Barbarians at the Gate

THE PRACTICE AND PROFESSION OF MEDICINE ARE UNDER SIEGE

In their desire to squeeze profits from the work of physicians on behalf of patients, insurance companies and managed care corporations have inserted themselves into the treatment decisions of doctors, often denying treatment to patients that their doctors had prescribed. Seeking to capitalize on the work and credibility of physicians, so-called retail clinics are offering a cut-rate discount imitation of medical care, threatening the quality of care available to those most in need. Medicare and Medi-Cal reimbursement rates have been so stagnant that doctors are paying 2007 wages and expenses with 1985 reimbursement levels.

None of this helps patients get greater access to their physicians; none of this helps physicians take care of their patients. Yet these are the primary driving forces affecting healthcare today.

The steady encroachment of non-physician, profit-seeking interests into a profession of such profound importance is hardly surprising. The human need  and thus market demand  for healthcare is matched by few sectors, if any. Any enterprising soul with a few weeks of Economics 101 would recognize the revenue and money-making possibilities of medicine.

Unfortunately, Economics 101 and MBA programs  and the people they produce  focus on profits, not the sacred responsibilities inherent in the doctor-patient relationship. Similarly, the people who work for managed care who are responsible for monitoring and denying treatment are not focused on the health of the individual patient  instead, they are focused on the profits.

But where does that leave us? And where does that leave healthcare?

Forty years ago, being a pharmacist was a noble profession. Local pharmacists had their own business on Main Street and accordingly a place of respect and credibility in the community. Now, pharmacist students examining their post-education options are looking at going to work for Sav-On or Walgreens. They are employees first, healthcare professionals second. Unless current trends are reversed, this is the future of medicine: doctors as employees, working for WalMart.

No more profession and practice of medicine. No more doctors. Just employees.

You don’t need me as CMA’s CEO to tell you this. You don’t need the California Medical Association or the San Diego County Medical Society to tell you this either. But it is very clear that the integrated advocacy of organized medicine that your CMA and your SDCMS provide is the only chance doctors and patients have of fighting back against the many forces blocking patients’ access to their doctors and disabling doctors’ abilities to take care of their patients. Period.

This battle to save the medical profession and the doctor-patient relationship must be fought on many fronts: legislative, regulatory, legal, economic, and in the arena of public opinion. I feel confident that CMA’s leadership recognized this when they hired a trial lawyer  me  to be their new CEO in 2006. Everything we have done at CMA since I came on board is intended to support the upcoming fight on behalf of physicians and patients on each of these many fronts, and I know that our county society partners have the same mindset.

Here is what CMA brings to the fight:

LEGISLATIVE ADVOCACY

The corridors of power are fraught with risk and potential for any group, but especially for physicians. Managed care companies in particular have successfully thrown their weight around in Sacramento and Washington, DC, sometimes to the detriment of physicians and the doctor-patient relationship. However, as public dissatisfaction with managed care has increased, so too has the ire of politicians toward managed care companies.

Our CMA Government Relations team has built an incredible track record of success in their recent advocacy for physicians. When Gov. Schwarzenegger introduced his ambitious healthcare reform plan earlier this year, doctors were both inspired and appalled: inspired by the governor’s goal of universal access to healthcare, a long-time goal of the medical profession; appalled that the governor would suggest that taxing doctors  the very people providing healthcare  was an appropriate way to finance expanded coverage.

Our Government Relations team swung into action in response, working to educate decision-makers about the hard work that doctors do for patients for little to no compensation, and made sure that the governor’s brainstorming didn’t translate into bad public policy. By the end of session, a tax on doctors had failed to make its way into any legislation and was off the table in serious discussions of ways to move the healthcare reform debate forward.

It is unclear whether for-profit managed care is a viable model  albeit with some serious modifications  to protect the doctor-patient relationship, or whether it will be necessary to push for-profit managed care completely out of the business of controlling treatment decisions. Either way, a strong lobbying effort at the local, state, and national levels will be a critical component of reining in the for-profits. We got it in spades.

LEGAL ADVOCACY

For-profit managed care corporations have proven time and time again that they are not willing to play by the rules. When CMA heard from our member physicians that managed care companies were engaged in unfair payment practices, we filed a federal, civil RICO lawsuit on behalf of 900,000 physicians against the companies. This lawsuit resulted in a major settlement under which the companies agreed to change their practices, and physicians received monetary settlements for payments they should have received.

While this lawsuit proved successful, it did not change the basic model of for-profit managed care. As many of you have experienced, these companies continue to insinuate themselves between doctors and patients, to the detriment of both. We have continued these efforts case-by-case in our state courts. If at some point the legislative process does not restore the doctor-patient relationship, it may become necessary to once more take action in our nation’s courts.

ECONOMIC AND REGULATORY ADVOCACY

One of the tremendously important benefits CMA offers its members is going to bat for physicians with managed care companies. Our economic services team educates physicians on how to negotiate contracts and how to effectively bill and collect from managed care companies. When public regulatory agencies fail to enforce the laws that CMA has helped pass to protect physicians, CMA’s economic services team stands up for physicians and ensures that these agencies fulfill their legal responsibilities. This includes filing formal complaints on unfair payment and abusive contracting practices.

CONCLUSION

I’ve given you a few examples of the work we at CMA do on behalf of doctors and patients. But we need all of you in the trenches backing and enhancing our efforts  building together the collective arsenal that will deliver victory.

When Tom Gehring and the other hard-working folks at SDCMS asked me to write a piece for San Diego Physician, they suggested the theme be: “Why you should be a member of CMA.” I suggest to you, as I do to every practicing physician in California, that what is at stake in your decision whether to join the California Medical Association and the San Diego County Medical Society is nothing less than your decision whether to fight on behalf of your chosen profession and your patients. If physicians do not stand together on behalf of their patients and profession, the practice of medicine will continue on its current degenerative path toward oblivion, leaving patients and profession to the predatory forces arrayed against them.

You may think this is just the stem-winding big finish from a trial lawyer, but it is the truth as I’ve experienced it based on years as a trial lawyer and eight years as a state senator. If physicians stand up and engage the political process on these many fronts, there is nobody that is going to stop them from directing the future of healthcare in California and in the United States.