AMA to White House: Don't Dictate Care

John Commins, for HealthLeaders Media , March 9, 2009

However, some healthcare policy experts believe that—in order to achieve systemic savings—the patient-doctor relationship will be greatly affected by evidence-based medicine.

Bill Roper, MD, the CEO of UNC Health Care and the former director of CMS and CDC, supports evidence-based medicine. However, he told HealthLeaders last week that the public will most assuredly have to make sacrifices in their own healthcare services to make any meaningful reforms work. "To cover those other approaching 50 million uninsured people means taking something that is currently being spent on you and me and spending it on a person without health insurance. That by any other name is a sacrifice," Roper says.

Roper says evidence-based medicine "means we will come up with better information on what works in what setting and that means we will say 'no' to your request for knee surgery or x, y, or z procedure."

"That means a sacrifice. The American people are owed our honesty in this debate and I'm delighted that we are beginning to do that," Roper says. "To go around saying, 'We have the world's best healthcare system,' which we don't, and saying, 'You can keep every bit of healthcare you got if you want to keep it,' are just not going do it."

Whatever healthcare reforms emerge in the coming months and years, Nielsen says she's not sure how it will impact physician compensation. "I think they will probably be paid differently," she says. "I haven't heard people talking about cutting the payments, although there have been some comments about certain areas. In the stimulus bill, they put in some things that are going to make it harder to get imaging unless it appears appropriate for that patient. So, there are areas that groups of doctors are obviously going to be concerned about and try to deal with."

"We really have to focus on the needs of the patient first and then we will definitely make sure that doctors can stay in practice," Nielsen says. "The last thing you want as a nation is to do something that is going to so demoralize those clinicians that they would hang it up and leave the practice. And if you read the president's budget, they recognize that Medicare and Medicaid underpay compared to private plans. They know that clinicians have to be paid somewhat comparably to those private plans. Otherwise it isn't going to work."

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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