I attended my very first Medicare Policy Summit conference today – and it was truly riveting (wonk alert). I took copious notes and will do my best to summarize some key points in a series of blog posts. This first post is devoted to the presentation by AMA President, Dr. Nancy Nielsen.
Dr. Nielsen began her lecture with an amusing story. She said, “congressional hearings are pure theatre” and described what she’d experienced three months ago at a meeting with Pete Stark. The conversation went something like this:
Stark: I’m sick of rich doctors driving up in their Porsches saying ‘I’m pulling out of Medicare.’
Nielsen: [Thinking to herself: First witness please?] I drive a GEO jeep.
Then Dr. Nielsen looked out at the Medicare Policy Summit audience and asked, “are there any doctors here?” I raised my hand enthusiastically at the back of the room. Then she responded, “Oh thank God. Well, you know we’re in the lion’s den…”
[Parenthetically, I didn’t see anyone else raise their hand – which is the subject for another conversation.]
What Is The AMA’s Current Agenda?
1. To expand coverage for the uninsured
2. To reform the physician payment system
3. To improve the quality and safety of healthcare
4. To improve public health
What Is The Bee In Nielsen’s Bonnet?
Nielsen explained that the sustainable growth rate is unsustainable. She stated:
“We can’t go through the annual death dance with congress over this. There is another 21% across-the-board cut in Medicare reimbursement scheduled for January 2010. And this cut will affect a group of small business owners (aka physicians) whose reimbursement has not increased since 2001 while their costs have increased 20%.”
What Does Nielsen Propose We Do?
1. Reform the system so that it reimburses for care coordination and prevention
2. Craft solutions based around patients’ needs
3. Rebase the SGR
4. Bundle services to increase value and reduce costs
5. Invest in disease prevention and wellness
6. Use comparative effectiveness to inform clinical decision-making (but NOT as a basis for coverage decisions)
7. Bring physicians into the policy decision-making process
Closing High-Five to Nurses
Dr. Nielsen closed with an amusing anecdote about inauguration day. Apparently she was standing in the sidelines of the parade route where Biden got out of his limo to greet the crowd. He gave a big hug to some nurses standing next to her and said, “I love nurses. They’re so much better than doctors.” Dr. Nielsen then had the opportunity to introduce herself to Biden and he responded, “Doctors saved my life, but nurses gave me the will to live.”