Late Monday, the AMA House of Delegates rejected, by an overwhelming majority of 350-167, efforts by dissident delegates to put the organization on record as not endorsing H.R. 3962. (The Associated Press/Washington Post has a good story on the organization's deliberations).
The House of Delegates did, however, pass a number of policies that require that the AMA Board of Trustees "oppose inclusion" of cost controls in the Senate Finance Committee bill that would result in redistribution of payments among physicians. With these actions, and the AMA's previous letter of support for H.R. 3926, the AMA effectively (and perhaps ironically) has allied itself with the House-passed bill, which some analysts label as the more "liberal" of the bills because it spends substantially more money than the Senate Finance bill. Among the policies opposed by the AMA are redistributing payments to physicians based on their outcomes and efficiency, redistributing payments from some specialties to increase payments for other (read primary care) specialties, penalizing physicians who do not successfully report on quality measures, and creation of a Medicare commission that would recommend and implement changes in payment and delivery systems to achieve specific savings unless Congress enacted an alternative. Many of the policies opposed by the AMA are the same as those opposed by a coalition of surgical specialty societies. Unlike the surgeons' letter, though, the AMA House action doesn't commit the AMA to opposing a Senate bill that includes such policies, only to advocate that they not be included. It will be interesting to see what the AMA will do, though, if the Senate bill ends up including many of the policies that the House of Delegates has directed it to oppose.
ACP shares some of the concerns about the provisions in the Senate Finance bill, but we have also noted the many policies we support and proposed alternatives -- such as more safeguards over the Medicare Commission -- rather than flatly opposing it.
Whether health reform legislation gets passed or not (and I still think it has a better chance of getting passed), it seems to me that policymakers, both within and outside of government, will insist on changes in payment systems to align incentives with the value of care being provided, which means that there will be redistribution among physicians and specialties depending on the value of the care provided. Just opposing such changes will not be effective if physicians want to influence their design.
Today's questions: Do you believe that organized medicine should oppose efforts to redistribute payments among physicians based on quality, outcomes, and efficiency? Or from other specialists to primary care?