Monday, December 7, 2009

New member survey shows broad support for ACP's views on health reform

Some internists who disagree with the ACP positions on health reform assert that we should survey membership before taking a position. They assume that a survey would show that most other ACP members share their opposition to policies advocated by the College.

ACP does not develop policies based on an opinion survey. Instead, as my colleague Jack Ginsburg wrote on this blog several months ago, we develop policy through a consensus process that involves the hundreds of internists and medical student members who sit on the College's committees, councils, Board of Governors, and Board of Regents. As we develop policy, we conduct a review of the evidence, and seek external review by outside experts, consumers, business leaders, and stakeholders.

Such a deliberative process, I believe, results in policies that are more thoughtful, nuanced, credible and evidence-based than if we made our decisions based on an opinion poll, yet they should lead to positions that most members would support.

Surveys are not the best way to make policy, but they can be useful in quantifying member opinions at a given point in time. In October and November, ACP's Research Center fielded a web survey of a random sample of 2,000 U.S. non-student, non-retired, current ACP members ages 65 and younger. It received 290 responses, a 15% response rate and a margin of error of plus or minus 8%. The number-crunchers on the research staff did not find any evident respondent bias, with the demographic and practice characteristics of the respondents generally mirroring those of the 2009 ACP Membership Survey, which had a higher response rate.

Below are the key findings from the Research Center's report:

"11% of respondents are very or extremely familiar with ACP's position on health reform, 59% are somewhat or moderately familiar, and 30% are not at all familiar. 59% of respondents are somewhat or very satisfied with ACP's position on health reform, 16% are neither satisfied nor dissatisfied, 14% are somewhat or very dissatisfied, and 11% are uncertain about their level of satisfaction."

"Respondents were asked whether or not ACP should support twelve different positions for achieving health reform. There was heavy support (over 85% of respondents) for the following five proposals:
- Health reform must include reforms in the medical liability system in order to be effective in controlling costs (93.5%).
- Individuals and small businesses should be able to have a choice of affordable plans through a purchasing pool (exchange) that gives them the same ability as larger companies to get the best group rates (93.5%).
- Insurance companies should not be allowed to turn away patients because they have medical conditions (90.2%).
- All legal residents should have access to affordable health insurance and financial help, when they can't afford it (85.7%). This is in line with data from the 2009 Member Survey (conducted before the executive and legislative branches began to debate health care reform), which show that 71% of members believe 'guaranteeing by law that all Americans have access to affordable coverage, with government subsidies for those who cannot afford coverage' should be given somewhat high (22%) or very high (49%) priority on ACP's advocacy agenda.
- The federal government should create incentives to encourage medical students and young doctors to go into primary care internal medicine (85.5%).This is in line with data from the 2009 Member Survey, which show that 84% of members believe 'policies to increase the number of general internists and other primary care physicians including improved reimbursement and loan forgiveness' should be given somewhat high (28%) or very high (56%) priority on ACP's advocacy agenda.

There was moderate support (between 50% and 85% of respondents) for the following five proposals:
- Insurance companies should be required to cover evidence-based practices that have been shown to prevent disease, as well as screening tests that detect diseases at no out-of-pocket cost to the patient (79.3%).
- Larger employers (defined by such factors as number of employees and payroll) should be required to offer health insurance to employees or pay into a fund to help pay for coverage for their employees (71.8%).
- All Americans should be required to buy health care coverage, as long as there are federal subsidies to make coverage available for those who can't otherwise afford it (65.1%).
- A public plan option should be available to compete with private health insurance plans on a level playing field as long as it has competitive payment rates and participation isn't mandated (63.7%).
-Insurance companies should not be allowed to charge patients more because they have medical conditions (61.8%)

The proportions of respondents who support the final two proposals reflect the fact that the proposals are correlates:
- The federal government should increase Medicare payments to primary care physicians even if this would result in lower pay for other specialties (66.5%).
- The federal government should increase Medicare payments to primary care physicians only if it does not involve reductions to other specialists (30.6%).

There were no differences in the proportion of respondents from different age, primary professional activity and practice size groups in their support for the twelve specific positions on reform ... A higher proportion of general internists (91%) than subspecialists (51%) feel ACP should advocate for the federal government to increase Medicare payments to primary care physicians even if this would result in lower pay for other subspecialties." (ACP has expressed a strong preference for increases for primary care to be funded in a way that does not cause budget neutral cuts to other subspecialists.)

As a very high level survey on broad priorities advocated by ACP (they weren't told what ACP's position was on each), the survey doesn't tell about the questions that weren't asked, like their opinion on raising taxes or the impact on the deficit. Still, it is reassuring to me that large majorities of ACP members support the College's priorities and positions on even on the most controversial issues - like individual and employer mandates, subsidies for health insurance, health exchanges, higher fees for primary care, and the public plan option - that are addressed by the pending House and Senate bills.

Today's question: What do you think the member survey tells us about ACP's advocacy agenda?


Rich Neubauer MD said...

There is no one right way to run an organization. However, by hard work and superb visionary leadership, ACP in its current incarnation has found the sweet spot on how to formulate policies and then use those policies in advocacy activities. Other organizations have found their forward momentum in the advocacy arena to be marked by discord within the ranks, stumbles, and positions that appear to be more in the realm of trade-style advocacy than suites my taste. ACP has not encountered those difficulties even as the health care reform debate has heated up to an intense degree.

The relatively few, very vocal, members who have vehemently opposed the positions ACP has taken have claimed they represent the majority. That the survey shows this not to be the case is reassuring.

I continue to be a proud member of our organization as it advances the causes we fight for with a patient centered focus.

Unknown said...

I could not disagree more that opinion surveys are inferior to your groups of surveyed people. You are stacking the deck with Obama pro health care people. The only really fair way to assess how members of the ACP feel is to survey everyone. We out in the field do not have opinions that are inferior to yours and it is arrogant and condescending to say the contrary. This kind of attitude will force many of us to leave the ACP.