shoring and encroachment of physician services by non-physicians. Nothing, I mean nothing will devastate the medical profession like off-shoring and professional encroachment. There are huge financial incentives to start sending patients over-seas for elective and semi-elective procedures and/or having non-physicians provide more and more services. If radiologists think that they are going to be earning $200-500K a year when films can be easily sent to India and China for review, they are completely nuts. Furthermore, the trend of sending healthy patients abroad for knees, hips, etc. is accelerating and will be a HUGE part of insurance industry's efforts to improve profits. California has already passed legislation, allowing nurse anesthetists to practice unsupervised.
The biggest fear the insurance industry has is that someone will FINALLY get smart and put some sort of "Buy America" provision into the bill. The steel and labor unions successfully did this almost a year ago and derailed the initial economic stimulus package. A very small group of people started raising these issues about six months ago as the healthcare debate picked up and a number of people at the AMA pointed out that these issues should be addressed in this bill, no matter how small the likelihood is. Let's just say that the CPT card was easily played and that was the end of the AMA taking a stand on those issues.
The AMA knows that physicians are disorganized, difficult to lead, distrustful and can be easily manipulated. Their calculus has been absolutely perfect to date. No profession has sacrificed as greatly nor is more responsible for the incredible healthcare people in this country get than physicians. We have squandered our professional birthright through our own hubris.
The real challenge is the apathy of our own colleagues. While I think confronting the AMA is a necessary step, I suspect that work to topple the AMA might have the greatest value in simply galvanizing physicians. Getting our colleagues to "wake up" and finally realize what is happening is the single biggest challenge.
We've all heard the proverb that it is always darkest before the dawn. I am starting to see this play out before our very eyes. Elimination of consult codes and the pending implementation of physician cuts are leading to a very real awakening among physicians. Of course, when politics finally starts to hit our pocket books physicians sit up and take notice. On Sermo we are seeing an acceleration in interest among physicians in these issues. In the past few months, physicians have gone from a sort of collective denial to more and more interest and excitement in taking back our profession. Technologies such as Sermo, Twitter, and the web act to level the playing field between physicians and those that have so effectively manipulated the healthcare system because they allow physicians to openly share information.
So before you plot the downfall of the AMA, re-engineer healthcare, or have any hope for a better tomorrow for our profession, the next step, the one most critical and hardest achieve.......
Get your colleagues to join the conversation. It is simple as that.
Rohack and the AMA (just like my professional organization, the AAFP) has demonstrated just how useless these organizations are. Even after overwhelming evidence demonstrates discontentment in the ranks, these "straw bosses" were taken into the most superficial layer of the administration which apparently produced the "starry-eyed child" effect amongst these (supposed) representatives of our profession. Subsequently, they seem to say and do anything to support a dead-end policy of "keeping our place at the table". Are these people so shallow that they cannot see that we have never had a place at the table. Foxes do not invite hens to sit AT the table with mutual objectives. Perhaps the most frustrating issue remains that neither the AMA or AAFP has polled the rank and file to solicit the will of those whom are supposedly represented by these organizations: working physicians. Rohack, you're an embarrassment.
I'm so glad I never renewed my membership to the AMA after my free one expired after residency; what a waste of money; the AMA does nothing for the clinician in the trenches.
Why do we keep repeating over and over the same thing ?. We KNOW we are not going to get ANYONE to listen to US as long as we continue to be PASSIVE, Everyone knows we docs will never get together to do any thing, some will say one thing and turn around and another and all it is is fear they are not going to be able to keep the income they desire. All is nice and good, that's what freedom is all about; but it is NOT going to take US ANYWHERE. We need to ORGANIZE and TAKE MEANINGFUL action, Not just talk but ACTION and if necessary STRIKE just like any other labor force . I promise you they will begin to listen, I know it sounds radical but unfortunately we presently don't have any other choice but STRONGLY REACT.
If the AMA is said to be a fair representation of physicians opinions and desires, be they a minority or not, it is not hard to understand that assertion since they are the single largest organization we have! The real question is how are those in the AMA benfitting from this representation? Why would these members continue to be counted as supporters if they were not happy with the outcome of the efforts of the AMA? Are they simply apathetic optimists assuming that this is their only hope or is there some unspoken conspiracy going on here? If you are a member of the AMA I would like to hear what you get out of that other than a yearly bill for dues!
The organization most in tune with the sentiments expressed here is the AAPS. Given sufficient support, I have no doubt they, using the Legal system, will be able to tie up, and eventually defeat, the confiscatory intentions of those in government who think that your professional services are somebody else's "right". Healthcare is no more a "right" than is food or shelter. The Founding Father's WERE smarter than many Nobel Laureates (think Carter and Gore) when they created our system of checks and balances. Our only hope if these bills are reconciled and passed is to use the Courts to protect our interests. We lost the Legislative battle before it began, making the AMA's participation rather ludicrous.
I agree with you,Sermo Doc 56. I don't take medicare or medicaid now and am fortunate to be busier than I prefer to be because I give compassionate,caring,and competent care. If the government tries to force me to accept medicare and medicaid, I will revolt. I thought this was supposed to be a free country. Seems like you have to be a terrorist to have any rights anymore. This place is major screwed up!
I come from a family of physicians starting with my father,and four brothers who in turn have ten nieces nephews and daughters in law that are practicing physicians in primary care as well as specialty medicine. all of whom have dropped out of the AMA this year. We are disgusted with the way we continually are being sold out. L Rossi MD
I agree! I'm not sure if it is denial, PTSD, apathy, plain old stupidity or the "I'll put my nose to grindstone and work harder" medical ethos; but, whatever it is too many of my colleagues don't seem to see the falling piano. Look up--quick!!
As a member of the AMA, I am proud to stand with the hundred of members of the House of Delegates who (by the way) are real practicing doctors who see patients everyday, deal with the frustrations of managed care, and are sued for malpractice.
I do not envy Dr. Rohack's difficult job of trying to make dozens of specialties, each with their own pet issues and concerns, play nice with each other so the AMA can do its best to collectively represent the interests of all physicians. For all its supposed ineffectiveness, the AMA continues to be the primary resource representing physicians in the eyes of Congress and our government. Through its actions, countless aspects of the current iteration of health care reform have been improved at the suggestion and request of physicians, and I agree that without the AMA's efforts, this process could be a lot worse for physicians.
What intrigues me the most are the people who seem to be relishing in the potential downfall of the AMA. I have asked this before and never heard a cogent response, what mechanism do you propose would successfully represent the interests of physicians that be successful in challenging the AHIP, the AHA, the trial bar, and convincing Congress to bend to the profession's will? For that matter, if the current system and the proposed reforms are not acceptable, I challenge the community to propose exactly what system you would like to see for American healthcare.
DDP, you stole the words out of my mouth. One more thing we must confront is the real possibility that this is the beginning of the end of small community practices.
However, those of us in community medicine need more help to help awaken those professional colleagues that are still in slumber. Sermo must help organize local groups so that we can effectively challenge the AMA.
We must provide no healthcare to medicare patients, except for emergencies. Let's get the politicians/public's attention. I can survive alot longer than they can.
again, Dan, thank you.
I am proud to say that Ihave NEVER been a member of the AMA.
What can those of us do who are old, still in debt, barely surviving? Unfortunately, need the money from Medicare at the moment. However, we do not take Medicaid and can, at least, take no new Medicare patients.
I know I sound like a broken record, but am trapped, at the moment. But willing to support whatever group may come to light to represent physician interests. Physicians, NOT providers, physicians
Sermo Doc 70, you are a brave man to express that opinion. I think though that at least on these pages most of us think the AMA has sold us out, and I agree with that conclusion.
It is not our job to solve the "Healthcare Crisis". Indeed, if there is a "Crisis", then those who would SOLVE it should DEFINE it.. That some people lack access to healthcare is a multifactorial problem that would largely go away if employment were better. Of course our elected elite plan to solve that problem with tax increases and additional Federal mandates. That primary care physicians are paid so little is a function of their own past behavior in the 1980's when Insurers and Government said they would take from the "rich" specialists and give to the "poor" primary care physicians. Like many promises, it was only half true. Primary physicians also had the rug pulled out from under them by the Stark laws, yet at the time I saw little opposition from either Organized Medicine or from the grassroots. Primary Care physicians better start either getting out of Government programs or start taking hospitalist positions. The managed care dominated primary care office of the future will be staffed by Nursing Assistants supervised by NP's. Eventually, the Hospitalists will be NP's, supervised by a physician. Clinton promoted the "dumbing down" of healthcare and Obama is a true believer.
We need to organize a response that will inform and motivate our complacent colleagues and the misinformed public. In addition to a well directed letter writing campaign and pleas in Washington perhaps we need to hire a film-maker such as Michael Moore or Ken Burns? I know this approach is not as direct but as soon as we go on strike we are the "bad guys" and we won't win.
Well, Sermo Doc 70, that's the conversation that should have been had before the the dems pushed this gigantic lie through congress. Oh, by the way, let's not forget the AMA played a role in helping them push that mess, and thereby short circuited the discussion. I well remember the Obamamessiah saying there were no sacred cows and that everything was on the table, Oh yeah, it was going to be "bi-partisan" too. Turns out that tort law was too sacred to be on the table. Instead the AMA supported "pilot" projects using relatively miniscule amounts of money, but only in states that don't try to cap malpractice awards. How amazing that Howard Dean was more truthful than the AMA when he admitted that no one in the dem party would take on trial lawyers..
I have read great ideas over the months from many people in these posts, but they will never be part of the discussion that you helped end, because there was never going to be a discussion, or bi-partisanship. That was all D.C. smoke and mirrors, and the AMA was either really naive, or horribly complicit.
My hope is that public will exert its will in the 2010 and 2012 elections. If that doesn't happen, at least in my part of the country , guns and bullets are flying off the shelves.
Wasn't it just three months ago that our community praised itself on delivering an appeal for malpractice reform to 99 senators?
Here we are now.
I believe we HAVE to declare "war" on all fronts.
How is it that we have become so backed into a corner?
We are now facing "bundled payments", in essence forcing ourselves to "screw" each other over, like a bone with a little piece of meat being thrown to a pack of hungry dogs! Make no mistake, this is how we are viewed.
Worse, we are like slaves with special knowledge being forced to work under certain conditions. Of course one can quit, but that's another issue.
So, what do we do?
Rohack, needs to go for one. He's endorsed the "DNP" degree in more than one way. We need to find dirt on that guy, I'm sure he's made some back door deals and expose him for the crook that he is, and bring shame to him.
We need more visibility.
We need to be more on the offensive and expose the dangers to patient safety.
For instance, the Senate bill essentially aims to equate mid-level providers with Physicians!!!! Of course, they are equal as people, but not equal in the level of knowledge or training! I mean come on, most of us can drive a public bus, but that doesn't mean we should be allowed to do so!
So, I think going on a strong offensive to highlight the dangers to patient safety through misrepresentation.... as in "Hi, I'm Doctor Nurse XYZ?" COME ON! How ridiculous is this?! Or is it going to be abbreviated to, "Hi I'm Doctor XYZ?" when in fact the individual is "Nurse XYZ".
The people don't know about this deception yet, and I'm surprised no one has latched on to this treachery.
Sermo Doc 70, what's your response to Dan's assessment of the AMA and his predictions? You are an AMA delegate? Do you feel like the true power players at the AMA are pulling the wool over your eyes, or have you been well-informed? Can you argue that the AMA has truly fought for physicians' interests in the "Health Reform" debate we've all been watching like a tragic accident playing out in slow motion? Most of we physicians here on Sermo (at least) feel betrayed, or at least let down, by the AMA which is just a special interest (its own) lobbying group in my opinion. I joined the AAPS and see them fighting back for us almost every day.
Like most people posting here, I concur with the wish that the current reform package was handled in a mroe bipartisan fashion and included other reforms. Meaningful tort reform is obviously seriously lacking in the current reform package, but remember that a Republican House, Senate, and White House with a physician majority leader failed to deliver tort reform. I have a hard time envisioning any serious tort reform coming from federal legislation for the foreseeable future.
I have sat as a delegate and watched real doctors debate and democratically set AMA policy. I find it to be an open, honest, deliberative process. The physician leadership of the AMA is responsible for implementing the will of the House and those who fail to do so are not re-elected to leadership.
Like most on Sermo, I lament the lack of bipartisanship in the health care debate. I also lament some the items included in the current reform package. If anyone out there has the ability to make Red and Blue play nice, or can convince them to repeal the SGR, or make tort reform a reality, the AMA would very much like to know how.
I do argue that the AMA has truly fought the physician's interests in the health reform debate. I have never understood the assertion that "the AMA is just looking out for itself". What is the mechanism by which the physician leadership of the AMA benefits from the failure to accomplish tort reform, or repeal the SGR?
The AAPS is engaged in reform, and the more physician voices there are in Washington, the better. But consider this as just one example of the myriad complexities of the system. Some physicians want America to adopt a single payer system. Others want nothing short of fee-for-service and concierge medicine to be the primary delivery system. Now imagine the impact from huge lobbying groups like AHIP and their interest in health care. Add to that the public's desire to be able to see their physicians when they want, how they want. Now, imagine the White House calls and wants a single answer about how all physicians want to be reimbursed. How do you answer?
Agree entirely with Sermo Doc 70 about how infinitely complicated it is to please everyone while trying to effect changes in the system.Nobody has the answers,especially not the president of the AMA who has to present unanimously 'agreed-on' agenda on behalf of physicians.However,over the years,the AMA has appeared rather docile,meek,unassertive,self-serving and virtually irrelevant from a practising clinician's perspective.Why has the AMA allowed everyone else to practice medicine?And,infact,endorsed same in more ways than one?The metaphorical 'line has been drawn in the sand';the AMA has to clearly demonstrate who they represent;the AMA has to show some POWER on behalf of physicians.The issue of tort reform is so blatantly begging for radical action.
Those lawyers, politicians, executives, and fellow MDs who take advantage of us (And carve away at our profession) must relish how "distracted" we are by providing good patient care. But, over the past year I have come to realize how divided we are. This synergy between distraction and division will always handicap us as we try to contend with the bloated and greedy forces that sit around the table and feast on our productivity and excellence.Their appetite is insatiable; They will continue to truncate, prune, strip, squeeze, and marginalize. We, as a profession, are not at the table in any meaningful way; and so are on the menu.
Sermo Doc 70 writing is like a breath of fresh air... some reasonable discussion of this issue.
The american medical system is NOT monolithic... there is no one solution... Organized medicine has tried to have input into the process, I am sure, and quite a few necessary changes are part of the current legislation. A few critically important issues we have mentioned on this site ad nauseum are NOT. So do we discard the baby with the bathwater?
A rigorously honest person would say to start over, there are too many flaws in the current bill.. However, a realistic person would respond that this may be the best we can get with the current political system. We need docs running for office in much larger numbers... Unless we have money or votes, we will continue to be marginalized. And we really, really need to have a better organization to represent us... That is not easy to produce.
Sermo could serve that function, but we would all have to kick in $1000 or more for any Sermoans to have a voice in the debate... to pay the necessary bribes, supply cocaine and booze and sports tickets and of course the prostitutes (male and female) to get the requisite support in Washington... Are you all willing to embark on that battle?
Unfortunately, fellow physicians, the real opponent is the general American society/culture belief system, that " health care is my right, and let someone else(read 3rd-party payors: insurance companies and Medicare/Medicaid) be responsible to pay for it. Oh, by the way, I don't really mind letting "them" decide what I get and whether what I got was O.K." Entitlementitis: this is not limited to health care, and has taken a firm hold. We can't change that, short of unionizing and going on slow-downs/strikes. BTW, I understand that very thing is happening in Germany, no bastion of free-market health care delivery
hey moose: you are obviously a "left-leaning" liberal, probably voted for O'man?? You write total gibberish! did you notice you contradicted yourself, in the same paragraph, no less. You liberals are laughable, except that you're dangerous, in that you lack self-respect and want to enforce your lack of standards on others
I believe that the greatest risk we face is an attempt to link licensure with acceptance of any reform legislation handed down from on high. In other words, those who intend to "opt out" in favor of cash only or other practice solutions will find the exit blocked. At that point we can try legal remedies which will take years of litigation. By that point, the decision even in our favor might be moot.
I think certain payment reform proposals are also dangerous, in that they implicitly suggest that we have no voice in the debate or the structure. We will be told how we will be compensated and will follow orders. Physicians will quickly become the indentured servants of the larger 'stakeholders' including hospitals and insurance companies as well as state and federal government. We are indeed 'on the menu'.
Our impotence is almost risible. Highly educated and presumably intelligent, nonetheless we have ceded control of our professional destinies to elements just salivating at the thought of reducing us to proletarian status. I think we must be ready to consider drastic action, even if it goes against the ethical grain of our consciences. I'm speaking of nationwide work slowdowns and stoppages as well as concerted attempts to achieve legislative reform to grant independent doctors the right to unionize. Otherwise we might as well resign ourselves to virtual indentured servitude. I don't use those terms lightly - that is the case.
I have been bitching about the lack of tort reform during the whole 8 years of Bush's presidency and nobody cared. Now over the last year to my surprise there is lots of talk about tort reform in the whole media during this whole healthcare awareness. But the funny thing is the lack of follow-up.
Next time you hear something on t.v. about tort reform pay attention and you'll see what I mean. Somebody will talk about tort reform but it will die right there, the news/media people or the politicians involved will just let the discussion die with no follow-up. And there will be no follow-up.
All you will see are isolated cries about tort reform that will die right there on the t.v. screen or will go to the trash with the newspaper page. There is no follow-up.
Now, if this was an issue about race black/white or gay issues you bet it will be follow-up, maybe ending with a beer meeting in the lawn of the white house or the firing of Don Imus, etc...
But "tort reform"... people won't care unless it really affects them.
I have been an AMA member for over 20 years but after spending the last year reading multiple posts on Sermo and the fact that the AMA is supporting the current health care reform bills, my membership will not be renewed.
This really isn't that complicated.
Rohack and the AMA sold the AMA name and backing - thought they could get a deal to squish SGR once and for all in exchange - didn't happen
AHA cuts in reimburement for universal coverage - didn't happen
Pharma cuts for protection form imports probably won't last
AARP sold out seniors to kill Medicare Advantage - 'cept not in Florida where seniors all live.
Rohack is at best Neville Chamberlain and at worst a dupe of the creepy "shadow leaders" of the non-practicing admin VPs of th AMA
Either way the AMA has to go . . .
I just sent Rohack an email explaining very briefly why I left the AMA. Trouble is, I disagree with Dr. Palestrant - I don't think Rohack is lying - I think Rohack simply has no clear idea of what the bill entails, same as the bastards who voted for it. This is a safer position - he can always claim that he didn't know... Just like when the stimulus package gave the executives at AIG, etc those insane bonuses - the very jackasses who voted for it later claimed (admitted incompetence is more like it) they did not know that that was in the bill and then taxed the bonuses.
Colleagues: Please note that the current "healthcare reform" is primarily about INSURANCE, and further enshrines in law the exorbitant and inefficient abuse of health insurance progressively imposed over the past three decades by Medicare/Medicaid (aped by private insurers). We can make the current "healthcare reform" legislation IRRELEVANT and an OBVIOUS BLUNDER to the American people if we do the following:
1. Individually incrementally withdraw from Medicare/Medicaid and all current insurance contracts over the next 2 years. Doing this incrementally will give both us and our patients time to adapt.
2. Explain as often and vigorously as needed to our patients that we are doing this for the benefit of American healthcare, because the abusive practices in current Medicare/Medicaid and network-based insurance impose monstrous inefficiencies and intolerable interferences on our profession, GREATLY IMPEDING our ability to provide quality, affordable care to our patients.
3. Point out to our patients that interference in healthcare delivery by government and insurers is not only inefficient, but unethical, un-American, and an INTOLERABLE INSULT to BOTH them and us.
If we do this, then the mandated insurance and Medicare/Medicaid will become progressively worthless, and voters will soon demand REAL REFORM as they realize they are getting NOTHING for the further infringement on their paychecks and civil liberties that Congress is imposing. At that point, Congress (no doubt, largely replaced by outraged voters) will have two choices:
1. Produce REAL REFORM that a) removes the Soviet-style price controls and central planning that have been progressively imposed over the past three decades, resulting in massive inefficiencies and rapid escalation of health care costs, and... b) replaces it with some version of Medicare/Medicaid that reimburses PATIENTS whatever taxpayers are willing to pay, without dictating physician fees, diagnoses and treatments, or...
2. Further Sovietize one-sixth of our economy and force all physicians to become salaried government stooges.
Which do your think is more likely to happen? It's up to us.
Yours For Better Healthcare, Dan Jones, MD www.jonesplan.blogspot.com
<Trouble is, I disagree with Dr. Palestrant - I don't think Rohack is lying - I think Rohack simply has no clear idea of what the bill entails>
You're wrong. Rohack is complicit. He is part of a larger corporate philosophy that has mathematically excluded practicing physicians from any hope of a rewarding professional future. Don't discount his betrayal. You could argue that he is is too stupid to understand the medical/industrial/political influence directing the future of medicine. But that is extremely unlikely. He's a puppet. Worse, he is a front for the business arm of the AMA that has much to lose if they are outed. The AMA is a criminal enterprise and should be treated as such.
Don't think what's there is a done deal. Write your senators, as well as the six blue dog dems, and urge family members to do the same. Email via Google takes less than three minutes. The senate will determine the outcome. They are poll responsive, and see these polls that show less than 30% supporting the bills. And they've been home,undoubtably gotten an earful, and have the huge government failure of the Christmas underwear terrorist fiasco reminding them how inept the government is at everything. Encourage them to have the political courage to do it over, and do it right---beginning with tort reform.
My 2 cents as a Rohack trained graduate of Texas A&M
Dr. Rohack,
As an a&m alumnus, please reconsider your position on medical liability in the reform process. "Experimentation" will leave thousands of Texans without docs when punitive damage caps are removed.
When I first returned to Texas to serve Bell and Lampasas counties, I was sued for alleged neck injury (I am a psychiatrist and do not treat neck injuries). After 15 years, the suit was finally dismissed. The only reason was my large policy and the favorable environment for trial lawyers in Texas in 1994.
My wife got a job in Alpine at a local university a few years ago. I have the only psychiatric office in a 150 mile radius. Without the caps, I could not afford the liability premium.
Please do not end my ability to keep my office open.
Stuart Crane MD
Past President, Texas Academy of Psychiatry
The AMA is bought off by big business... just like the rest of our Government. Our nation has had a Government For the Corporation, By the Corporation for decades... why do you think the AMA leadership will be any different? Easily bought off to be an ineffective voice for medicine. That's their job. Doctor's feel like there is an entity (the AMA) out there representing their interest, so they don't organize otherwise.
Dr. Palestrant, thank you so much for everything you have done for our profession! You are absolutely right. Doctors have been picked on for so long because they know we are too busy taking care of patients to fight back. It's time that we need to start taking care of ourselves and our profession. If we don't, we may lose the profesion that we love. Don't forget why we went to medical school at the first place. We didn't go through years of training and sacrifice to be told what to do by the government and AMA.
With 60 votes in the senate, it is easy to disregard the wishes of the people and throw common sense and 'budget neutrality' into the trash. Show your support for Scott Brown in Massachussetts, send him a contribution to help re-balance the senate.
The political corruption in Washington demands change, we have the opportunity to do so in this MA special election. www.brownforussenate.com
If the AMA wanted to redeem itself it should have " studied the BIG PHARMA playbook" I really do not understand why they were able to pull off a victory as big as this. Big pharma will have a net profit after this all is over. Why not copy their tactic's, spend money all over Washington like they do.. PS remember Mr. Obama said he would not allow any lobbyist-special interest in the capital.... ummmm what happened to that!!!! " If you can't beat them join them" and please lets not hear any of the white glove "docs" who above it all... and say we are too "profession" for all that..... because you will feel very "profession" making less than some pro- athlete(Tiger) or movie star who will make more in one day than your whole working life.... doc's we have to get together and stop this.
Dan, nobody could have said it any better or with more clarity:
1. Physician Hubris is killing us.
2. Physician Apathy is our cancer.
WE badly need physician engagement if we are to overcome our professional decline.
Great insights are found in a new book-" How the Mighty Fall" by John Collins.
Where is our physician thumos( courage)?
A subset of physicians, those who work in underserved areas and especially those few ethnic physician leaders can help spread their knowledge and leadership skills that have made them successful to our larger physician population.
Only one glitch- physicians have to be willing to learn and trust from one another. Easier said than done.
If anyone here thinks that it's right that we, as a profession, should sacrifice our incomes or prerogatives in order to help solve this ill-defined crisis, then I would ask why farmers and grocers are not likewise FORCED to sacrifice to solve hunger and why builders are not FORCED to sacrifice to solve homelessness. The majority in Washington want to forcibly take what should only be ours to give. Does no one see the Constitutional issues here?
I rejoined the AMA a couple years ago when I saw the looming Healthcare Reform winds blowing because I felt physicians needed a voice in the debate. I cancelled my membership when I found the AMA endorsed the house bill. What a huge disappointment.
For too many centuries Atlas and the producers of this world have born its weight and never gone on strike. For bringing the comfort of fire to humans, Prometheus was chained to a rock to be eviscerated. So what's new? What's new is that many of us in this noble profession will refuse to become government hacks when forced to participate in a federal universal health care program as a condition for licensure. Rarely mentioned by its proponents is that Medicare, Medicaid and VA programs are all voluntary, for both patients and physicians. But for how long? Answer: Just show up on November 2nd. Save the date, and our profession. Sermo Doc 96
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Sermo Doc 70 Cardiology Posted Jan 01, 2010 at 3:45 PM .
... For all its supposed ineffectiveness, the AMA continues to be the primary resource representing physicians in the eyes of Congress and our government. Through its actions, countless aspects of the current iteration of health care reform have been improved at the suggestion and request of physicians, ...
"Res ipsa loquitor" - The thing speaks for itself.......
That is the biggest problem with our global phyisician response to all of this. Most say nothing, and even more do nothing.
I recently posted question on the ASCRS listserv - as i was outraged to find that the language penalizing state for proposing or passing any limitations on trial attorneys for malpractice, medicine errors, or equipment suits. That coupled with the 22% cut that has yet to be taken off the books, and the elimination of medicare consultations, was very upsetting overall. Out of perhaps 200-400 surgeons, I got 2 responses!!!! Both of which said, "what can you do".......As I said "res ipsa loquitor".
Our founding fathers were not more brilliant or predictive of the future. Their strength was and is in the fact that they all argued, discussed, but ultimately LISTENED to one another for the greater good. Their strength was in the use of numbers and experience rather than opinion to drive what had to be done. They used their collective experiences, good and bad, and above all else they knew one critical thing...........History repeats!!! Today many people say it but few actually look at history and use the learning tools to avoid those mistakes. In 1776, they were brilliant enought to know what they did not want to happen and the fruit of that brain trust was our constitution. An attempt to allow us the ability to adapt, avoid singular thought, and allow for checks/balances to avoid the mistakes of partisan thought/tyranny/and urepresented dictum that would result another revolution.
In their infinite wisdom, our current judicial system, executive branch, and entire legislative body has very effieciently destroyed those warnings, preventative measures, and history. Proof positive....Language in this house bill the actually states certain facets CANNOT BE CHANGED OR REPEALED BY FUTURE LEGISLATIVE BODIES. If that is not the definition of unconstitutional then nothing is, yet I have not heard a peep from either democrats/republicans, let alone our clueless/uninformed, ill equip president.
If we collectively choose to ignore our constitution, fore fathers writings/teachings, and the lessens taught throuhout our short history, we will fall [as most great nations do when they deem themselves mighter than their roots], and a new age, country will be born......this one will NOT be the land of the free, nor the home of the brave. It will simply be another tumbled/pathetic once powerful city-state, ruled by the corrupt, and served by the masses......aka Rome/Persia/Macedonia/British/Monguls/Chinese dysnasties. Take a look at the history books, or if need be the History channel. Each of these powers have several key things in common with our current situation. RES IPSA LOQUITOR.
Sermo Doc 97, The info you request is on the AMA home page; click the Health System Reform link and it takes you to the 12/23 bulletin. DWINCHES did his homework!
Interesting comments from everyone. I'd like to draw out two points.
-First, I am seeing people fall into the same mistake of attacking AMA defenders, such as Sermo Doc 70. I think this is a mistake. It takes courage and conviction to join this discussion, defending the community. I for one would like to thank Sermo Doc 70. Members of this community should be making every possible effort to engage with AMA members. They can be your guides and can help us better engage with the AMA system. Whenever I speak about the AMA, I go to great efforts to emphasize that there are two different sides to the AMA. While it might serve our purposes to portray the AMA's physician leadership as intoxicated with power or corrupt, this just hasn't been my experience. At the senior level and most certainly at the delegate level I find that physicians invest their time and effort in the AMA out of an earnest interest in serving our patients and serving our profession.
The real issue is the professional side of the organization. Is there a single physician out there that can tell me who really runs the AMA? Who holds the power? There are a group of five men who control the AMA's finances and publishing efforts. Ultimately, these people control the AMA's political efforts.
Sermo Doc 70 do you know who these people are? Have you ever met Bob Musachio? Have you ever seen the finances of the organization that proports to represent you? As an AMA member don't you have the right to know how many paying members there are?
Dr. Rohack is lying because the truth is that he does not know the answers and the truth is that he does not really have any power. His leadership there is an illusion. At best he is a puppet at worse he is completely in the dark. Dr. Rohack, is unfortunately finding out a sad truth that every AMA President learns.....he has no authority over the professional side of the organization. He cannot ask to see salaries, nor can he demand actual membership numbers. He has clawed his way to the top of the AMA hierarchy only to find that he is a pawn to the real power brokers.
-The second point I'd like to draw out is something I am hearing several of you reference......our colleague's apathy. It is our collective shame. Ultimately, we are completely ineffectual unless we can shake other physicians out of their collective apathy. If I encourage each and every one of you to focus on one thing, one single thing, that would be it. Talk to your colleagues. Get them to join the conversation.
Since this is a FtF post, it will be available to the public. Can I ask my local newsmen to take a peep? I am sure it can be googled when it is out of the barn.
So do I,Ebola;it would be a BLESSING,the catalyst to overcome inertia,the ultimate ignition,the very last straw that broke the doctor's back,the one step beyond the threshhold........................................................................:-)
The real issue isn't if and when this all comes to fruition, but rather, what happens when it does.
There will be 2 responses: 1. Those will limp to mediocraty, tail between the legs, and do what they are told, be paid what is granted, and become a tool. 2. Those who rail up and fight for what we have all worked for, believe in, and what will make the phoenix rise again. Here's the big question........which side do each of you choose?
The interesting thing that I see daily, is that there is far more concern from my patients than I can see spontaneously or ellicit from my colleagues. 8/10 patients that I see ask what my take on the reform means to me, and could mean to them. I easily spend 10-15 minutes per patient discussing this daily. That makes me have hope that there are people out there smart enough to ask questions, even if it isn't the physicians that are doing it.
History does teach. If you look at every dictatorship, what group[s] were targeted/destroyed/controlled or killed to facilitate that regime.....The scientists/teachers/scholars/media. Interesting how the groups that had the platform and means to ask questions were the first to be silenced. If we as physicians stop asking those questions, or fail to push ourselves/and our colleagues to do so, we are to be the first silenced by whatever means. It is already happening, and the AMA is akin to Obama's Hienrich Himmler. I don't believe that is too far a stretch, in fact I see more and more parallels to that horrible chapter in human history everyday. In post war Germany, many nationalists/soldiers and civilians were charged with war crimes due to their involvement or lack of attempts to stop the genicide of the concentration camps. The take home point....you don't have to pull the trigger to be guilty. We are guilty of allowing this to happen if we do not step up and fight for what is just, right, and most importantly in our patients and medicines true interest. It is safe to say that if we do not, no one will do it for us.
Taking from one to give to another because the other needs is immoral. This bill will pass unless it is exposed as evil. The injustice, the expence, the contradictions, the arbitraryness are alltogether insuficient to defeat it as long as it is considered moral. Physicians own their lives. They own the vales they produce in practicing medicine. They own these values by having brought them into existence by using their own minds. If physicians stand up and announce they will have nothing to do with this program if enacted into law it would collapse. Pride in the virtue of such a position would awaken the admiration and support of true Americans.
sermo should send the AMA president and each of the Senators the new version of Jon Huntsman book "Winners Never cheat"..I think most doctors who end up in CEO positions have a conscience they choose to turn off when on a throne. www.amazon.com
Delighted to see your comments in the blog line. If I may, I would like to "pontificate" on my 30+ years of clinical practice (for what our successors may validate or nullify), but I will add that none of you passive whiners can state that I didn't have the fortitude to go totally "fee for service for over 20 years". (Which ALL of your gutless followers lack); Yet, while willing to bilk the system for remimbursement--I love the brainless response of the contemporary neophytes, who's reply is ..."but I didn't imagine it would come to this"!? Wake up, Homer Simpson!!
I have said before, and I will repeat--- what goes around, comes around....we have been self-absorbed and loving the big $$ cash flow in the practice of medicine that we have ignored the insididous penetration of mid-level administrators and other ancillary idiots who draw unjustified salaries---well, guess what, my colleague losers, now it all comes to haunt you. The axiom you should enter in your haunted and troubled memory is:
"All of our problems started the very first day ANY hospital administrator earned more than $40K per year." Suck it up you passive whimps--pay your AMA & specialty dues... then DREAM on!!
I cannot fathom why so many innately intelligent professiononals are expressing themselves as total idiots-----I can hope hope and pray that in 2010, some, if only a few, will learn pragmatism, grow up and move on.
Happy New Year, Whimps----why not move on to create your own destiny, which you've ALL been derilect to to for God who's know how long??!!
Don't hold back, let us know what you think....but please use a touch of tact. Even gutless wonders have feelings too.
I would agree that fee for service is the way to go, and that many should have and need to do just that. You are also correct, midlevels and non-physician cancers have pervaded the system. All for the love of money, but the key thing is that the majority of us don't do that and don't agree with that. You generalize far to much, and have little specific content. Your diatribe is fun to read.
If you are are as brilliant as you beleive that you are, what have you done [aside from serve yourself], to make an impact or change in the ENTIRE system, not just your little corner. So you prove yourself to be part of the problem. Rather than call peoples names, why not put forth a constructive solution or idea. The real problem isn't what you think you know, but rather recognizing what you don't know, and affecting change to that end.
Our challenge is the need to be action focused , created a organizational competitive alternative to the AMA and be adaptable and flexible in creating the necessary change.
Infiltrating the AMA is a good thought, but that will take time and energy that could be better used to help the new phoenix rise from the ashes of the 21% cut and the new health care reform that will be be signed by mid March 2010.
How are physcians getting prepared to rebuild our profession?
Your comments are a perfect example of the variations in medical practice that make it so difficult to organize the medical profession in a meaningful way. It is one thing to do fee for service (assuming you mean no participation in any type of insurance program including Medicare) in a practice of dermatology when you see a patient every 5 minutes or less (maybe not you but I know many dermatologists who do) and then present a bill that probably 90% of the patients in your practice can afford to pay and a totally different thing to present a bill for major cancer resections . . . not affordable to most people.
Not to take away from the point you are trying to make as it is a valuable addition to the discussion but to suggest that your particular presentation is an answer to our problems leaves a lot to be desired.
I strongly agree with Sermo Doc 102. We need to make the moral argument here. We own our lives, our work, and the values that we create--just like every other productive member of society.
We should speak out loudly to our colleagues, patients, friends, family and acquaintances about our opposition to the current "reforms". And we should educate ourselves about where we currently are, and how we got here.
The best article I've read explaining this is "Moral Health Care Vs. Universal Health Care" by sermoan Dr Paul Hsieh, M.D. and Lin Zinser:
Most of my colleagues think I'm a big conspiracy theorist when I tell them all of this that is going on. They say there is no way a 21% cut will be allowed to happen and that the senior citizens represent to big a population to piss off and that law makers will back down to them for fear of not being re-elected. Then they say, Oh well, if does happen and it gets that bad i'll just find another job in Pharma or somewhere else. IDOITS!
I am the only one in my town who does not say what Sermo Doc 106 describes. It is unbelievable how stupid doctors can be. Typical answers that I get: - They will never do that - It can not happen - Oh well, whatever happens to me will be happening to everyone else too, so I am fine - Oh, we get paid more than 95% of Americans anyway - Oh, we will find some way out - Oh I will just see more patients - what can I do
If you calculate hourly pay of a PCP, it comes to 50-60$/hr .... after all the investment of money, time, effort and personal life, all the risk and liability they take, all the crap they face
Gentleman: We are in the 9th inning, the count is 3 & 2, there are two outs and we have nobody on base. The time to recruit people to engage in conversation is long past.
Common sense kowns, that to win, one needs to put a well prepared and skillful team on the field; with appreciation of the critical need to go for the the thrill and the fruits of victora. Sadly, that is something we have not have in decades. Lets be realistic, at this time, the only thing that can save the madical profession is an honest, wise and courageous President, assisted by an equaliy qualified Congress. Both pushing together to make reality the magnificent potential of the US Medical Sciences
If we are really serious about such target, play by the rules, find and get elected the candidates that can get the job done. The rest is wasting time and energy
everyone should read it. It shows how govt despite the best intentions fails to be good at running a business. It also gives us a glimpse of what will it be like in future for all of us. It tells how MA, despite the highest doctor to population ratio fails to offer access to care as we desire. More people have insurance "card" but fewer people have access to health "care"
thought in my drunk mind is "Should we take the message from MA experiment and use it to the advantage of our nation?" If that type of policy leads to everything opposite of what we want, should we be doing opposite of what was done in that experiment? It reminds me of Seinfeld's episode where George Costanza does everything counter-common-belief. Its a very unconventional thought ...... that damn wine must be good!
You are absolutely correct. But the solution you describe is moot, and impossible, b/c the current president and the current congress is so bogged down with personel agendas/lobbyist money/corruption-greed, and a current plan that is the exact opposite of what is really needed.
Your are absolutely correct, but I would offer that the only real solution is to keep our enemy closer.....aka hire a cut throat legal team, sue the US gov't and STRIKE.
Yes that is a bit drastic, and at present not allowed by our current gov't, but we all know the only reason it is not allowed is due to the power it would shift to the physicians. Anything can change, and things deemed unlawful, have since been changed to lawful acts.....Abortion/flag burning to name a few.
So I would submit that we should collectivley group, have a single voice legally and nationally, and let it be known that we are worth more than this, we deserve what we work for, and we are the voice of healthcare, not Edward E. Obama, Pelosi, Reid, or society with self interest [AMA].
As for Sermo Doc 103 comments, I would boldy state that as a challenge to anyone to step and join hands, move forward and for a change we take back our profession, lives, and most importantly our patients care.
Why has no one in Massachusetts sued to remove the mandatory participation as a condition of licensure provision? It is clearly unconstitutional and would quickly be struck down.
1. The Mass. participation mandate is constitutional because licensure is a state matter and it is a state mandate. A federal law cannot tell states how or how not to do licensure.
2. Even if there were a participation mandate, just participate but have no appointments for poor payers until 2023.
Physicians must organize! We must stand up and fight for ourselves and our patients.
SERMO could help more. Why is that that the information about the MMM was placed on the home page AFTER the march had taken place? Why wasn't the information sent in an e-mail to all Sermo participants?
I'm convinced that enough physicians would join together to effectively represent our cause and change the course of history if we had effective leadership. To best help us Sermo must move beyond being just a forum of ideas and discussion and become an effective way to rapidly disseminate information to thousands of physicians. There are several physician groups doing nice work but relatively few physicians are aware.
The difficulties we are facing affect all practicing physicians whether in private practice, academia or at large multi-specialty clinics. Thus, there is common ground that most of us can unite behind. Again we need effective leadership and a mechanism for rapid dissemination of information.
I'm not an AMA member and have not been since they aligned themselves with Hillarycare back in '93. I HAVE joined the American Association of Physicians and surgeons (AAPSonline.org) and am quite impressed! Give 'em a try!
BTW, my resume' and business card both state in bold type "NOT AN AMA MEMBER"
I stopped being a member of the AMA over 15 years ago when I realized they were not about representing the physicians. I'm glad I've saved all that money, which I will use to attend law school, now that medicine as a profession is dead.
Thanks for the interesting and damning information about the AMA. Exposing the AMA for what it really is got me interested in SERMO as a website. (Never a member of the AMA, and listed as a non member on their site- I did look myself up)
I don't know what the future holds. Perhaps, besides cash only practices, you could do more topics on alternatives to current practice situations, since we will all be reconsidering our current situations in the future.
I agree with Dr. Dan's comments about getting more colleagues involved. If each of us can convince 3 colleagues to get involved with Sermo and then they each tell 3.......
we can grow our sphere of influence.
"Nothing is politically right which is morally wrong" Lincoln
"All tyranny needs to gain a foothold is for people of good conscience to remain silent"
Thomas Jefferson
It is very obvious that absolutely nothing will get done about tort reform. I have not seen one commercial to the public about this topic. If the trial lawyers where concerned at all they would launch a tremendous campaign scaring all. Apparently they have nothing to fear because the only way to get anything done is to withhold our services. In a court of law we are only very unfairly degraded by the trial lawyers. Doctors who worry about the ethics of medicine are not realistic about the very sad state we are being forced to practice. I have been saying for years that we will accomplish nothing unless we unite and fight this corrupt system.
Sermo Doc 74, I don't think we need to consider a strike. We just need, as many of us as can, to gradually withdraw from Medicare, Medicaid & all contractual insurance; and create our own business models. We have that right, and we should exercise it. If such contracts and the absurd accompanying micromanagement of our actions had been presented to us like they are today, in one fell swoop, in 1966 (when Medicare was introduced), we would have all said "Blow it out your ass." We only got into our current predicament because these constraints were introduced piecemeal, over several decades, like the proverbial camel's nose under the edge of the tent. But now it has far passed the point of tolerability, and it's time to exit those ridiculous programs. That will be much easier for some of us than others. But one thing is clear, THE MORE OF US WHO EXIT, THE EASIER IT BECOMES FOR EVERYONE ELSE. Dan Jones, MD www.JonesPlan.BlogSpot.com
Dr. Dan P. thanks for refocusing us again and I agree if all each one of us did was bring one new mwmber into Sermo, we would be 210,000 . Maybe not all in the discussion, but hopefully many of us. Let's all commit to bring at least one new member in.
Very few posts here by Pediatricians on this subject as anything the AMA does to benefit us is strictly coincidental. I took their advice to decrease overhead by not renewing my membership. If our state medical association , or the AAP doesn't get more active, I see further overhead reductions.
I was always stunned by how glaringly 'Anti-Physician' so many of the AMA's activities, policies and position statements were. I begin to understand.
Daniel: Why am I reading your explanation here, an NOT on the front page of perhaps every major news outlet that still has an editor with a conscience?
How about a quarter-page photo of the AMA opulence to highlight the arrogance? (In fairness, many of our 'best' medical schools exhibit the same attitude! The executives' secretaries work in airy 30x50' windowed-spaces with marble columns and Persian rugs and solid cherry furniture, while the 'grunt' medical faculty work out of 6x8' cubicles with 40 year-old grey stainless desks and chairs.)
Dan, seriously, there are plenty of Americans who DO care about what is happening in health care and would greatly benefit from knowing what you've uncovered. Shine the light.
I just cancelled my AMA membership after a good friend who is an AMA delegate described his discussion with James Rohack at a recent meeting. I am a solo cardiologist now getting whacked on all imaging (nuclear & echo) as a result of the CMS rule for 2010. I wish those thousands of dollars would go to my referring physicians down the street, but I have not heard of any primary care doctors striking it rich in 2010 to retire. Dr. Rohack has sold out the good doctors of this country. I don't know why, but he has. As others have mentioned, it doesn't matter why; he has lost all touch with reality. C'mon He comes from a hospital that only uses persantine, for their nuclear stress testing, because it is so cheap to use, which is the equivalent of using Ether on a patient for anesthesia!
I think the FLaRheum doc and others are correct: nothing is going to change by sitting around typing emails to each other. I haven't seen Avatar yet, but I suspect if Dr. Palestrant were to lead doctors into a more meaningful battle there is a chance of revolution. It will take a Sermo Doc 20ful director to get us out of our chairs and become physician Avatars!
peaceful, non-violent, deliberate, legal slow-down is what will work. reschedule your medicare pt far out. limit number of new pt. limit number of medicare pt a day. fill your schedule with better paying pt - it will help improve your revenue too.
As long as this is just a forum to complain about the AMA, without an alternative vision, it is not likely to have much effect. An actionable "Ten Point Plan" would go far to get the attention of our complacent colleagues and the public. But to have a meaningful Plan, we would have to grapple among ourselves with some real issues such as the disparities in reimbursements between primary care and specialists/ proceduralists, and cost containment. Is there some positive plan articulated on the Sermo site? Having Michael Moore do a film would not help if he showed a bunch of doctors bitching about other doctors. A strike would be great, but what is our list of goals?
"Dr. Morris Fishbein (1889-1976) originally studied to be a clown. Realizing he could make more money as a doctor, he entered medical school (where he failed anatomy), then barely graduated. He never treated a patient in his life.
Why is he so important? Because he became head of the AMA, a position that he used to enrich himself and crush legitimate therapies out of existence. He appeared to be motivated solely by money and power.
As head of the AMA (and editor of the Journal of the American Medical Association from 1924-1949), he decided which drugs could be sold to the public based only how much advertising money he could extort from drug manufacturers, whom he required to place expensive ads in the JAMA. There were no drug-testing agencies, only Fishbein. It was irrelevant if the drugs worked.
Fishbein was a shakedown artist. Yet, today, there is a Morris Fishbein Center for the History of Science and Medicine at the University of Chicago.
The AMA, a State-backed guild which today has a near-stranglehold on the medical profession, was founded in 1847 merely as a social and scientific organization. Its original purpose was totally appropriate. It was in their private (and the public's) interest for practitioners to get together to trade knowledge, and, for all the outward seriousness of the organization, to have some fun. The original purpose always seems to get lost, though. Some members always want to use the State to reduce the supply of practitioners (which increases income) and eliminate competition (which also increases income, and, much more seriously, reduces innovation). This happened with he AMA, which is why it is now a danger to the health of the American people.
In 1900, while attending the annual AMA convention in St. Paul, Minnesota, three doctors came up with the always-destructive but all-too-human idea of using the AMA as a front, in order to form a closed corporation for their financial benefit. A constitution, bylaws and a charter were created which appeared to give the members of the AMA a say in the activities of the corporation, whereas in reality the three directors had complete control. These three formed smaller political machines in every state, which they controlled through the main corporation.
In 1924, not surprisingly (perhaps inevitably) one of the directors became involved in a scandal and had to resign. He appointed Fishbein to take his place. Fishbein ultimately took control of the AMA, and by 1934 owned all of the stock. In his new position he was able to assume dictatorial control of the state licensing boards and made it as difficult as he could for any doctor who did not join. He, and the three doctors who formed the corporation, were little more than extortionists, ones who made millions by using the power of the State.
The AMA, which started out as a legitimate organization, rapidly became crooked. And Fishbein was the main cause. "
A strike will not work. It will only bolster the public's general opinion of doctors as money-hungry whores. We are above that.
A work slow-down will not work because it will only piss off patients and decrease our own incomes while increasing profits at the insurance companies. We can't hold out as long as they can. Insurance companies don't want you to work or see their patients.
The only thing that I see that will work is for physicians to stop accepting insurances that suck, even if it means all of them. I do have some good payers and will stick with them. My own group several years ago dropped 2/3rds of our insurance contracts, worried like hell and then watched incomes go up dramatically.
But as long as there are fools out there willing to take pennies for a dollar's work, Medicare, Medicaid and insurance companies will continue to offer less and less for our work.
He is not lying, he is just doing the governments bidding. Did you forget the AMA was in the oval Office the minute they announced reforms to the medical care, signing on to whatever will come forth and not knowing any details? There is no more pretending about the direction the Obamacare wants to take us; socialized medicine like that in many European countries. One example is my old country I came from where all physicians were required to work an predetermined amount of hours a week for the government and after that some, usually evening, hours could be spent to have private duty in one's office. Not an easy life but they were unionized and suffering in unison, so they had some bargaining power in order to survive. To achieve this goal in this country, first they must eliminate the independence of physicians and they are already on the way by limiting compensation and increasing regulation. No physician in small practices will be able to weather this.
It's about money. The AMA's working with the government and inadequately representing practicing physicians because of the 70 million dollars they earn yearly from their licensing fees of the ICD codes. (see last week's letter to the editor in the Wall Street Journal). This is done under the Fed government's 'contract' with them. This is nearly double what they collect in membership dues. It's no wonder then since 'Money talks and..."
Thank you Daniel for your leadership and the very detailed and revealing analysis of the AMA.
It is very clear that lack of unity has been very damaging to our livelihood and profession. The de-professionalization of physicians is a trend that will surely continue, UNLESS we pull up our sleeves, step up to the plate, and boldly defend our turf. The Open Letter ( md.sermo.com ) and the Physicians' Appeal ( md.sermo.com ) were magnificent gestures by the physician community, which signaled our readiness to voice our real concerns.
The next step, i.e taking ACTION, requires a tightly organized and coherent vehicle. Sermo has been a superb channel of communication.
The questions is, how can we take the voices expressed on Sermo and turn them into ACTION?
Sermo Doc 124, it seems from prior posts that you have taken our energy and converted it to reality with your open letter. I would pass that back to you as a sucessful Sermoan that has crafted somethong to be delivered to Congress, how do we take the next step since Dr. Dan has not stepped forward to carry our torch?
Sermo Doc 86- thats exactly what I call deliberate slow down. I am so selective about insurances that I forget that people still contract with lousy insurances. I started my brand new practice 6 months ago. I accept only BC PPO, BS PPO, a local IPA. Recently I signed up with CIGNA. Last night only I sent message to Aetna that unless they include fee for my common codes in the contract, I will not even read rest of the contract. I was taking Medicare but has stopped seeing Medicare pt since 01/01/2010. I have already started getting calls from doctors and patients.
Dan, thank you again for this posting. I just returned from being gone for vacation over the holidays and was mercifully disconnected from the Internet and most news. I haven't read the above comments, however, I can guess the tone of most of them.
Americans in general and physicians should be tired of and outraged by the "political spin". Most of us are well aware that this is dishonest nonsense and is self serving to the politicians and to people like Dr. Rohack who has been drawn into this mess over the years(by his own choice). These people need to be ousted. We are in a critically dangerous situation in America. We are being systematically lied to, deceived and abused...for what? The answer is simply for the solidification of power, money and position and has nothing to do with preserving our democracy or defending our Constitution. Unless we organize a significant non participation revolt, we we be trampled upon by what is occurring in Washington. The politicians don't care about us, Dr. Rohack or the American people. There may be some exceptions, but in general they are trying to preserve their power and their positions. Currently, the only way to do that is to lie publicly and make secret deals in private. While that occurs they are selling our country and our profession down the drain. We have a right and a duty as American citizens to point this out and to take action to change it. We must keep up the fight. We must continue to educate our colleagues and the public.
Sermo is a wonderful communication tool to assist us, but we still need an organized front with power and strong leadership to accomplish the task ahead.
Thanks folks. I agree that the outrage around this seems to be growing. As physicians we all recognize we need to start taking steps to change our predicament. While I agree there needs to be more action and leadership taken by physicians, the challenge is a bit more fundamental. I have seen attempt after attempt that failed to rally physicians to action. Physicians are just too distracted by their intense commitment to patient care and a strange "victim mentality" that has made them incredibly disenchanted. What I've learnt is that the next step is the most basic of all. We simply need to broaden physician engagement and interest before we can do anything else.
The good news is that I I am definitely seeing a new level of interest and commitment as physicians are seeing just how significantly these changes will affect physicians and their patients. There is "fresh blood" among physicians on Sermo interested in tackling this. For now, set your goals very low. Just get your colleagues to log-in and enjoy the discussion. That would be a HUGE accomplishment in its self.
For Sermo's part, we have long seen this trend coming. Over a year ago, we started investing in CME and physician education programs for alternative business models. There is already a series of ACCME-accredited CME modules developed with UPenn that help educate physicians around this. Consider logging into the Practice Management Exchange:
I had quit Sermo for some months after they gave full access to Senator Specter. md.sermo.com
I am back at Sermo and looking at the steam roller slowly crushing us. It is obvious that the AMA sold us out. Anybody who is still a member should get out of the AMA. MD's who go cash-only will not have to buy their coding books and can starve them of their revenues.
I have less respect for the AMA versus BO. Everybody with half a brain knew what BO would be doing but it hurts much more to be stabbed in the back by an organization that is supposed to stand up for your interests. The divide and conquer tactics worked. We have less representation than hotel maids and grocery store clerks. We are forced to work longer hours so we have less time to pull our heads out of the sand and do something about this. Like others, I welcome the 21% cut. I will pare the office overhead down to a minimum and give every Medicare patient the office phone numbers and email addresses of all the liberal politicians in our state. At this point I charge cash-paying no-insurance patients $88 per visit (some patients with insurance pay $70 as co-pay). That is much better than what Medicare pays and I have happier patients.
I looked at the aapsonline.com website and their takebackmedicine.com campaign. I would love Sermo to join the AAPS in this endeavor. Sermo will not be able to do much on their own, just like AAPS is not strong enough. Together we should have the power to de-throne the AMA as the "Voice of American Physicians".
Dan great comments, but I am concerned that just following a single strategy of "spreading the word" without real ACTON will not create the real physician engagement that will be needed to attack this complex health care crisis.
As stated by Sermo Doc 124, real action, leading to real change needs to take place. It's simple concepts that are difficult at best to implement into real action.
We have to start somewhere and with few alternatives out there, Sermo is our best option.
We have the Open Letter and Physician Appeal- how can we leverage these communication pieces at this critical time. The greater public needs to be aware of what a large number of physician have formed conscensus around.
I doubt we will be able to effect enough change in the coming weeks to make a difference in the passage of the Health Care Reform bills now in 'committee-or behind closed doors".
What I think we should do is start planning for the 2010 elections. We should gather the list of potential canidates that are running for various house and senate seats. Fromt there we should begin to "Vet" them and find out where they stand in regards to the problems that face physicians. Next we publish the list of those that we need to support regardless of political party. As indivduals we can choose to donate money/time etc to those that we support to get them elected so that we can effect some real change.
Sermo Doc 13,
I strongly agree with you!
We must focus on the coming mid-term election and make sure that we develop support for the candidates that support us!
Your State Medical Association (and/or their PAC) probably already did their homework and endorses candidates that are not anti-physician. If we put our money where our mouth is and support pro-MD candidates all over the country, we can make a difference. I never miss an opportunity at the end of the visit to talk with my patients about Obama's plans. I make sure that especially elderly patients know how many billions he will "save" from Medicare. Living in Texas I end up preaching mainly to the choir but the physicians in blue states could do a lot to get patients on our side.
I did talk to the AMA president in person while he came to our annual convention of Indiana delegates in Indianapolis. I asked him if he knew of any doctors taking patient's Kideneys out to sell as claimed by President Obama. I told him I did not hear you on the TV to oppose that. He told me that he does not have the money to buy a TV spot. he said that he did oppose in a communication to AMA members that he opposes that. I also asked him why I hear that you are endorsing the healthe reform.
He said that he did not endorse the whole bill , only parts of it. He said if I oppose ,then I will not be allowed to participate , at least this way I hear what is going on. He promised to communicate better. He could not convince no one that what he was doing was any good to any physician.
Striking isn't necessary, and would be very bad PR. We just need to gradually withdraw from Medicare/Medicaid and private contractual insurance over the next 2 years. That will make us all happier and financially better off (due to reduced overhead and improved efficiency of our time use), while giving us and our patients time to adapt. And we need to be proactive in explaining to our patients our noble motives in withdrawing from this lunacy that is destroying American healthcare, stifling innovation, and driving employment and even medical procedures overseas. The more we withdraw, the more apparent and irrelevant Congress' lunacy becomes.
I have resigned from the ama for the first time in 10 years after the insult the ama imposed upon the academy of surgeons over supporting the new bill. My husband shocked me with a blatant statement: the ama was created with and still works for pharma. My husband works with pharma now. A purpose is a purpose, just don't lie to us anymore, be accountable please ( directed to the ama)
I have also stopped taking medicare now for 2 years. This is more common as I hear from more physicians. However, I still help out in our clinic and take the hospital budget plan and state medicaid at this time.
This Health Care Reform Bill is identical to the one rejected in 1961 called HR 4222. An short excerpt:
...or, except as otherwise specifically provided [the Secretary of Health, Education and Welfare to exercise any supervision or control over the administration or operation of any such hospital, facility or agency. HR4222.
The AMA opposed, with the following. Everyone opposed it and the bill was defeated. The AMA said, at THAT time-
1.It [HR 4222] would lower the quality of medical care
2.It was unnecessary.
3.It would be unpredictably but extremely expensive.
4.It would endanger the social security system.
5.It would undermine private health insurance and other prepayment mechanisms.
6.It would lead to the decline, if not the demise, of voluntary efforts at the community level.
7.It would expand to a full-fledged system of socialized medicine eventually covering every citizen of this nation.
8.It would cover millions of people who neither need help in paying the costs of their health care, nor want such help.
9.It would compel the nation's younger workers to pay for these unnecessary benefits through an increased compulsory gross payroll tax
10.It would determine eligibility for medical aid on the basis of age rather than on the basis of need.
11.It would destroy the concepts of individual and familial responsibility
12.It would overcrowd existing facilities through overuse.
(Ways and Means Committee, Health Services for the Aged under the Social Security Insurance System.
Volume III, 1317. 1961)
How far the mighty have fallen.
By fussing about so-called tort reform, which benefits only insurance companies, instead of focusing single-mindedly on SGR, we lost the thing most important for _our_ economic interest. Next time, keep it simple and straightforward.
Did anyone know that the Chief Operating Office of the AMA (AMA Inc., the corporation that is the "profit-making" and thus powerful portion of the AMA, aka, licenses CPTs to the insurance companies) is the Chairman of the American Insurance Association and serves on the board of another, publicly traded insurance company called Arthur J. Gallagher and Company??? I believe his name is Bernie Hengesbaugh. Someone correct me if I am wrong.
Furthermore, the Trustees (i.e., Bernie and Bernie-ites) have written their power (and our powerlessness) into the very fabric of the AMA. Please note:
Bylaws of the American Medical Association
November 2008
12.30 Articles of Incorporation. The Articles of Incorporation of the AMA may be amended at any regular or special meeting of the House of Delegates by the approval of two-thirds of the voting members of the House of Delegates registered at the meeting, provided that the Board of Trustees shall have approved the amendment and submitted it in writing to each member of the House of Delegates at least 5 days, but not more than 60 days, prior to the meeting of the House of Delegates at which the amendment is to be considered.
Article IX Amendments
The House of Delegates may amend this Constitution at any meeting provided the proposed amendment has been introduced at the preceding meeting and provided two-thirds of the voting members of the House of Delegates registered at the meeting at which action is taken vote in favor of such amendment.
In other words, we (the members of the AMA, though I myself am no longer one) cannot change our own corporate governing bylaws unless the "Trustees" approve it.
Actually, now that I think about it, maybe the best thing to do is for all of us to become members of the AMA (hear me out) and sue our own organization for having acted on bad-faith on behalf of its members and demand punitive damages in the billions (the incomes we have all lost) and/or dissolution of the AMA and thus discontinuation of the ICD/CPT trap.
Seriously, can we do that? My ONLY reason for joining that mafia institution would be to kill it, once and for all.
There may be another way to amend the constitution in order to kill the AMA bureaucracy: The Council on Ethics and Judicial Affairs does NOT need to have their agenda approved or edited by the Trustees. These, however, are 9 "active members of the AMA" appointed by the President-Elect and each serves 7 years. This particular council is the judicial body of the AMA and what they say, goes. Who is on the CEJA?
Dr. John McMahon
Dr. Sharon P. Douglas
Dr. Stephen Brotherton
Dr. Susan Goold
Dr. H. Rex Greene
Ms. Julia Halsey (Med. Student...serves 2 year term versus others' 7)
Dr. Patrick McCormick
Dr. Kavita Shah (Resident/Fellow Rep...serves 3 year term versus others' 7)
These folks' job is to "interpret the Constitution, Bylaws and rules of the AMA".
They can also: Request that the President appoint investigating juries to which it may refer complaints or evidence of unethical conduct which in its judgment are of greater than local concern. Such investigative juries, if probable cause for action be shown, shall submit formal charges to the President, who shall appoint a prosecutor to prosecute such charges against the accused before the Council on Ethical and Judicial Affairs in the name and on behalf of the AMA. The Council may acquit, admonish, suspend, expel or place on probation the accused.
So, ironically, a voting majority of these actual physician members of the AMA could potentially upend the current built-in AMA insurance oligarchy. I think. I hope.
The only other Council which does not require Trustee "agenda approval" is the Council on Legislation. HOWEVER, these 12 "active members of the AMA" are appointed by the Board of Trustees and therefore have been edited already to the Trustees' favor.
By the way, I read all this information on the AMA's website itself, at:
Oh. Good Lord. I have been away from Sermo for a loooong time. This post closed on Jan 14th. I do apologize. I think I will put my above comments in a new post altogether...
The language by the anti-AMA docs is clearly appalling!! Sermo Doc 14 gave a good logical approach to our dealing with the AMA. They are working to get something out of Healthcare Reform. Why do we not care about the 40million without insurance?? Because we pay for their care when they hit the Emergency Room!!! It is unbelievable that the wealthiest nation in the world spends so much on health care,but has such a dismal record on health care to the whole country!!!!! Wake up!!! GEt some kind of health care(or insurance) reform and then gradually improve it similar to what Canada and other countries have done.!!!!
So, if the AMA is providing Congress with this much money in donations, and they ONLY represent about 17% of physicians, who or what is this amount of money being given to the Congress for?
He has no choice. Truth is seriously damaging to their image and claim of being assertive. AMA has been made a non-event by our elected politicians. AMA knows this and is very uncomfortable trying to cover this up as a positive.
Logic and reasoning that Dr R gave are very stupid, immature and counter intuitive.
BTW, I could have tried making it budget neutral by raising tax on cigarettes, alcohol and oily foods.
md.sermo.com
Dan, we need a very proactive leadership. We have it here on SERMO. We need to organize and move ahead. AMA is an insult to used car salesmen
Wake up - it's all about the $$$.
As far as making acceptance of Medicare mandatory for state licensure, this is what happened when Canada started their National health care. Most doctors opted out of Medicare. Patients were unable to find a doctor who took Medicare. The government made it mandatory and also made it illegal to charge more than the Medicare approved amount. The key difference is that in Canada, they are allowed to collectively bargain with Medicare. Each provincial Medical Society negotiates their rates with Medicare. I we cannot stop this boondoggle, we at least need to be able to collectively bargain.
The truth that President Obama thinks nothing of using people to achieve his agenda.
The truth that the Congress has used the statment made by the AMA to mean that ALL doctors suppor this reform
The truth That despite their best efforts the AMA has not succeeded in any of its major political objectives over the past 5-10 years (Rpeal fo the SGR and Tort Reform)
The truth thata physicians will become slave labor to the government
Recvoery is a twelve step process and until one can admit to the problem there is no recovery. The AMA as it stands now will not admit that there is a problem and therefore will nto recover. I forsee the future where the AMA will no longer exist and a new forces fills the gap left by their abscence.
It is even more outrageous than the snip posted here.
Do you think they have any idea what it's like to get that call from your friendly "risk management department" telling you a lawsuit has been filed on behalf of a patient you saw 2 years ago?
Do you think they've ever traveled to medical records to look at that chart, then realize in shock "I didn't do anything wrong"?
Do you think any of them have had to spend 4 years, thousands of dollars, thousands of hours, trying to defend themselves, being threatened with loss of assets, while some moron insults them, all the while knowing "I didn't do anything wrong"?
Do you think any of them understand, when seeing a patient, the thought of "well, I really like this patient, I want to do what's best for him, but the healthcare system has f-cked me, so now I have to order CT's, MRI's and consults to defend myself".
Because it's no longer enough to say "I didn't do anything wrong"
So why would they understand tort reform?
Medical liability reform, SGR repeal and the health reform bills
Posted at 12/29/2009 7:17 AM CST
Over the weekend I received an e-mail from a long-time AMA member asking how he and his fellow members would benefit from health system reform legislation the Senate passed on Christmas Eve. In his e-mail, he wrote that he found no mention in the bill of two issues that are of particular concern to many physicians: medical liability reform and permanent repeal of Medicare's SGR formula. I'd like to explain how both, which are among the AMA's seven critical elements for reform, are addressed in the Senate bill.
The Senate bill contains $50 million for medical liability reform funding for state pilots, and that is in addition to the $25 million President Obama already directed the Agency for Healthcare Research and Quality to provide in grants. The AMA has heard loudly from states that have caps on noneconomic damages—such as California and Texas—that they are opposed to any federalization of tort reform that puts their state reforms at risk. During the George W. Bush administration, when the majority in Congress was Republican, the starting bid for caps in the Senate was double that of California and Texas and was opposed. So scientific testing of alternatives to caps is valid and a move forward to reducing unnecessary costs of defensive medicine.
Medicare's flawed SGR formula predates all the discussion on health system reform. The Senate's original bill included a temporary fix to the SGR, but the AMA opposed it. As a result, the Senate removed the SGR from the reform legislation and included a provision in a Department of Defense appropriations bill that would avert a scheduled 21 percent Medicare physician payment cut on Jan. 1 by extending the 2009 conversion factor for 60 days.
Money originally allocated to the SGR then was instead used to remove from the reform bill a Medicare enrollment fee for doctors, a cosmetic surgery tax, and a provision calling for a primary care and rural general surgery bonus that would have been paid by taking from other specialists. Senate leaders have stated their intent to pass legislation to repeal the SGR formula after the holidays.
The Senate's action mirrors a similar move by the House, which pulled the SGR out of its reform package and did not include it in the total cost of health system reform. The House then passed separate legislation to permanently eliminate the SGR.
The AMA's support of the Senate bill and the House bill earlier this year came after careful consideration. There are some who have wanted the AMA to oppose this reform effort all along. However, I believe that without the AMA being constructively engaged, the result would have been devastating for physicians—and AMA members would have asked why the AMA was not involved in the reform process.
The AMA has been consistent with its goals and achieving as much as it can in spite of the toxic partisan nature in Congress. We are closer than ever to realizing a number of those goals, but we still have important work to do to secure additional changes in the final bill during the House-Senate conference committee. With your help, input and support we can continue to advance health system reform policies that will benefit patients and physicians. I encourage you to visit the AMA's health system reform Web site to learn more about the provisions in both the House and Senate bills and how they relate to AMA policy.
This is my favorite from the blog.
We live in the age of "Liars". Remember Madoff and the rest of his ilk?
They do not represent me.
"Hau'oli Makahiki Hou",
Anti Medical Association = Leave Individuals Empty.
Isle, I think the problem is there are too many Haoles in government and on the AAFP and AMA boards!!
Today the N Y Times has an editorial saying the ENTIRE state government should be voted out of office, both parties, because of hopeless corruption and lying.
Editorial
Failed State
Published: December 30, 2009
New Yorkers should be appalled at their failed state government, particularly their corrupt and clueless Legislature. Scandal and irresponsibility have been Albany's creed for decades. This year, the gang added another outrage to the list: complete fiscal incompetence.
The only solace is this: The entire Legislature is up for re-election in 2010. And unless there is a sudden turnaround — and, so far, we see few signs of it — New Yorkers have no choice but to vote out all the lawmakers and start over.
"Power tends to corrupt; absolute power corrupts absolutely."
"It has been said the greatest volume of sheer brainpower in one place occurred when Jefferson dined alone..." John Kennedy
When we get piled upon one another in large cities, as in Europe, we shall become as corrupt as Europe.
Thomas Jefferson
The democracy will cease to exist when you take away from those who are willing to work and give to those who would not.
Thomas Jefferson
It is incumbent on every generation to pay its own debts as it goes.
A principle which if acted on would save one-half the wars of the world.
Thomas Jefferson
I predict future happiness for Americans if they can prevent the government from wasting the labors of the people under the pretense of taking care of them.
Thomas Jefferson
My reading of history convinces me that most bad government results from too much government.
Thomas Jefferson
No free man shall ever be debarred the use of arms.
Thomas Jefferson
The strongest reason for the people to retain the right to keep and bear arms is, as a last resort, to protect themselves against tyranny in government.
Thomas Jefferson
The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants.
Thomas Jefferson
To compel a man to subsidize with his taxes the propagation of ideas which he disbelieves and abhors is sinful and tyrannical.
Thomas Jefferson
"Haole" literally translates as "One without a soul." I think you are correct.
However, I have told them, said here, and I will repeat here, that health care reform that does not address the liability catastrophe we have, the mis/mal-payment issues and does not contain DIRECT, up front, explicit cost containing measures, will be doomed to failure - over the short term possibly, and certainly over the long term... I think Howard Dean is right here, and the whole kit and caboodle should be discarded, and a more incremental approach started... And I would start immediately...
I fear this will not happen, the current law, in much of its incarnation will pass (and much of it is very good), but the meaty, real issues that consternate so many of us, will continue to be swept under the carpet.
Oh, the Jeffersonian quotes are great, but the idea that he was smarter than the host of Nobel Laureates that Kennedy hosted is inane.
I worked with Dr. Rohack in Texas.. He is a smart, hard working guy. I also had high hopes when he surmounted the AMA throne... but it appears that he is as enthralled by the power structure as all who enter that arena... One begins to compromise to keep as many people happy as possible, and ones principles become diluted.
In fact, I would not be surprised if they start paying their members for membership. I know if I were running AMA, I would pay doctors to join AMA. And make it up on CPT license fee.
If you really hate AMA and BO and HCR and .. and .. and ... and .... just about everything in current system, transition to a direct to pt care model. I know it is a piece of cake for PCPs in most areas to do that. Visit IMP group and you will realize how easy and relaxing it is to practice without insurance.
There is no CPT in cash practice.
Stop buying CPT books.
CPT = Crooked Political Tools!
Leaving the AMA will not make it stronger or our specialty societies stronger
Approx. 23 state and county societies have written Congress and had the letter published in the Congressional Record opposing the stand of AMA leadership and opposing the present Senate bill.
Non dues revenue such as publishing the CPT is the backbone of most professional organizations and keeps our dues down. I would rather have AMA (physicians) controlling CPT than someone else such as AETNA or HUMANA or the USGOVT. The members of CPT are physicians and appointed by specialty societies. The system in uniform and universally accepted.
Yes, the AMA has lost its leverage with congress but the work of AMA is not just legislative. Science, Public Health, Education, Ethics and PAC are all area of significant AMA input and discussion.
Don't leave the AMA, take it back!
We've apparently come to the point in our culture where "spin" somehow is NOT seen as one's attempting to have someone else believe something that is not the truth....i.e., a form of lying....deceiving....defrauding....purposefully misleading....
Sermo Doc 12, surely you are being sarcastic... yes?
Spin is lying....and we need to begin calling it what it is. It is a purposed attempt to mislead another, yes?
The AMA has merely been more willing than usual to show its true colors. What's new? Corruption at all levels....and resultant distrust at all levels.
The fine country we once knew.....the one where "telling the truth" was highly valued, where integrity was a character quality one was to be appropriately proud of, where cheating was thought of as a very bad thing, where trust was something one did not want to lose, where politicians were truly desirous of serving those they were sent to represent..... The United States of America.
"Change!" "Change this country as we know it!" "No more politics as we know it!"
Well.....those who voted for Obama and his camp are getting what they voted for! They have aided in the introduction of incremental socialism....and the medical realm is in no way shielded from "the change".
Fasten your seatbelts!
Bashing the AMA as such is a path to nowhere.
Rather, use the kinetic energy of AMA-bashing for smashing the Unholy Trinity of trial lawyers, the so-called 'consumah' groups & leftist Big 'Laybah'.
['consumah' & 'laybah' being NooYawker/Brooklynese for consumers & labor {unions}, respectively]
Until and unless the profession can speak with a sustained and meaningful voice or is willing to defy the law and undertake a meaningful work action nationwide in defense of its advocacy for excellence in patient care, there will be no change in the progressive loss of power and privilege that the Oath of Hippocrates once offered.
The specialty societies and the AMA have so fragmented the underpinnings of our profession that the politicians can now simply ride roughshod over us in the process of destroying all that we have built. Shame on them, but more importantly, shame on us.
Government knows that Doctors will never stage a "Million Man" march on Washington or stage a massive walk out in American hospitals. Instead, they know that, like a flock of sheep, we will go quietly to our slaughter.
We need our own Abraham Lincoln and our own "Emancipation Proclamation." But we have lost the public to the demagoguery of the Congress and the media. We seem helpless in organizing ourselves and selling a reasonable position.
Go to the polls in November and re-elect no one. Then go to church and pray.
The issue is that the country elected a left-leaning democratic president and large democratic majorities in both houses of congress, with far-left "behind the scene" political operatives that engage in "take no prisoner", cut-throat, gutter politics. That puts the AMA in the same position as legislators like Senators Lieberman, Nelson, Landtrieu and others. They have serious concerns about the situations and many of the proposals but are acutely aware of the political reality.
AMA could have taken the "just say no" posture embraced by many republicans, when it became clear there were no intentions of crafting a "good faith" bipartisan bill. That would have producd '" feel good" accolades from many AMA members but substantive "squat", as it has for republicans. The AMA exercised a strategy much like that employed by the Senators noted above. By doing so they invited - and received - criticism, scorn, and ridicule by individuals on both sides of the issue.
If the legislation passes - and the political operatives honor their committments - these senators and the AMA will come out far ahead of those who just said no. If the legislation does not past and/or they get screwed by the political operatives (which would not surprise me in the least), they and their constiuencies will get screwed. However, this current group of politicians and operatives has no great love for physicians and would screw us worse if we just said no. I do not trust these politicians and fear we will get screwed in the end but certainly no worse than if we had just said no.
Viscerally I would feel better if we had stood up to this proposal and opposed a massive increase in the federal role within health care but pragmatically believe that posture woul have just hastened and intensified the takeover. I am not terribly optimistic that the AMA strategy will produce significant gains for physicians or the public but can not castigate them for trying to get something rather than nothing from this group of thugs. .
Doctors and Lawyers do not mix either
It seems almost impossible for lawyers (politicians) to make decisions about medicine.
Unfortunately, the lawyers who are politicians outnumber the physicians who truly represent the interests of the majority of physicians. How will we ever be heard and acknowledged?
we must fight for ourselves since the organizations we trusted have let us down.Sermo has some of the most informed and concernd individuals ,probably because we actually treat patients and don't sit in ivory towers making outrageous salaries without a care in the world.We must organize and screw the AMA.We are the healthcare system!!!!!!!!!!
Consider starting a counter to the AMA. I would be the first in line. SERMO is the closest thing I have seen to a cohesive group of 'docs in the trenches' in the twenty years I have been in practice.
There must be enough of us who have had enough
Not that Dick Morris is the most trustworthy of politicos and he has been on both sides of the fence but.....he maintains on his site, Dickmorris.com, that members of both houses have their own insurance, which they keep upon retiring, as well as their present salary.
This time I returned the statement with a statement of my own.
Not enough is being said about the divide between the interests of physicians at-large and the AMA's 'representation' of those interests.
majority of voters position of not supporting a bill that was not available to read until the weekend before is a disgrace to American politics. The next step is to dislodge the untrustworthy politicians and start fresh with a more conservative bunch. Then start over and fix the problems of present healthcare, with tort reform, allowing insurances to compete across the nation, and support a safety net for those who are Legal citizens who have the need for an affordable health plan. Deport the rest of the illegals.
1) expose to the American public the lies and payoffs of both Congress and the AMA, and
2) present a rational plan to undo the damage already done to our healthcare system by Congress, CMS, etc., and to restore fundamental American principles of freedom, competition and charity to our healthcare system.
Regarding CPT and ICD codes: they comprise a "parallel universe" created for bureaucratic purposes. As such, they never can, could or will accurately reflect the realm of medical practice. If bureaucrats want to use them for bureaucratic purposes, that is their privilege. As physicians, we now all clearly have a responsibility to totally extract ourselves from any involvement with this time-wasting and resource-gulping parallel universe as quickly as possible.
Although some states might be foolish enough to try it, hopefully state or federal requirements to accept Medicare would not survive court tests. Also, it is very unlikely that any individual state(s) would enact such legislation, since it would surely result in a flight of physicians from that state.
In any event, we must never forget that we are free professionals practicing in a free land. But freedom only survives when it is nurtured and defended. For too long we have allowed our freedoms to be eroded around the edges. Clearly, it is now imperative that, both as individuals and as a group, we stand up for the rights of our patients and ourselves to associate freely in a free-market economy. Else we will all soon be salaried government stooges.
Dan Jones, MD
www.jonesplan.blogspot.com
Most of the "reforms" aren't due to start until a few years from now (except for the increased taxes to pay for them), so I believe we have time to stop or reverse these corporate and special-interest boondoggles and protect our profession and our patients from the idiots.
The AMA misrepresents doctors and is losing members rapidly and lying about membership numbers. Malpractice lawyers are the enemy and the worst form of humanity. Let's throw a wrench into the works and confuse everybody (probably including ourselves): what if every doctor who was misrepresented as being an AMA member files a class-action lawsuit (using, of course, a sleazeball billboard law firm) for defamation of character against the AMA? Not sure what it would accomplish but it would make this whole thing a lot more fun, and at least a bit satisfying that we as doctors were finally able to "stick it" to somebody rather than constantly getting punched in the face.
Dan Jones, MD
www.jonesplan.blogspot.com
If they force us to accept medicare as a condition of licensure and still most of us refuse to comply, let them try to lock all of us up! I'd continue to fight the government. We could get a class action attorney and sue for restraint of trade. Are we going to continue being sheep?
Keep it up. It is what you do best. Make the survey's shorter.
Stan
Stanley Feld M.D.,FACP,MACE
Http://stan.feld.com
Repairing the healthcare system
The AMA has irrevocobally BETRAYED all of us
One fundamental problem with the healht crissis, lets be honest, is that we have quite a few rooten apples within the barrel. Not to mention the mistrust that physician greed has sawn whithin the people that we are meant to serve. Healht Reform needs to start by purging the barrel...any thing else is hot air and self deception
While I appreciate some of the efforts of my union leaders in the AMA as well as the leadership in the American College of Surgeons and the Society for Vascular Surgery in representing my personal interests as a guildsman, I feel they have not represented the best interests of the society in which I live. In addition to rearranging the deck chairs on the Titanic, they and our legislators have brought on deck some newer chairs able to accommodate more passengers with increased seating options. But the hole in the hull is ignored and won't fix itself -- a hole caused by the iceberg of COST........I know, I know - we keep hearing from various bean counters about how overall costs are going to be contained - don't believe it! Our legislators have simply battened some hatches while opening and reconfiguring others while the sea water continues to sink the ship of American healthcare.......In order to contain costs, our society needs to undergo a fundamental cultural change regarding needs, wants and futility. Space prevents me from expounding in depth but the truths of health care reform have been branded heresy by the self-serving healthcare industry. The truths are: We don't need more doctors, we probably need less but with a different specialty mix and geographically redistributed with the addition of more physician extenders; We need to test, treat and prescribe based on scientific evidence and in the context of societal benefit as we appropriately attend to the needs of the individual; We need to (re)educate those (lay populace) who have been beaten into a state of fear by our industry, media and politicians playing loosely with facts, often for their personal benefit; We don't need more bureaucracy - commissions, panels, insurance overseers, forms and regulations - on the contrary, the process needs to be simplified and streamlined. And finally, we need tort reform that allows health care providers to do their best for their patients without fear ........Although I believe we will see changes in our healthcare system, it will take courageous and enlightened leadership to reduce costs and effect true healthcare reform and our current political system won't allow that to happen. Please, Save Our Ship.
1. The way the AMA really works
I think, we as physicians make a common mistake of thinking of the AMA as a single, monolithic organization. The AMA is in fact two distinct organizations. On the one side is the elected physician leadership, which includes all the delegates, the presidents, etc. There is also a "professional" side of the organization that includes people mostly coming from the publishing and insurance industries that have built their careers within the AMA. This includes more Vice Presidents than you can count and enough people earning $300K+ salaries to make you sick. The first real clue you get that there is something odd at the AMA is their offices. You have never seen such opulence in your life. Having spent my share of time in the Goldman Sachs and Citi offices, I can tell that the "professional offices" at the AMA are FAR more opulent and the sanctum sanctorum is straight out of Hudsucker Proxy.
The professional side of the AMA looks down at the elected physician leadership with a mixture of disdain and pity. They know that the elected leadership is a revolving door and that the vast majority of people will do their time at the AMA and then "retire" as board members for large hospital systems or insurance companies. A very senior person at the AMA described it to me as "the mushroom treatment". The AMA professionals carefully keep the physicians in the dark and feed them bullshit. At the AMA, it is a matter of great contention, that the physicians are not given the actual membership numbers, nor are they "allowed" to understand the actual mechanics of how the business runs.
Whenever there are points of real contention, the strategy that the professional side of the organization uses is both simple and effective. Just wait. Invariably, the physicians start bickering over politics and/or hierarchy. Worse case scenario, the physician leadership rotates every few years and the problem goes away.
Above all, the professional side of the organization will protect their own income.
2. What is about to play out
The AMA has been investigating the issue of declining membership for some time now. A few years ago, there was a "crisis of conscious", where the AMA had to decide if they would take the necessary steps to regain physician loyalty (which would invariably mean giving up a huge part of their revenue from insurance companies) or start plotting a new course.
The AMA decided to start plotting a new course.
In the near-term, that course has meant increasingly aggressive tactics to shore up their membership numbers (actual paying members is believed to be 80,00-110,00). There are a number of these efforts underway, but I am sure the one that you have seen are the "invoices" that you receive in the mail, but are actually HIGHLY EFFECTIVE ploys to trick physicians into becoming "members".
It is the longterm plan that physicians should be most concerned about.
The AMA is now actively transforming itself into a public health organization. The AMA will continue to cling to the physician brand only so long as it takes to establish themselves as a public health organization. As I am sure many of you have noticed, the AMA has removed most references to physicians from their branding. Beyond the caduceus, there is very little left that indicates that the AMA has anything to do with physicians. In the next few months you'll see the AMA start to take incremental steps to expand their membership to non-physicians. Mark my word, you'll soon see the AMA accepting PAs, NPs, and eventually RNs.
From a marketing standpoint, the AMA's new branding makes perfect sense. They have done the research and it clearly indicates that they have the most "brand equity" among non-physicians, especially the general public. The $40MM that the AMA spent on the "Campaign for the Uninsured" was the first public phase of this evolution and we will see that effort accelerate. These efforts will have two things in common. They will focus on the general public (read, patient population) and they will never mention physician interests. Right now, physicians are providing a convenient midwife (please excuse the pun) to a new organization, but make no mistake, as physicians, the AMA is actively trying to lessen their dependence on us.
All of this is important in the "new world order" for healthcare. Physicians will be functionaries among the many "providers". The government was able to easily "buy" the AMA's endorsement by simply hinting (not even threatening), that the CPT monopoly could be easily taken away from the AMA. They knew where the AMA was most vulnerable and used it to their advantage. Having achieved the "brass ring" they needed, a pretense that physicians supported the healthcare reform effort, the government has absolutely no incentive to publicly question the AMA's hegemony.
Believe it or not, it get's even more scary.
The real powder kegs, the ones that the insurance companies needed to make sure was kept out of the healthcare debate at any cost was the issue of off-shoring and encroachment of physician services by non-physicians. Nothing, I mean nothing will devastate the medical profession like off-shoring and professional encroachment. There are huge financial incentives to start sending patients over-seas for elective and semi-elective procedures and/or having non-physicians provide more and more services. If radiologists think that they are going to be earning $200-500K a year when films can be easily sent to India and China for review, they are completely nuts. Furthermore, the trend of sending healthy patients abroad for knees, hips, etc. is accelerating and will be a HUGE part of insurance industry's efforts to improve profits. California has already passed legislation, allowing nurse anesthetists to practice unsupervised.
The biggest fear the insurance industry has is that someone will FINALLY get smart and put some sort of "Buy America" provision into the bill. The steel and labor unions successfully did this almost a year ago and derailed the initial economic stimulus package. A very small group of people started raising these issues about six months ago as the healthcare debate picked up and a number of people at the AMA pointed out that these issues should be addressed in this bill, no matter how small the likelihood is. Let's just say that the CPT card was easily played and that was the end of the AMA taking a stand on those issues.
3. The real challenge
The AMA knows that physicians are disorganized, difficult to lead, distrustful and can be easily manipulated. Their calculus has been absolutely perfect to date. No profession has sacrificed as greatly nor is more responsible for the incredible healthcare people in this country get than physicians. We have squandered our professional birthright through our own hubris.
The real challenge is the apathy of our own colleagues. While I think confronting the AMA is a necessary step, I suspect that work to topple the AMA might have the greatest value in simply galvanizing physicians. Getting our colleagues to "wake up" and finally realize what is happening is the single biggest challenge.
We've all heard the proverb that it is always darkest before the dawn. I am starting to see this play out before our very eyes. Elimination of consult codes and the pending implementation of physician cuts are leading to a very real awakening among physicians. Of course, when politics finally starts to hit our pocket books physicians sit up and take notice. On Sermo we are seeing an acceleration in interest among physicians in these issues. In the past few months, physicians have gone from a sort of collective denial to more and more interest and excitement in taking back our profession. Technologies such as Sermo, Twitter, and the web act to level the playing field between physicians and those that have so effectively manipulated the healthcare system because they allow physicians to openly share information.
So before you plot the downfall of the AMA, re-engineer healthcare, or have any hope for a better tomorrow for our profession, the next step, the one most critical and hardest achieve.......
Get your colleagues to join the conversation. It is simple as that.
Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.
It's like working with the Stepford Wives.
I agree! I'm not sure if it is denial, PTSD, apathy, plain old stupidity or the "I'll put my nose to grindstone and work harder" medical ethos; but, whatever it is too many of my colleagues don't seem to see the falling piano. Look up--quick!!
I do not envy Dr. Rohack's difficult job of trying to make dozens of specialties, each with their own pet issues and concerns, play nice with each other so the AMA can do its best to collectively represent the interests of all physicians. For all its supposed ineffectiveness, the AMA continues to be the primary resource representing physicians in the eyes of Congress and our government. Through its actions, countless aspects of the current iteration of health care reform have been improved at the suggestion and request of physicians, and I agree that without the AMA's efforts, this process could be a lot worse for physicians.
What intrigues me the most are the people who seem to be relishing in the potential downfall of the AMA. I have asked this before and never heard a cogent response, what mechanism do you propose would successfully represent the interests of physicians that be successful in challenging the AHIP, the AHA, the trial bar, and convincing Congress to bend to the profession's will? For that matter, if the current system and the proposed reforms are not acceptable, I challenge the community to propose exactly what system you would like to see for American healthcare.
However, those of us in community medicine need more help to help awaken those professional colleagues that are still in slumber. Sermo must help organize local groups so that we can effectively challenge the AMA.
I am proud to say that Ihave NEVER been a member of the AMA.
What can those of us do who are old, still in debt, barely surviving? Unfortunately, need the money from Medicare at the moment. However, we do not take Medicaid and can, at least, take no new Medicare patients.
I know I sound like a broken record, but am trapped, at the moment. But willing to support whatever group may come to light to represent physician interests. Physicians, NOT providers, physicians
Thanks again, Dan
I have read great ideas over the months from many people in these posts, but they will never be part of the discussion that you helped end, because there was never going to be a discussion, or bi-partisanship. That was all D.C. smoke and mirrors, and the AMA was either really naive, or horribly complicit.
My hope is that public will exert its will in the 2010 and 2012 elections. If that doesn't happen, at least in my part of the country , guns and bullets are flying off the shelves.
Here we are now.
I believe we HAVE to declare "war" on all fronts.
How is it that we have become so backed into a corner?
We are now facing "bundled payments", in essence forcing ourselves to "screw" each other over, like a bone with a little piece of meat being thrown to a pack of hungry dogs! Make no mistake, this is how we are viewed.
Worse, we are like slaves with special knowledge being forced to work under certain conditions. Of course one can quit, but that's another issue.
So, what do we do?
Rohack, needs to go for one. He's endorsed the "DNP" degree in more than one way. We need to find dirt on that guy, I'm sure he's made some back door deals and expose him for the crook that he is, and bring shame to him.
We need more visibility.
We need to be more on the offensive and expose the dangers to patient safety.
For instance, the Senate bill essentially aims to equate mid-level providers with Physicians!!!! Of course, they are equal as people, but not equal in the level of knowledge or training! I mean come on, most of us can drive a public bus, but that doesn't mean we should be allowed to do so!
So, I think going on a strong offensive to highlight the dangers to patient safety through misrepresentation.... as in "Hi, I'm Doctor Nurse XYZ?" COME ON! How ridiculous is this?! Or is it going to be abbreviated to, "Hi I'm Doctor XYZ?" when in fact the individual is "Nurse XYZ".
The people don't know about this deception yet, and I'm surprised no one has latched on to this treachery.
We should make this be known.
Like most on Sermo, I lament the lack of bipartisanship in the health care debate. I also lament some the items included in the current reform package. If anyone out there has the ability to make Red and Blue play nice, or can convince them to repeal the SGR, or make tort reform a reality, the AMA would very much like to know how.
I do argue that the AMA has truly fought the physician's interests in the health reform debate. I have never understood the assertion that "the AMA is just looking out for itself". What is the mechanism by which the physician leadership of the AMA benefits from the failure to accomplish tort reform, or repeal the SGR?
The AAPS is engaged in reform, and the more physician voices there are in Washington, the better. But consider this as just one example of the myriad complexities of the system. Some physicians want America to adopt a single payer system. Others want nothing short of fee-for-service and concierge medicine to be the primary delivery system. Now imagine the impact from huge lobbying groups like AHIP and their interest in health care. Add to that the public's desire to be able to see their physicians when they want, how they want. Now, imagine the White House calls and wants a single answer about how all physicians want to be reimbursed. How do you answer?
Our Big Ass Mistake America, (just write out the capital letters)
But, over the past year I have come to realize how divided we are.
This synergy between distraction and division will always handicap us as we try to
contend with the bloated and greedy forces that sit around the table and feast on our productivity and excellence.Their appetite is insatiable; They will continue to truncate, prune, strip, squeeze, and marginalize.
We, as a profession, are not at the table in any meaningful way; and so are on the menu.
some reasonable discussion of this issue.
The american medical system is NOT monolithic... there is no one
solution... Organized medicine has tried to have input into the process, I am
sure, and quite a few necessary changes are part of the current legislation.
A few critically important issues we have mentioned on this site ad nauseum are NOT. So do we discard the baby with the bathwater?
A rigorously honest person would say to start over, there are too many flaws in the current bill.. However, a realistic person would respond that this may be the best we can get with the current political system. We need docs running for office in much larger numbers... Unless we have money or votes, we will continue to be marginalized. And we really, really need to have a better organization to represent us... That is not easy to produce.
Sermo could serve that function, but we would all have to kick in $1000 or more for any Sermoans to have a voice in the debate... to pay the necessary bribes, supply cocaine and booze and sports tickets and of course the prostitutes (male and female) to get the requisite support in Washington... Are you all willing to embark on that battle?
I wonder.
I think certain payment reform proposals are also dangerous, in that they implicitly suggest that we have no voice in the debate or the structure. We will be told how we will be compensated and will follow orders. Physicians will quickly become the indentured servants of the larger 'stakeholders' including hospitals and insurance companies as well as state and federal government. We are indeed 'on the menu'.
Our impotence is almost risible. Highly educated and presumably intelligent, nonetheless we have ceded control of our professional destinies to elements just salivating at the thought of reducing us to proletarian status. I think we must be ready to consider drastic action, even if it goes against the ethical grain of our consciences. I'm speaking of nationwide work slowdowns and stoppages as well as concerted attempts to achieve legislative reform to grant independent doctors the right to unionize. Otherwise we might as well resign ourselves to virtual indentured servitude. I don't use those terms lightly - that is the case.
Next time you hear something on t.v. about tort reform pay attention and you'll see what I mean. Somebody will talk about tort reform but it will die right there, the news/media people or the politicians involved will just let the discussion die with no follow-up. And there will be no follow-up.
All you will see are isolated cries about tort reform that will die right there on the t.v. screen or will go to the trash with the newspaper page. There is no follow-up.
Now, if this was an issue about race black/white or gay issues you bet it will be follow-up, maybe ending with a beer meeting in the lawn of the white house or the firing of Don Imus, etc...
But "tort reform"... people won't care unless it really affects them.
Rohack and the AMA sold the AMA name and backing - thought they could get a deal to squish SGR once and for all in exchange - didn't happen
AHA cuts in reimburement for universal coverage - didn't happen
Pharma cuts for protection form imports probably won't last
AARP sold out seniors to kill Medicare Advantage - 'cept not in Florida where seniors all live.
Rohack is at best Neville Chamberlain and at worst a dupe of the creepy "shadow leaders" of the non-practicing admin VPs of th AMA
Either way the AMA has to go . . .
Should we have expected any less?
1. Individually incrementally withdraw from Medicare/Medicaid and all current insurance contracts over the next 2 years. Doing this incrementally will give both us and our patients time to adapt.
2. Explain as often and vigorously as needed to our patients that we are doing this for the benefit of American healthcare, because the abusive practices in current Medicare/Medicaid and network-based insurance impose monstrous inefficiencies and intolerable interferences on our profession, GREATLY IMPEDING our ability to provide quality, affordable care to our patients.
3. Point out to our patients that interference in healthcare delivery by government and insurers is not only inefficient, but unethical, un-American, and an INTOLERABLE INSULT to BOTH them and us.
If we do this, then the mandated insurance and Medicare/Medicaid will become progressively worthless, and voters will soon demand REAL REFORM as they realize they are getting NOTHING for the further infringement on their paychecks and civil liberties that Congress is imposing. At that point, Congress (no doubt, largely replaced by outraged voters) will have two choices:
1. Produce REAL REFORM that
a) removes the Soviet-style price controls and central planning that have been progressively imposed over the past three decades, resulting in massive inefficiencies and rapid escalation of health care costs, and...
b) replaces it with some version of Medicare/Medicaid that reimburses PATIENTS whatever taxpayers are willing to pay, without dictating physician fees, diagnoses and treatments, or...
2. Further Sovietize one-sixth of our economy and force all physicians to become salaried government stooges.
Which do your think is more likely to happen? It's up to us.
Yours For Better Healthcare,
Dan Jones, MD
www.jonesplan.blogspot.com
You're wrong. Rohack is complicit. He is part of a larger corporate philosophy that has mathematically excluded practicing physicians from any hope of a rewarding professional future. Don't discount his betrayal. You could argue that he is is too stupid to understand the medical/industrial/political influence directing the future of medicine. But that is extremely unlikely. He's a puppet. Worse, he is a front for the business arm of the AMA that has much to lose if they are outed. The AMA is a criminal enterprise and should be treated as such.
They are poll responsive, and see these polls that show less than 30% supporting the bills.
And they've been home,undoubtably gotten an earful, and have the huge government failure of the Christmas underwear terrorist fiasco reminding them how inept the government is at everything.
Encourage them to have the political courage to do it over, and do it right---beginning with tort reform.
Dr. Rohack,
As an a&m alumnus, please reconsider your position on medical liability in the reform process. "Experimentation" will leave thousands of Texans without docs when punitive damage caps are removed.
When I first returned to Texas to serve Bell and Lampasas counties, I was sued for alleged neck injury (I am a psychiatrist and do not treat neck injuries). After 15 years, the suit was finally dismissed. The only reason was my large policy and the favorable environment for trial lawyers in Texas in 1994.
My wife got a job in Alpine at a local university a few years ago. I have the only psychiatric office in a 150 mile radius. Without the caps, I could not afford the liability premium.
Please do not end my ability to keep my office open.
Stuart Crane MD
Past President, Texas Academy of Psychiatry
The political corruption in Washington demands change, we have the opportunity to do so in this MA special election. www.brownforussenate.com
1. Physician Hubris is killing us.
2. Physician Apathy is our cancer.
WE badly need physician engagement if we are to overcome our professional decline.
Great insights are found in a new book-" How the Mighty Fall" by John Collins.
Where is our physician thumos( courage)?
A subset of physicians, those who work in underserved areas and especially those few ethnic physician leaders can help spread their knowledge and leadership skills that have made them successful to our larger physician population.
Only one glitch- physicians have to be willing to learn and trust from one another. Easier said than done.
What's new is that many of us in this noble profession will refuse to become government hacks when forced to participate in a federal universal health care program as a condition for licensure. Rarely mentioned by its proponents is that Medicare, Medicaid and VA programs are all voluntary, for both patients and physicians. But for how long?
Answer: Just show up on November 2nd. Save the date, and our profession.
Sermo Doc 96
Sermo Doc 70 Cardiology Posted Jan 01, 2010 at 3:45 PM .
... For all its supposed ineffectiveness, the AMA continues to be the primary resource representing physicians in the eyes of Congress and our government. Through its actions, countless aspects of the current iteration of health care reform have been improved at the suggestion and request of physicians, ...
-----------------------------------------------------------------------------------------
Can you give us some examples?
That is the biggest problem with our global phyisician response to all of this. Most say nothing, and even more do nothing.
I recently posted question on the ASCRS listserv - as i was outraged to find that the language penalizing state for proposing or passing any limitations on trial attorneys for malpractice, medicine errors, or equipment suits. That coupled with the 22% cut that has yet to be taken off the books, and the elimination of medicare consultations, was very upsetting overall. Out of perhaps 200-400 surgeons, I got 2 responses!!!! Both of which said, "what can you do".......As I said "res ipsa loquitor".
Our founding fathers were not more brilliant or predictive of the future. Their strength was and is in the fact that they all argued, discussed, but ultimately LISTENED to one another for the greater good. Their strength was in the use of numbers and experience rather than opinion to drive what had to be done. They used their collective experiences, good and bad, and above all else they knew one critical thing...........History repeats!!! Today many people say it but few actually look at history and use the learning tools to avoid those mistakes. In 1776, they were brilliant enought to know what they did not want to happen and the fruit of that brain trust was our constitution. An attempt to allow us the ability to adapt, avoid singular thought, and allow for checks/balances to avoid the mistakes of partisan thought/tyranny/and urepresented dictum that would result another revolution.
In their infinite wisdom, our current judicial system, executive branch, and entire legislative body has very effieciently destroyed those warnings, preventative measures, and history. Proof positive....Language in this house bill the actually states certain facets CANNOT BE CHANGED OR REPEALED BY FUTURE LEGISLATIVE BODIES. If that is not the definition of unconstitutional then nothing is, yet I have not heard a peep from either democrats/republicans, let alone our clueless/uninformed, ill equip president.
If we collectively choose to ignore our constitution, fore fathers writings/teachings, and the lessens taught throuhout our short history, we will fall [as most great nations do when they deem themselves mighter than their roots], and a new age, country will be born......this one will NOT be the land of the free, nor the home of the brave. It will simply be another tumbled/pathetic once powerful city-state, ruled by the corrupt, and served by the masses......aka Rome/Persia/Macedonia/British/Monguls/Chinese dysnasties. Take a look at the history books, or if need be the History channel. Each of these powers have several key things in common with our current situation. RES IPSA LOQUITOR.
-First, I am seeing people fall into the same mistake of attacking AMA defenders, such as Sermo Doc 70. I think this is a mistake. It takes courage and conviction to join this discussion, defending the community. I for one would like to thank Sermo Doc 70. Members of this community should be making every possible effort to engage with AMA members. They can be your guides and can help us better engage with the AMA system. Whenever I speak about the AMA, I go to great efforts to emphasize that there are two different sides to the AMA. While it might serve our purposes to portray the AMA's physician leadership as intoxicated with power or corrupt, this just hasn't been my experience. At the senior level and most certainly at the delegate level I find that physicians invest their time and effort in the AMA out of an earnest interest in serving our patients and serving our profession.
The real issue is the professional side of the organization. Is there a single physician out there that can tell me who really runs the AMA? Who holds the power? There are a group of five men who control the AMA's finances and publishing efforts. Ultimately, these people control the AMA's political efforts.
Sermo Doc 70 do you know who these people are? Have you ever met Bob Musachio? Have you ever seen the finances of the organization that proports to represent you? As an AMA member don't you have the right to know how many paying members there are?
Dr. Rohack is lying because the truth is that he does not know the answers and the truth is that he does not really have any power. His leadership there is an illusion. At best he is a puppet at worse he is completely in the dark. Dr. Rohack, is unfortunately finding out a sad truth that every AMA President learns.....he has no authority over the professional side of the organization. He cannot ask to see salaries, nor can he demand actual membership numbers. He has clawed his way to the top of the AMA hierarchy only to find that he is a pawn to the real power brokers.
-The second point I'd like to draw out is something I am hearing several of you reference......our colleague's apathy. It is our collective shame. Ultimately, we are completely ineffectual unless we can shake other physicians out of their collective apathy. If I encourage each and every one of you to focus on one thing, one single thing, that would be it. Talk to your colleagues. Get them to join the conversation.
Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.
AMA has unknowingly helped our profession by supporting 21% cuts!
Let there be "reform".
Let there be 21% cut.
Let there be crisis and chaos.
We will build a new system from there. A system where healthcare decisions are made between doctor and patient. No 3rd party intrusion.
exchange.diamondconsultants.com
He also shows up in this interesting article about how the AMA sold physician prescribing data to pharmaceutical companies:
www.medscape.com
What else should we know Dan?
There will be 2 responses: 1. Those will limp to mediocraty, tail between the legs, and do what they are told, be paid what is granted, and become a tool. 2. Those who rail up and fight for what we have all worked for, believe in, and what will make the phoenix rise again. Here's the big question........which side do each of you choose?
The interesting thing that I see daily, is that there is far more concern from my patients than I can see spontaneously or ellicit from my colleagues. 8/10 patients that I see ask what my take on the reform means to me, and could mean to them. I easily spend 10-15 minutes per patient discussing this daily. That makes me have hope that there are people out there smart enough to ask questions, even if it isn't the physicians that are doing it.
History does teach. If you look at every dictatorship, what group[s] were targeted/destroyed/controlled or killed to facilitate that regime.....The scientists/teachers/scholars/media. Interesting how the groups that had the platform and means to ask questions were the first to be silenced. If we as physicians stop asking those questions, or fail to push ourselves/and our colleagues to do so, we are to be the first silenced by whatever means. It is already happening, and the AMA is akin to Obama's Hienrich Himmler. I don't believe that is too far a stretch, in fact I see more and more parallels to that horrible chapter in human history everyday. In post war Germany, many nationalists/soldiers and civilians were charged with war crimes due to their involvement or lack of attempts to stop the genicide of the concentration camps. The take home point....you don't have to pull the trigger to be guilty. We are guilty of allowing this to happen if we do not step up and fight for what is just, right, and most importantly in our patients and medicines true interest. It is safe to say that if we do not, no one will do it for us.
www.amazon.com
Delighted to see your comments in the blog line. If I may, I would like to "pontificate" on my 30+ years of clinical practice (for what our successors may validate or nullify), but I will add that none of you passive whiners can state that I didn't have the fortitude to go totally "fee for service for over 20 years". (Which ALL of your gutless followers lack); Yet, while willing to bilk the system for remimbursement--I love the brainless response of the contemporary neophytes, who's reply is ..."but I didn't imagine it would come to this"!? Wake up, Homer Simpson!!
I have said before, and I will repeat--- what goes around, comes around....we have been self-absorbed and loving the big $$ cash flow in the practice of medicine that we have ignored the insididous penetration of mid-level administrators and other ancillary idiots who draw unjustified salaries---well, guess what, my colleague losers, now it all comes to haunt you. The axiom you should enter in your haunted and troubled memory is:
"All of our problems started the very first day ANY hospital administrator earned more than $40K per year." Suck it up you passive whimps--pay your AMA & specialty dues... then DREAM on!!
I cannot fathom why so many innately intelligent professiononals are expressing themselves as total idiots-----I can hope hope and pray that in 2010, some, if only a few, will learn pragmatism, grow up and move on.
Happy New Year, Whimps----why not move on to create your own destiny, which you've ALL been derilect to to for God who's know how long??!!
Don't hold back, let us know what you think....but please use a touch of tact. Even gutless wonders have feelings too.
I would agree that fee for service is the way to go, and that many should have and need to do just that. You are also correct, midlevels and non-physician cancers have pervaded the system. All for the love of money, but the key thing is that the majority of us don't do that and don't agree with that. You generalize far to much, and have little specific content. Your diatribe is fun to read.
If you are are as brilliant as you beleive that you are, what have you done [aside from serve yourself], to make an impact or change in the ENTIRE system, not just your little corner. So you prove yourself to be part of the problem. Rather than call peoples names, why not put forth a constructive solution or idea. The real problem isn't what you think you know, but rather recognizing what you don't know, and affecting change to that end.
Infiltrating the AMA is a good thought, but that will take time and energy that could be better used to help the new phoenix rise from the ashes of the 21% cut and the new health care reform that will be be signed by mid March 2010.
How are physcians getting prepared to rebuild our profession?
2nd only to "clipboard nursie"
dog dear - I dont need tact. You can yell at me but English is my ESL, so a bit easier level please.
Your comments are a perfect example of the variations in medical practice that make it so difficult to organize the medical profession in a meaningful way. It is one thing to do fee for service (assuming you mean no participation in any type of insurance program including Medicare) in a practice of dermatology when you see a patient every 5 minutes or less (maybe not you but I know many dermatologists who do) and then present a bill that probably 90% of the patients in your practice can afford to pay and a totally different thing to present a bill for major cancer resections . . . not affordable to most people.
Not to take away from the point you are trying to make as it is a valuable addition to the discussion but to suggest that your particular presentation is an answer to our problems leaves a lot to be desired.
We should speak out loudly to our colleagues, patients, friends, family and acquaintances about our opposition to the current "reforms". And we should educate ourselves about where we currently are, and how we got here.
The best article I've read explaining this is "Moral Health Care Vs. Universal Health Care" by sermoan Dr Paul Hsieh, M.D. and Lin Zinser:
www.theobjectivestandard.com
IDOITS!
Typical answers that I get:
- They will never do that
- It can not happen
- Oh well, whatever happens to me will be happening to everyone else too, so I am fine
- Oh, we get paid more than 95% of Americans anyway
- Oh, we will find some way out
- Oh I will just see more patients
- what can I do
If you calculate hourly pay of a PCP, it comes to 50-60$/hr .... after all the investment of money, time, effort and personal life, all the risk and liability they take, all the crap they face
Common sense kowns, that to win, one needs to put a well prepared and skillful team on the field; with appreciation of the critical need to go for the the thrill and the fruits of victora. Sadly, that is something we have not have in decades. Lets be realistic, at this time, the only thing that can save the madical profession is an honest, wise and courageous President, assisted by an equaliy qualified Congress. Both pushing together to make reality the magnificent potential of the US Medical Sciences
If we are really serious about such target, play by the rules, find and get elected the candidates that can get the job done. The rest is wasting time and energy
www.theobjectivestandard.com
everyone should read it.
It shows how govt despite the best intentions fails to be good at running a business.
It also gives us a glimpse of what will it be like in future for all of us.
It tells how MA, despite the highest doctor to population ratio fails to offer access to care as we desire.
More people have insurance "card" but fewer people have access to health "care"
thought in my drunk mind is "Should we take the message from MA experiment and use it to the advantage of our nation?"
If that type of policy leads to everything opposite of what we want, should we be doing opposite of what was done in that experiment? It reminds me of Seinfeld's episode where George Costanza does everything counter-common-belief.
Its a very unconventional thought ...... that damn wine must be good!
excellent article. read it.
You are absolutely correct. But the solution you describe is moot, and impossible, b/c the current president and the current congress is so bogged down with personel agendas/lobbyist money/corruption-greed, and a current plan that is the exact opposite of what is really needed.
Your are absolutely correct, but I would offer that the only real solution is to keep our enemy closer.....aka hire a cut throat legal team, sue the US gov't and STRIKE.
Yes that is a bit drastic, and at present not allowed by our current gov't, but we all know the only reason it is not allowed is due to the power it would shift to the physicians. Anything can change, and things deemed unlawful, have since been changed to lawful acts.....Abortion/flag burning to name a few.
So I would submit that we should collectivley group, have a single voice legally and nationally, and let it be known that we are worth more than this, we deserve what we work for, and we are the voice of healthcare, not Edward E. Obama, Pelosi, Reid, or society with self interest [AMA].
As for Sermo Doc 103 comments, I would boldy state that as a challenge to anyone to step and join hands, move forward and for a change we take back our profession, lives, and most importantly our patients care.
1. The Mass. participation mandate is constitutional because licensure is a state matter and it is a state mandate. A federal law cannot tell states how or how not to do licensure.
2. Even if there were a participation mandate, just participate but have no appointments for poor payers until 2023.
SERMO could help more. Why is that that the information about the MMM was placed on the home page AFTER the march had taken place? Why wasn't the information sent in an e-mail to all Sermo participants?
I'm convinced that enough physicians would join together to effectively represent our cause and change the course of history if we had effective leadership. To best help us Sermo must move beyond being just a forum of ideas and discussion and become an effective way to rapidly disseminate information to thousands of physicians. There are several physician groups doing nice work but relatively few physicians are aware.
The difficulties we are facing affect all practicing physicians whether in private practice, academia or at large multi-specialty clinics. Thus, there is common ground that most of us can unite behind. Again we need effective leadership and a mechanism for rapid dissemination of information.
SERMO will you help?
md.sermo.com
They have done more damage to the US than Al-Qaeda has by way of their forced monopoly of CPT codes which has made health care this expensive
Can we start a class action lawsuit against AMA for stealing our info without our permission?
How do I opt out? They seem to have changed their webpage and I am not able to find it.
BTW, my resume' and business card both state in bold type "NOT AN AMA MEMBER"
I'm glad I've saved all that money, which I will use to attend law school, now that medicine as a profession is dead.
Here is the link to opt-out. Everyone should do this.
webapps.ama-assn.org
I did it.
As I moved to a new state, I had to do it again after I had done it last yr.
I don't know what the future holds. Perhaps, besides cash only practices, you could do more topics on alternatives to current practice situations, since we will all be reconsidering our current situations in the future.
we can grow our sphere of influence.
"Nothing is politically right which is morally wrong" Lincoln
"All tyranny needs to gain a foothold is for people of good conscience to remain silent"
Thomas Jefferson
i will not give them a nickel
Dan Jones, MD
www.JonesPlan.BlogSpot.com
Daniel: Why am I reading your explanation here, an NOT on the front page of perhaps every major news outlet that still has an editor with a conscience?
How about a quarter-page photo of the AMA opulence to highlight the arrogance? (In fairness, many of our 'best' medical schools exhibit the same attitude! The executives' secretaries work in airy 30x50' windowed-spaces with marble columns and Persian rugs and solid cherry furniture, while the 'grunt' medical faculty work out of 6x8' cubicles with 40 year-old grey stainless desks and chairs.)
Dan, seriously, there are plenty of Americans who DO care about what is happening in health care and would greatly benefit from knowing what you've uncovered. Shine the light.
I think the FLaRheum doc and others are correct: nothing is going to change by sitting around typing emails to each other. I haven't seen Avatar yet, but I suspect if Dr. Palestrant were to lead doctors into a more meaningful battle there is a chance of revolution. It will take a Sermo Doc 20ful director to get us out of our chairs and become physician Avatars!
reschedule your medicare pt far out. limit number of new pt. limit number of medicare pt a day. fill your schedule with better paying pt - it will help improve your revenue too.
"Dr. Morris Fishbein (1889-1976) originally studied to be a clown. Realizing he could make more money as a doctor, he entered medical school (where he failed anatomy), then barely graduated. He never treated a patient in his life.
Why is he so important? Because he became head of the AMA, a position that he used to enrich himself and crush legitimate therapies out of existence. He appeared to be motivated solely by money and power.
As head of the AMA (and editor of the Journal of the American Medical Association from 1924-1949), he decided which drugs could be sold to the public based only how much advertising money he could extort from drug manufacturers, whom he required to place expensive ads in the JAMA. There were no drug-testing agencies, only Fishbein. It was irrelevant if the drugs worked.
Fishbein was a shakedown artist. Yet, today, there is a Morris Fishbein Center for the History of Science and Medicine at the University of Chicago.
The AMA, a State-backed guild which today has a near-stranglehold on the medical profession, was founded in 1847 merely as a social and scientific organization. Its original purpose was totally appropriate. It was in their private (and the public's) interest for practitioners to get together to trade knowledge, and, for all the outward seriousness of the organization, to have some fun. The original purpose always seems to get lost, though. Some members always want to use the State to reduce the supply of practitioners (which increases income) and eliminate competition (which also increases income, and, much more seriously, reduces innovation). This happened with he AMA, which is why it is now a danger to the health of the American people.
In 1900, while attending the annual AMA convention in St. Paul, Minnesota, three doctors came up with the always-destructive but all-too-human idea of using the AMA as a front, in order to form a closed corporation for their financial benefit. A constitution, bylaws and a charter were created which appeared to give the members of the AMA a say in the activities of the corporation, whereas in reality the three directors had complete control. These three formed smaller political machines in every state, which they controlled through the main corporation.
In 1924, not surprisingly (perhaps inevitably) one of the directors became involved in a scandal and had to resign. He appointed Fishbein to take his place. Fishbein ultimately took control of the AMA, and by 1934 owned all of the stock. In his new position he was able to assume dictatorial control of the state licensing boards and made it as difficult as he could for any doctor who did not join. He, and the three doctors who formed the corporation, were little more than extortionists, ones who made millions by using the power of the State.
The AMA, which started out as a legitimate organization, rapidly became crooked. And Fishbein was the main cause. "
More at...
www.rense.com
what does AMA do for us?
why do we need alternative to AMA?
A work slow-down will not work because it will only piss off patients and decrease our own incomes while increasing profits at the insurance companies. We can't hold out as long as they can. Insurance companies don't want you to work or see their patients.
The only thing that I see that will work is for physicians to stop accepting insurances that suck, even if it means all of them. I do have some good payers and will stick with them. My own group several years ago dropped 2/3rds of our insurance contracts, worried like hell and then watched incomes go up dramatically.
But as long as there are fools out there willing to take pennies for a dollar's work, Medicare, Medicaid and insurance companies will continue to offer less and less for our work.
Did you forget the AMA was in the oval Office the minute they announced reforms to the medical care, signing on to whatever will come forth and not knowing any details?
There is no more pretending about the direction the Obamacare wants to take us; socialized medicine like that in many European countries.
One example is my old country I came from where all physicians were required to work an predetermined amount of hours a week for the government and after that some, usually evening, hours could be spent to have private duty in one's office. Not an easy life but they were unionized and suffering in unison, so they had some bargaining power in order to survive.
To achieve this goal in this country, first they must eliminate the independence of physicians and they are already on the way by limiting compensation and increasing regulation. No physician in small practices will be able to weather this.
It is very clear that lack of unity has been very damaging to our livelihood and profession. The de-professionalization of physicians is a trend that will surely continue, UNLESS we pull up our sleeves, step up to the plate, and boldly defend our turf. The Open Letter ( md.sermo.com ) and the Physicians' Appeal ( md.sermo.com ) were magnificent gestures by the physician community, which signaled our readiness to voice our real concerns.
The next step, i.e taking ACTION, requires a tightly organized and coherent vehicle. Sermo has been a superb channel of communication.
The questions is, how can we take the voices expressed on Sermo and turn them into ACTION?
I started my brand new practice 6 months ago. I accept only BC PPO, BS PPO, a local IPA. Recently I signed up with CIGNA. Last night only I sent message to Aetna that unless they include fee for my common codes in the contract, I will not even read rest of the contract. I was taking Medicare but has stopped seeing Medicare pt since 01/01/2010. I have already started getting calls from doctors and patients.
Americans in general and physicians should be tired of and outraged by the "political spin". Most of us are well aware that this is dishonest nonsense and is self serving to the politicians and to people like Dr. Rohack who has been drawn into this mess over the years(by his own choice). These people need to be ousted. We are in a critically dangerous situation in America. We are being systematically lied to, deceived and abused...for what? The answer is simply for the solidification of power, money and position and has nothing to do with preserving our democracy or defending our Constitution. Unless we organize a significant non participation revolt, we we be trampled upon by what is occurring in Washington. The politicians don't care about us, Dr. Rohack or the American people. There may be some exceptions, but in general they are trying to preserve their power and their positions. Currently, the only way to do that is to lie publicly and make secret deals in private. While that occurs they are selling our country and our profession down the drain. We have a right and a duty as American citizens to point this out and to take action to change it. We must keep up the fight. We must continue to educate our colleagues and the public.
Sermo is a wonderful communication tool to assist us, but we still need an organized front with power and strong leadership to accomplish the task ahead.
The good news is that I I am definitely seeing a new level of interest and commitment as physicians are seeing just how significantly these changes will affect physicians and their patients. There is "fresh blood" among physicians on Sermo interested in tackling this. For now, set your goals very low. Just get your colleagues to log-in and enjoy the discussion. That would be a HUGE accomplishment in its self.
For Sermo's part, we have long seen this trend coming. Over a year ago, we started investing in CME and physician education programs for alternative business models. There is already a series of ACCME-accredited CME modules developed with UPenn that help educate physicians around this. Consider logging into the
Practice Management Exchange:
md.sermo.com
Daniel Palestrant, MD
Founder & CEO
Sermo, Inc.
I had quit Sermo for some months after they gave full access to Senator Specter.
md.sermo.com
I am back at Sermo and looking at the steam roller slowly crushing us.
It is obvious that the AMA sold us out. Anybody who is still a member should get out of the AMA. MD's who go cash-only will not have to buy their coding books and can starve them of their revenues.
I have less respect for the AMA versus BO. Everybody with half a brain knew what BO would be doing but it hurts much more to be stabbed in the back by an organization that is supposed to stand up for your interests. The divide and conquer tactics worked. We have less representation than hotel maids and grocery store clerks. We are forced to work longer hours so we have less time to pull our heads out of the sand and do something about this.
Like others, I welcome the 21% cut. I will pare the office overhead down to a minimum and give every Medicare patient the office phone numbers and email addresses of all the liberal politicians in our state. At this point I charge cash-paying no-insurance patients $88 per visit (some patients with insurance pay $70 as co-pay). That is much better than what Medicare pays and I have happier patients.
I looked at the aapsonline.com website and their takebackmedicine.com campaign.
I would love Sermo to join the AAPS in this endeavor. Sermo will not be able to do much on their own, just like AAPS is not strong enough. Together we should have the power to de-throne the AMA as the "Voice of American Physicians".
Unity + Consensus = Change
As stated by Sermo Doc 124, real action, leading to real change needs to take place. It's simple concepts that are difficult at best to implement into real action.
We have to start somewhere and with few alternatives out there, Sermo is our best option.
We have the Open Letter and Physician Appeal- how can we leverage these communication pieces at this critical time. The greater public needs to be aware of what a large number of physician have formed conscensus around.
What I think we should do is start planning for the 2010 elections. We should gather the list of potential canidates that are running for various house and senate seats. Fromt there we should begin to "Vet" them and find out where they stand in regards to the problems that face physicians. Next we publish the list of those that we need to support regardless of political party. As indivduals we can choose to donate money/time etc to those that we support to get them elected so that we can effect some real change.
I strongly agree with you!
We must focus on the coming mid-term election and make sure that we develop support for the candidates that support us!
Our patients could even help us with this effort.
If we put our money where our mouth is and support pro-MD candidates all over the country, we can make a difference.
I never miss an opportunity at the end of the visit to talk with my patients about Obama's plans. I make sure that especially elderly patients know how many billions he will "save" from Medicare.
Living in Texas I end up preaching mainly to the choir but the physicians in blue states could do a lot to get patients on our side.
He said that he did not endorse the whole bill , only parts of it. He said if I oppose ,then I will not be allowed to participate , at least this way I hear what is going on. He promised to communicate better. He could not convince no one that what he was doing was any good to any physician.
...or, except as otherwise specifically provided [the Secretary of Health, Education and Welfare to exercise any supervision or control over the administration or operation of any such hospital, facility or agency. HR4222.
The AMA opposed, with the following. Everyone opposed it and the bill was defeated. The AMA said, at THAT time-
1.It [HR 4222] would lower the quality of medical care
2.It was unnecessary.
3.It would be unpredictably but extremely expensive.
4.It would endanger the social security system.
5.It would undermine private health insurance and other prepayment mechanisms.
6.It would lead to the decline, if not the demise, of voluntary efforts at the community level.
7.It would expand to a full-fledged system of socialized medicine eventually covering every citizen of this nation.
8.It would cover millions of people who neither need help in paying the costs of their health care, nor want such help.
9.It would compel the nation's younger workers to pay for these unnecessary benefits through an increased compulsory gross payroll tax
10.It would determine eligibility for medical aid on the basis of age rather than on the basis of need.
11.It would destroy the concepts of individual and familial responsibility
12.It would overcrowd existing facilities through overuse.
(Ways and Means Committee, Health Services for the Aged under the Social Security Insurance System.
Volume III, 1317. 1961)
How far the mighty have fallen.
www.cms.hhs.gov
How do you know when an inmate is lying?
Answer: Their lips are moving.
I guess not too much difference with the AMA.
Furthermore, the Trustees (i.e., Bernie and Bernie-ites) have written their power (and our powerlessness) into the very fabric of the AMA. Please note:
Bylaws of the American Medical Association
November 2008
12.30 Articles of Incorporation. The Articles of Incorporation of the AMA may be amended at any regular or special meeting of the House of Delegates by the approval of two-thirds of the voting members of the House of Delegates registered at the meeting, provided that the Board of Trustees shall have approved the amendment and submitted it in writing to each member of the House of Delegates at least 5 days, but not more than 60 days, prior to the meeting of the House of Delegates at which the amendment is to be considered.
Article IX Amendments
The House of Delegates may amend this Constitution at any meeting provided the proposed amendment has been introduced at the preceding meeting and provided two-thirds of the voting members of the House of Delegates registered at the meeting at which action is taken vote in favor of such amendment.
In other words, we (the members of the AMA, though I myself am no longer one) cannot change our own corporate governing bylaws unless the "Trustees" approve it.
Actually, now that I think about it, maybe the best thing to do is for all of us to become members of the AMA (hear me out) and sue our own organization for having acted on bad-faith on behalf of its members and demand punitive damages in the billions (the incomes we have all lost) and/or dissolution of the AMA and thus discontinuation of the ICD/CPT trap.
Seriously, can we do that? My ONLY reason for joining that mafia institution would be to kill it, once and for all.
There may be another way to amend the constitution in order to kill the AMA bureaucracy: The Council on Ethics and Judicial Affairs does NOT need to have their agenda approved or edited by the Trustees. These, however, are 9 "active members of the AMA" appointed by the President-Elect and each serves 7 years. This particular council is the judicial body of the AMA and what they say, goes. Who is on the CEJA?
Dr. John McMahon
Dr. Sharon P. Douglas
Dr. Stephen Brotherton
Dr. Susan Goold
Dr. H. Rex Greene
Ms. Julia Halsey (Med. Student...serves 2 year term versus others' 7)
Dr. Patrick McCormick
Dr. Kavita Shah (Resident/Fellow Rep...serves 3 year term versus others' 7)
These folks' job is to "interpret the Constitution, Bylaws and rules of the AMA".
They can also: Request that the President appoint investigating juries to which it may refer complaints or evidence of unethical conduct which in its judgment are of greater than local concern. Such investigative juries, if probable cause for action be shown, shall submit formal charges to the President, who shall appoint a prosecutor to prosecute such charges against the accused before the Council on Ethical and Judicial Affairs in the name and on behalf of the AMA. The Council may acquit, admonish, suspend, expel or place on probation the accused.
So, ironically, a voting majority of these actual physician members of the AMA could potentially upend the current built-in AMA insurance oligarchy. I think. I hope.
The only other Council which does not require Trustee "agenda approval" is the Council on Legislation. HOWEVER, these 12 "active members of the AMA" are appointed by the Board of Trustees and therefore have been edited already to the Trustees' favor.
By the way, I read all this information on the AMA's website itself, at:
www.ama-assn.org/ama1/pub/upload/mm/475/conandbylaws-08.pdf
I would greatly appreciate if someone of lawyerly expertise and/or inside knowledge of the AMA could give his/her interpretation of the above.
The Board of Trustees of the AMA (the "clinical" portion) are just puppets. So far.
Dan P., what do you think?
(Sorry if my comments above are redundant--I didn't have time during work to read them all in detail.)
www.opensecrets.org