APA Medical Director James H. Scully Jr., M.D., was among the physician
leaders participating in a health care reform meeting last month with the
Obama administration to share insights on how to improve the quality of and
access to patient care and strengthen the medical profession.
Physician representatives of about 40 organizations were invited to the
meeting, which was led by Ezekiel Emanuel, M.D., Ph.D. He is senior counselor
on health care in the White House Office of Management and Budget and is
working to develop a program of universal insurance coverage while lowering
costs. Other invitees included four deans of medical schools and five
chancellors of scientific medical centers.
The meeting, closed to the public and media, produced unofficial consensus
priorities that physicians suggested the administration address as part of its
overall health care reform effort.
"They wanted an open dialogue and specific recommendations, which
they got," Scully told Psychiatric News.
Scully emphasized to the administration that strong, carefully crafted
regulations were needed to implement the insurance parity provisions of the
Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act
of 2008. APA has urged expedited issuance of guidelines to clarify how the
federal law will complement existing state parity laws and to address the
extent of coverage that insurance plans must provide for treatment of mental
The administration used the physician meeting to lay out its goals for
health care reform. Emanuel, brother of Obama's chief of staff, Rahm Emanuel,
discussed the overarching goals that health care reform advocates will aim to
address, including the availability of affordable, quality care for all
Americans and controls on the rising costs of health care.
Physicians said they could help meet those goals through changes in the
health care reimbursement system. Among the physician consensus priorities was
the need to overhaul federal physician payment systems, such as those of
Medicare and Medicaid, and to design a funding approach that rewards
physicians for providing good outcomes.
"Physicians have to be paid for the time it takes to get to know
their patients," Scully said about the need for reimbursement for
cognitive care aspects of treatment.
Physicians also sought changes in federal antitrust law. Clinicians have
been unable to meet and cooperate in finding cost-saving approaches to care
because they could be charged with undermining competition, thus violating
federal antitrust laws.
Loosening antitrust restrictions on collective negotiations or
collaborations also could benefit patients, Scully noted, because physicians'
close interactions with other physicians could control costs by eliminating
redundant and expensive services.
Another area in which physicians urged reform was malpractice liability.
They want strong legal protections from malpractice lawsuits for physicians
who adhere to established practice guidelines. "Integrated
networks" of physicians from various specialties could also generate
guidelines providing legal protection from lawsuits for physicians who provide
care through a multidisciplinary approach.
Meeting participants also sought federally supported changes in medical
education. The federal government could encourage the greater integration of
various areas of medicine, according to the physicians, through modifications
in graduate medical education that train student doctors how to work together
The physicians' forum was a departure from the last federal health care
reform approach undertaken by former President Bill Clinton in the 1990s.
Emanuel, who served on the ethics section of Clinton's Health Task Force, used
the March meeting to obtain physicians' input on reform much earlier than had
the Clinton initiative, which was nearly a year old before physicians' views
were sought. The higher physician profile in the Obama effort is expected to
continue, including plans for more such physician forums as the health care
overhaul moves through the legislative process. ▪