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October 25, 2006

Q&A with AMA Trustees

I had the opportunity to meet a couple of the AMA trustees today, Dr Ardis Hoven (pdf bio) and Dr Robert Wah (pdf bio). They're on a roadshow, talking to students at various schools, and, I gather, some other audiences as well.

Here are the questions I asked and their responses, as best I can remember them:

1) Responding to Dr Hoven's opening question (What do you, the students, think is the number one question in medicine?), I said information control. Dr Wah responded. He was the chief Health Information Systems officer in the Department of Defense before retiring recently. The military has had a world-wide integrated database for years, but he doesn't believe that other populations really need such a requirement (ed. what about the mobility of the US population: moving on average every seven years?). He questioned the wisdom of keeping the old model of physicians being the custodians of patient data. Instead, he invisioned perhaps custodians should exist on the free market and physicians would the rent data from the custodian for the patient's benefit. (ed: of course, the cost would ultimately be passed on to the patient). Alternatively, perhaps the growing non-system of disparate (ed: and dysfunctional) electronic medical record systems at every hospital and doctor's office will become the norm.

2) Given that drug companies purchase portions of the AMA Physician Master File and also purchase physician prescribing information from pharmacies, and correlate the two data sources to tailor marketing to individual physicians, had the AMA considered acting on behalf of its members to get the same prescribing data from pharmacies (big pharmacies, like Walgreens, and CVS) and provide their members, even on a fee-for-service basis, with their own prescribing data, with perhaps intraspecialty and local trend comparisons? Dr Wah fielded this also, indicating that this sort of data warehousing was not one of the AMA's core competencies, and it would probably be on the table for discussion, but would probably be farmed out to a third party, perhaps a pharmacy managment firm.

3) Someone else asked a question I've been dying to find the answer to: how many physicians belong to the AMA? Dr Hoven indicated about 250,000 were members and she went on for a couple of minutes stumping for people to sign up. I seem to recall a recent article indicating there are about 891,000 physicians in the US.

4) How does the AMA's insurance reform plan compare to the recently passed Massachussetts plan? Dr Hoven said the AMA plan has 3 pillars (ed. don't they all?): health insurance portability, tax credits (she thought vouchers might be a better word), and insurance market reform. The AMA differed with Massachussetts in the second two. With respect to the vouchers, instead Massechussetts used an employer mandate. Interestingly, Dr Wah seemed to come out in favor of the employer mandate, citing that had, since the 1940s, been a component of the US system (ed. See Paul Starr's The Social Transformation of American Medicine). I also question these vouchers, because they really are tax credits, which means they really a form of investment, so where's the government going to get that money? I think keeping the employers in the loop of responsibility makes a lot of sense. As for insurance market reform, the AMA's plan called for starting subsidies for people making less than 500% of the poverty line, which would cover 11% of the existing uninsured; Massechussetts set the bar at 300% of the poverty line, which covers roughly 90% of those currently without insurance (Steinbrook, NEJM 354:2095-2098). These differences, 500% vs 300% and tax credits vs employer-mandate, make the AMA plan essentially a clone of the Republican plan, or is the Republican plan a clone of the AMA plan (some comparative stats here)?

Posted by Niels Olson at October 25, 2006 9:49 PM

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