CMA Goals for 2011: Working Together With SDCMS, We Are Indeed Stronger

Your Goals

So what do you expect your CMA to do for you and your patients in 2011? I’m pretty sure you want maintenance and improvement of the physician-patient relationship, fair compensation for services rendered, and removal of the barriers to providing the care your patients need. At the annual session of CMA’s House of Delegates (HOD) in October 2010, the highest priorities assigned to actions were for fixing the problems of the Affordable Care Act (ACA) and helping physicians address the Accountable Care Organizations (ACOs) it enabled. CMA’s member survey conducted last summer also told us that you believe the “uninsured/underinsured” to be the greatest challenge for our future, followed by “reimbursement,” “limited access,” and “funding/solvency.”

My Goal

I am delighted that the CMA HOD has chosen me to become CMA’s president-elect, but no one person creates the agenda, nor does any one person achieve its goals. I believe in building consensus, in building the team, and, by doing so, in creating the internal governance that makes real accomplishment possible. Therefore, my goal for this year and the next is to work with President Hinsdale and the entire CMA Executive Committee (EC), Board of Trustees (BOT), and all the CMA components to have CMA become what the AMA motto says we should be: “Together, we are stronger.”

Our Goals

The CMA EC has recommended focusing on a few very important issues for the coming year, and I’ll discuss them individually. They are:

1. Helping members address the coming ACOs;
2. Helping members implement the health reform law while working to reform the reform by revising its harmful pieces;
3. Defeating the MICRA challenge certain to be awaiting us this year;
4. Creating an entirely new communications system within CMA, including a user-friendly and compelling website;
5. Promoting membership by paying better attention to component and subsidiary relationships.

Accountable Care Organizations

Commonly referred to as “unicorns” (because no one has seen one yet), ACOs are an attempt to tie together the parts of the care delivery system for improvement in quality and economy. By aligning the incentives of systems created of physicians, hospitals, ancillary care, and others in models that deliver total care to at least 3,000 Medicare patients over at least three years, 80 percent of any savings achieved relative to the cost of traditional care can be returned to the ACOs. Beyond that basic premise, the rest of who, how, and how it will be measured or regulated is as yet unknown. CMA’s job will be to educate physicians about the opportunities and threats this provides. First and foremost, physicians must be in control of all clinical decision-making in any new systems created, and certainly must be wary of ceding governance control to any nonphysician entity in order to create an ACO. Hospitals cannot be an ACO without physicians, but physicians can be an ACO without a hospital. Of course, the best design will include both. The CMA HOD adopted “The Physician-Hospital Alignment TAC Report” in October, which established 12 principles that should guide us as we enter into this effort, the first of which is the key guiding principle: “to increase access to care, improve the quality of care, and ensure the efficient delivery of care.” The second states that “ACOs must be physician-led.” Members can access the full report and its recommendations on CMA’s website at www.cmanet.org.

The September issue of San Diego Physician was devoted entirely to this subject, but it bears reminding ourselves of the sea change that this is likely to create in the way we deliver care. CMA and its leadership are aware of this and will advocate vigorously to protect your interests and those of your patients. Solo practice is not dead, and the corporatization of medicine has not happened … yet. We will find innovative ways to connect privately practicing physicians into virtual or more tightly integrated entities, to achieve relief from the antitrust laws that prevent such alignment, and to ensure that attempts to be more “efficient” do not aggravate the financial stresses physicians now face or diminish the quality of or access to care for our patients.

Implementing and Reforming Reform

There are many excellent parts of the ACA that physicians welcome, including the reduction in the number of uninsured patients, the insurance reforms that will make health insurers better perform what they are chartered to do, the emphasis on increasing access to primary care, and the experiments with ways to get better data about what care is most effective, what liability reform efforts might be tested by the states, and how we can connect with each other for the sharing of patient information. CMA will continue to educate members about how to prepare for the increased volume of patients in an already stretched delivery system, how to adapt to the electronic world (EHRs and HIEs, for example), and how to participate in the financial rewards the ACA created for doing so. We will advocate for state laws and regulations that will implement the federal mandates in a positive way.

Meanwhile, however, we will be traveling to Washington, DC, as often and as long as it takes to correct the flaws in the new law. SGR and GPCI must be fixed. The IPAB (Independent Practice Advisory Board) must be killed or at least made accountable to someone open to hearing reasonable arguments before it can make its mandated cuts to funding in order to balance federal healthcare budgets. We must continue to fight to convince Congress that “private contracting” isn’t a way to gouge seniors, but a way to replace the funding of medical care with OPM (other people’s money) and actually therefore reduce federal spending, while also enabling seniors the liberty of choosing how they want to receive their care. Boosts in reimbursements for Medicare and Medicaid should be for all specialties and reflective of what the costs of delivering that care actually are. “Value modifiers” as proposed by those in the Midwest must be defeated. No way should a region that has one third the rental costs and one half the labor costs be rewarded because they deliver care more cheaply. And the ridiculous mandate to create 1099 reports for everyone we pay for service must be defeated as well.

MICRA Challenge

It is clear that the trial lawyers will test the new governor’s position on MICRA in this legislative session. We were protected for many years by governors who were certain to veto any attempt to modify the 1975 law that is the envy of the nation in liability reform. Consequently, few attempts were made to do so, but there is rising sentiment among some legislators and many in the media that the cap on non-economic damages should be indexed to some inflation or cost-of-living standard. A doubling or tripling of the $250,000 cap, as has been proposed, would have a significant effect on the premiums we physicians pay to our liability carriers and also harm the clinics, the hospitals, and the universities already struggling to stay afloat. Access to care, not a concern of the trial bar apparently, will seriously suffer. We will need every one of you to help fight this attack, and we are already beginning plans for fund-raising to mount that fight.

Communications

Every focus group and every survey CMA does reinforces the understanding that physicians, members and nonmembers, rarely know what CMA does and what CMA stands for. This year you will see the roll out of a new website and an entirely new way of communicating with members and nonmembers, not just to “tell” you what we do, but to be able to “ask” you what you want and need. CMA’s new vice president of communications, Rosanna Westmoreland, has already transformed what is happening internally. You will soon recognize the difference and see the benefit, including better public awareness of our advocacy.

Management and Governance Changes

It isn’t your father’s CMA, and this isn’t Kansas, Toto. CEO Dustin Corcoran has changed the culture at CMA’s office and revitalized an already powerful team. Now it is up to the physician leadership to follow his lead and re-create the relationships among the parts of organized medicine. The county medical societies need to be more tightly aligned with CMA and with each other. The specialty societies need to work with CMA and each other to avoid conflicting messages to the public and the legislature. The subsidiaries of CMA are already more closely tying their missions to CMA’s. All components need to better promote leadership development to enable the “Team” of the future. We will lose to the corporate and governmental forces if they can divide us. We must not be divided. Disagreements and conflicts in needs must be hammered out within the walls of the house of medicine, not in the media or in the halls of Congress. CMA’s strategic plan, adopted by the BOT, and the focused priorities of the EC both consider this goal to be essential to the accomplishment of all others; hence both have unity of purpose as one of the top five priorities for this year.

Conclusion

Focus does not mean other issues will be ignored. I personally will continue to lead the effort to re-create a viable and effective Physician Health Program for California to replace the Diversion Program ended by action of the Medical Board in 2007. I will continue to work to see that liability coverage becomes available to physicians who volunteer their efforts for the uninsured. And I will continue, while no longer the speaker, to assist Speaker Luther Cobb and Vice Speaker Ted Mazer in assuring that the HOD remains the force it is in establishing the policies you want that will guide our actions in the future.

I am available to you at any time. Please let me know what your goals and priorities are. SDCMS remains the most vibrant and effective county medical society in the state, and your leadership and staff make it so. CMA is one of the most influential and effective state associations in the country. With SDCMS working together with CMA, we are indeed stronger.