This column was originally published in AMA eVoice on April 4, 2008. Dr. Davis is president of the American Medical Association.
Hundreds of physicians capped off this week's AMA National Advocacy Conference (NAC) in Washington, D.C., with an impressive display of unity during a rally Wednesday at Capitol Hill's Upper Senate Park in support of the Save Medicare Act of 2008 (PDF, 75KB) (S. 2785). The rally was a huge success and a testimony to organized medicine's strong, powerful voice on national issues such as Medicare physician payment cuts.
Introduced last month by U.S. Sen. Debbie Stabenow, D-Mich., S. 2785 would prevent a 10.6 percent cut in Medicare physician payments planned for July 1, retain current levels for the remainder of this year, and enact a 1.8 percent increase for 2009. It also would continue rural extender provisions that are set to expire, such as the floor for Work Geographic Practice Cost Indices and the bonus for physician scarcity areas. Sen. Stabenow, one of my two Michigan senators and a great champion for physicians and patients, was not able to attend this year's NAC, but we captured a photo of her wearing her "AMA purple" when she spoke at the 2007 conference.
A recent AMA poll found that eight out of 10 Americans are concerned about access to care for seniors and baby boomers because of payment cuts to physicians caring for Medicare patients. In a separate AMA survey of physicians (PDF, 119KB), 60 percent of doctors said this year's cut alone will force them to limit the number of new Medicare patients they can treat.
The AMA has produced a number of materials that demonstrate the urgency of this issue, including a five-minute podcast featuring AMA President-elect Nancy H. Nielsen, MD, PhD, that discusses S. 2785 and outlines the AMA's concerns for seniors and baby boomers if the payment cut planned for July 1 occurs.
Ensuring access to care for seniors and the elderly is crucial given the number of baby boomers who will be eligible for Medicare benefits in the coming years. The Medicare-eligible population is projected to grow to 69.7 million by 2030, which could overwhelm physicians caring for the elderly.
A significant portion of the nation's health care resources already is used to care for seniors. According to government figures from 2003, seniors comprise 28 percent of the physician workload in primary care, 32 percent in surgical care, 43 percent in medical specialty care, and 43 percent in emergency medical care. And much of that care is for treating chronic conditions. During a 2004 hearing to a U.S. House Ways and Means subcommittee, the Urban Institute—an economic policy research group—reported that about 20 percent of Medicare beneficiaries have five or more chronic conditions, account for more than two-thirds of Medicare spending, see about 14 different physicians in a year, and have almost 40 office visits on average each year.
The chances of an otherwise unnecessary hospitalization—for conditions that can and should be managed effectively on an outpatient basis—increase from about 1 percent for a beneficiary with just one condition to about 13 percent for a beneficiary with five conditions and about 27 percent for a person with eight chronic conditions. Further, the Urban Institute found that the number of chronic conditions has more influence than age on health care spending in the Medicare population.
Last year, the AMA began a multiyear initiative on the impact of aging on health care to ensure that all physicians caring for the elderly are proficient in geriatric care principles and practices. As part of that, the AMA joined the Association of American Medical Colleges and other health care stakeholders to identify specific medical student competencies in geriatric medicine, which have been approved by the American Geriatrics Society. The next step is to expand this collaboration to explore the development of geriatric competencies at the residency level.
Today's health care system clearly is ill-equipped to provide comprehensive and coordinated services to patients with chronic conditions, so they are relied upon to organize and manage their own care. Thus self-management support—the systematic provision of education and supportive interventions by health care professionals to increase patients' skills and confidence in managing their health problems—is a central component of effective care for individuals coping with chronic conditions. Self-management support has been shown to be very effective in reducing costs as well as improving quality of care.
Geriatric health is one of the AMA's top issues. At the Annual Meeting of the AMA House of Delegates this June, the AMA will offer an educational session (along with continuing medical education credit) to help physicians understand self-management support strategies for elderly patients and apply them to their practices.
A routine part of physicians' geriatric medical services should be driver safety. Motor vehicle injuries are a leading cause of injury-related deaths in those age 65 and older. The AMA has several policies regarding older driver safety and, with the National Highway Traffic Safety Administration, developed the Physician's Guide to Assessing and Counseling Older Drivers to help physicians evaluate the ability of their older patients to drive safely. The AMA also has resources that physicians can share with patients and caregivers about driving safety and alternatives to driving, including a self-assessment questionnaire to help start what can be a difficult conversation.
The health of those caring for the elderly sometimes becomes an issue, so it's important for physicians to address the burden of caregiving with a patient's family members and loved ones. The AMA has developed several materials that can assist physicians in helping family members provide ongoing care, including information about the health risks involved with caregiving and a questionnaire (in English and Spanish) that physicians can use to identify if a caregiver needs supportive services.
In addition, the AMA has produced resources that cover home care (PDF, 870KB) and helping elderly victims of disasters. (PDF, 1.25MB)
Later this month, the Institute of Medicine (IOM) will be announcing the results of a study to determine the nation's health care needs of the elderly. I look forward to seeing the results of this study and the IOM's recommendations on the subject.
With the number of America's seniors set to skyrocket in the coming years, two things are of the utmost importance: All physicians must be able to effectively care for the elderly, and those patients need to have access to physicians. Please urge your senators to support S. 2785 and ask Congress to stop the Medicare payment cuts. You can contact your lawmakers via e-mail or through the AMA's toll-free Grassroots Hotline at (800) 833-6354.
Please send comments, questions, and replies to amaprez@ama-assn.org.
Content provided by: Robert M. Davis, MD