Access to care, revising the Medicare payment formula, encouraging healthy
lifestyles, and medical education reform.
Those are among the AMA's top priorities, according to Michael Maves, M.D.,
the AMA's executive vice president and chief executive officer. He was the
keynote speaker at APA's Institute on Psychiatric Services last month in
Chicago. Maves was standing in for Rep. Danny Davis (D-Ill.), who was unable
to attend due to the financial crisis requiring Congress to be in Washington
to deliberate bailout
Michael Maves, M.D., the AMA's executive vice president and chief
executive officer, tells attendees at last month's Institute on Psychiatric
Services that the problem of the uninsured was the AMA's leading
Credit: Ellen Dallager
Maves said the AMA has been striving to make its legislative and lobbying
agenda more patient- and public-health friendly, reversing its public image as
sometimes being primarily concerned with the financial interests of doctors.
As part of this effort, Maves said, the AMA was focusing on encouraging
healthy patient behaviors, with an emphasis on diet; physical activity; and
tobacco, drug, and alcohol use. He added that the AMA is planning to provide
primary care physicians with tools to address these subjects in every patient
"The AMA is trying to become engaged and to advance an agenda not
only for the profession, but most importantly for the patients we
serve," Maves told psychiatrists and others at the APA institute."
We are putting ourselves in a position that perhaps we should have been
in for many, many years but haven't."
During a meeting at which APA President Nada Stotland, M.D., emphasized the
need for health-system reform, Maves said the number-one priority for the AMA
is the problem of under- and un-insurance. And he offered a broad outline of
the AMA's proposal for health insurance reform and tax credits designed to
give individuals power to buy their own insurance.
"Do I think this will pass? No. Do I think it will help start a
discussion? Yes." He added, "Ours is a market-based proposal, but
I don't think any one proposal is ever going to solve this problem."
Moving on to Medicare fee concerns, Maves said that for several years, the
AMA has had to go back to Congress "as a supplicant" to reverse
fee-schedule reductions that were projected to be as high as 10 percent this
year. This year advocates were able to secure an adjustment resulting in
approximately a 1.5 percent across-the-board increase, along with a phase down
from 50 percent to 20 percent in the copay that Medicare requires
beneficiaries to pay for mental health services.
"The bad news is that in 2010 we are scheduled to have roughly a 21
percent cut [in physician Medicare fees], and by 2015 it will be 40
percent," Maves said. "You don't need to have an M.B.A. to figure
out what will happen to profits and losses in your practice. People will be
running away from Medicare because they cannot afford to provide the
What's needed, he said, is a permanent fix that would replace the
sustainable growth rate formula, which requires that increases in Medicare
volume be paid for by decreases in physician payment and without compensation
for increasing practice costs. "There is no doubt in my mind that if
these cuts go through, we will have a medical-care crisis, just as we are
having a financial crisis," he said.
Maves predicted that a Medicare reform bill would be packaged with
reauthorization of the popular State Children's Health Insurance Program
(SCHIP), which is expected to expire next March. "Reauthorization [of
SCHIP] will be a top priority," he said, adding that he believed that
Congress will continue to authorize coverage within SCHIP for women who are
pregnant—a source of some controversy among lawmakers.
Finally, Maves cited reform of medical education as another priority for
AMA in coming years. He noted that the current model of education—two
years of preclinical book work followed by two years of clinical practice and
bedside education—derived from a model developed nearly 100 years ago by
Abraham Flexner in the 1910 "Flexner Report."
And he said that AMA would be looking at ways to update the model to meet
"Any of you involved in academic medical education know that things
are not that simple anymore," Maves said. "The way medical
students are being educated today is sporadic, and they have to connect the
He said that in 2010, the 100th anniversary of the "Flexner
Report," the AMA will release a new report on medical education
outlining the challenges and opportunities of medical education in the 21st