In the midst of belt-tightening and a 2% membership loss, the American Medical Association is trying to remind members what it can still do for them: make high-tech connections, set professional standards and pressure Congress.
But at the AMA's annual House of Delegates meeting in Chicago last week, the problems of membership attrition and red ink surfaced frequently in both committee and floor debates. The 550-member house sets policy for the AMA, which represents about 30% of the nation's 735,000 doctors.
A proposal introduced by the Oregon delegation urged the AMA to consider automatically granting membership to all doctors without dues payments. Although dues money is important, the resolution said, across-the-board physician representation is even more so.
Membership dues accounted for 25% of the AMA's total operating revenue of $242.8 million in 1999. The proposal did not address how that revenue would be replaced.
The house decided the board of trustees must study the proposal further before considering adoption of a free-membership policy. Meanwhile, annual dues of $420, with substantial discounts for residents and new doctors, will remain in place for the next year.
"We've got to be able to find revenues before we can give away membership," said Ted Lewers, M.D., chairman of the AMA's board of trustees.
Although it has responded to last year's acute fiscal shortfall with various budgetary cuts (June 5, p. 8), the AMA is pinning its future recovery in large part on information technology initiatives. Executive Vice President E. Ratcliffe Anderson said the AMA's goal is to double its nondues revenue in the next five years, with technology products playing a major role in that effort.
"We must do more with technology to remain viable," Anderson said. "What I've done is direct staff to plan an overall strategy to promote our survival and success in the Internet economy. We are probably the most data-rich entity anywhere in the world of medicine. We want to provide that (information) to our members."
Included in that push is Medem.
com, a San Francisco-based online health network that the AMA and six specialty societies created. Medem launched its first product, Your Practice Online, at the AMA's annual meeting. The customized World Wide Web site allows a physician to provide patients with selected content from Medem's partner societies and other clinical practice information. Revenue will come from a combination of sponsorship, e-commerce and licensing.
The AMA also has made several of its publications available online, including American Medical News and the Journal of the American Medical Association and its archives.
Where cuts have been made, including the layoff of 80 employees, the AMA stressed its new strategy of fiscal discipline and what it sees as its core programs.
"We are shifting from a requirements-driven spending budget to a resource-based spending program," said Yank Coble, M.D., AMA trustee and finance committee chairman, in a speech to the House of Delegates.
Thomas Reardon, the AMA's immediate past president whose term expired last week, said budget cuts, ranging from 7% to 25%, have been imposed in every unit of the organization, including the board, the house and its councils.
Funding cuts do not always mean service cuts, officials said. In the wake of shutting down the business arm of the American Medical Accreditation Program, or AMAP (March 27, p. 12), for example, the delegates adopted a board report that outlines the AMA's continued role in setting standards. The board may not fund the accreditation business, but Reed Tuckson, M.D., senior vice president of professional standards, stressed that the infrastructure, staff and resources for the AMA's clinical performance-measurement efforts were untouched in the budget cuts.
The AMA will continue its work with the Performance Measurement Coordinating Council, a collaborative venture of the AMA, the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance. Tuckson said the PMCC is working on performance measures, which are based on clinical guidelines, in 12 areas. The measures are designed to be used by physicians, hospitals and health plans. The PMCC will soon release its first report, on diabetes, and others on cardiovascular and prenatal care will follow.
Another issue continued to surface at the meeting--a call to AMA delegates to urge their colleagues to help pressure for passage of the patients' bill of rights in Washington. With crowd-rousing announcements from Lewers and others on the progress of their lobbying efforts, AMA leaders rallied the troops and emphasized the organization's political advocacy on behalf of its members and their patients.
"We are one vote away in the Senate from winning an historic victory for our patients," Lewers said. "Let's give it everything we've got. With your help, we will win this battle."
Such speeches helped create an air of optimism among delegates, despite fiscal and membership woes.
Evoking the adage "better late than never," the delegates joined the burgeoning list of provider groups lobbying Congress for additional Medicare dollars, seeking as much as $2 billion in federal budget surplus dollars for physicians.
"Physicians have been under Draconian cuts since 1985, and this is the time to go to Congress, as hospitals did, and get more money," Bohn Allen, M.D., of Arlington, Texas, told the delegates.
The money would be added to the Medicare physician fee schedule, which this year is expected to pay a total of $33.1 billion, according to the Congressional Budget Office.
Providers last year sought and won $16.1 billion over five years in increased payments from Medicare, Medicaid and the State Children's Health Insurance Program. Early this year, hospitals started lobbying for another $25 billion over five years. A month ago, Medicare HMOs said they want $13 billion over five years.
Two weeks ago, the Senate Finance Committee was asking physicians for their wish list. Until its house vote, the AMA didn't know what to ask for. Its members did know they didn't want hospitals and nursing homes to get all the presents.
In other House of Delegates action, following in the footsteps of some state medical and specialty societies, the delegates approved the addition of a public, nonphysician member to the board of trustees. The external board member, who will likely be elected within the next 12 to 18 months, would serve a two-year term with a maximum tenure of three terms, or six years. The trustee will be a full voting member but won't be eligible for elected leadership positions or to vote in intra-board elections.