Thursday, November 01, 2007

Strange Bedfellows

I've got to rant.

From a recent press release by the AMA:
"On behalf of the American Medical Association, I would like to commend New York Attorney General Cuomo for his groundbreaking agreement with CIGNA. Physicians greatly appreciate your leadership and your commitment to our shared goal of enhancing the quality of care and ensuring patients are provided with reliable information that is meaningful to them.

"The AMA also commends CIGNA for leading the industry by renouncing physician evaluations and rankings based solely on economic factors, and agreeing to a balanced approach that acknowledges physician ratings have a risk of error and should not be the sole basis for selecting a physician."
I feel so reassured when our physician political leadership is in bed with the insurance industry in the interest of "enhancing quality of care and ensuring patients are provided with reliable information that is meaningful to them."

What a bunch of double-speak. What really should have been said by the AMA to Mr. Cuomo was this:
"Physicians who still are members of the AMA greatly appreciate your leadership and your commitment to siding with the insurance industry's efforts to rank physicians. We at the AMA share your vision of disempowering physicians so they become better providers of healthcare as measured by industry- and government-mandated milestones which, to date, have had little to no proof of being effective."
Now THAT, my friends, would have been the truth.

Instead, in the push to belly-up to the corporate interests, Mr. Cuomo has negotiated a system that works best for the his government and the insurers, and does little to nothing to reduce the ultimate cost of healthcare and healthcare outcomes for our patients, now dubbed "healthcare consumers." Can we honestly think that the bureaucracy developed by these interests really will save costs for our health care system? You know it's bad when other press releases describe such terms as "actionable information:"
"'Our program is focused on providing actionable and meaningful information and is founded on clinical integrity to ensure comparisons are fair,' (Jeffrey) Kang (chief medical officer of Cigna) said today at a news conference in New York."
Pardon me, but what the hell is "actionable and meaningful information?" Actionable by whom - the insurance industry? Government agencies? Web-site developers? Healthcare "consumers?" Or do we really mean 82-year old patients who have never used a computer in their life and will never pick up a computer mouse because they can't even see the computer screen?

Who the hell are we kidding?

I must admit, I initially felt a bit warm and fuzzy when the good Mr. Cuomo threatened Cigna, Aetna and UnitedHealth with lawsuits from the State of New York. I thought he got it:
He warned the companies that the ratings are confusing and potentially deceptive, in part because insurers don't disclose how prone to error their rankings are. The move follows rankings lawsuits by doctors accusing insurers of libel, unfair business practices and breach of contract in other states.
So why the change of heart? Could it be that the Great State of New York wanted its cut of the monies that the insurance companies can bring to bear in the rush to tap the Almighty Healthcare Dollar? Where, exactly, will the oversight 501(3c) organization, funded in part to a tune of $100,000 seed monies from Cigna, be based? Could it be in New York? Would they have to pay property taxes on their building to the State of New York? What about the employee's state taxes contributed by all of the little gnomes working for this newly-formed organization? Will they have to pay New York state income tax? Ah, the potential for revenue streams for the Great State of New York are endless! And if "this will be a rating system that will serve as a model for the nation," as Mr. Cuomo hopes, then it really WILL be an economic engine for New York, won't it?

But that is not enough. Seizing on a potentially lucrative opportunity, our "own" AMA has quickly joined in the congratulatory praise. But wasn't it recently that they were found to have sold our prescribing information to the pharmaceutical companies behind our backs for revenue to their organization? Could the AMA now be on board with Mr. Cuomo because they can provide similar information to an even bigger deep-pocket: the insurance companies? Hot damn! Jackpot indeed! What's that you say? That'll never happen because of an independent organization? We wonder: which measures will the oversight organization (paid, of course by Cigna's grant and dubbed the "Select Few") be tasked to review - those published overtly or those covertly performed? Will they be privy to the backroom dealings of the AMA with the insurance corporations? Unlikely.

It is no secret that drug companies carefully track the effectiveness of their doctor "lunch" meetings by noting a rise in prescriptions filled by a physician's name. To achieve this analysis, pharmacies and the AMA sell the information on prescriptions actually filled by the patient back to the drug companies. The drug companies then have specially-hired marketing firms scruitinize the data to decide where best to invest in their next marketing efforts. Transparent? Hardly. So what's to stop the AMA from doing similar shenanigans with the insurance industry?

Meanwhile, patients continue to be restricted from purchasing insurance across state lines, are forced to buy pre-arranged medical care plans decided for them by their employer (in concert with the insurers) and have no method of measuring the "quality" of the insurer. Claim denials and payment delays to physicians and patients alike continue, and the AMA stands "happy" with these measures "negotiated" by New York Attorney General Cuomo.

I've got a headache.


Rachel M. Werner, MD, PhD; Eric T. Bradlow, PhD. "Relationship Between Medicare’s Hospital Compare Performance Measures and Mortality Rates" JAMA. 2006;296:2694-2702. (ed. note: This report concluded: "Hospital performance measures predict small differences in hospital risk-adjusted mortality rates. Efforts should be made to develop performance measures that are tightly linked to patient outcomes.")

Bruce E. Landon, MD, MBA; Ira B. Wilson, MD, MSc; Keith McInnes, MS; Mary Beth Landrum, PhD; Lisa Hirschhorn, MD, MPH; Peter V. Marsden, PhD; David Gustafson, PhD; and Paul D. Cleary, PhD. "Effects of a Quality Improvement Collaborative on the Outcome of Care of Patients with HIV Infection: The EQHIV Study." Ann Intern Med. 2004;140:887-896.


Dr. Rob said...

Nice Rant. I am not a member of the AMA and have never felt they protect the PCP's worth anything. The problem is that they are put out there as THE organization representing physicians. Clearly there is a large group that does not know that this is a political organization that only represents some of their interests but all of its own interests

Anonymous said...

you hit the nail on the head here

DrWes said...

Thanks. I was trying to find the latest figures on the number of US physicians who are members of the AMA. All I could find was these data from 1997 in the NYT, which stated: "Only about 40 percent of the country's roughly 700,000 doctors and 55 percent of its medical students are now members, in contrast with the organization's heyday in the 1960's, when about 90 percent of doctors in private practice belonged."

Anyone have more recent data on these stats?

Anonymous said...

the AMA is just another political party. it really does not represent the best interests of the general doctor(espec family medicine and internal med an peds). Nor does it always keep the best interests of the common man(or woman) in mind. Sometimes it does good things, but in the long term i doubt it does much to improve health care in the US

Aggravated DocSurg said...

Dr. Wes -- the last time I was able to find any data, the AMA represented only about 28% of US physicians (2005 data). Hardly a group that should be viewed by any governmental agency as representing the interests of all physicians.

DrWes said...

aggravated docsurg -

Thanks. I seem to remember that number, too. Any reference?

Happyman said...

brilliant post.

The AMA has long been at odds with primary care docs especially, pandering to the interests of big money (pharma, devices, insurers), directly harming the daily practice of primary care medicine.

County & state medical societies do a better job of at least pretending to be interested in the myriad issues facing small practices. When paying dues to these groups, one has to be careful to not include the AMA fee, inadvertently becoming a member. I suspect that a big chunk of their membership is obtained this way.

It irks me to hear (or read in blogs) people who feel that somehow all docs are conspiring to screw the public using the AMA as their unified political strongarm (what a crock of sh!+).