What made the AMA change its mind? In the statement from the organization's president-elect, Cecil Wilson, MD, he said, "We are pleased that the [Senate] manager's amendment addresses several issues of concern to AMA. It increases payments to primary care physicians and general surgeons in underserved areas while no longer cutting payments to other physicians. It eliminates the tax on physician services for cosmetic surgery and drops the proposed physician enrollment fee for Medicare."
Well, that explains why Senate Majority Leader Harry Reid rescinded the tax on plastic surgeons and replaced it with one on tanning salons. But he's not out of the woods yet with physicians. The AMA is staying at the table to make sure that, in January, the Senate permanently retracts the planned cuts in physician reimbursement, which have been postponed for only two months as part of a defense bill that President Obama is expected to sign. A few weeks ago, the House passed legislation to eliminate those pay cuts at a cost of nearly $200 million. The AMA's endorsement is a strong sign that the Senate plans to follow suit.
The other issues that the AMA and its fellow medical societies raised in early December also remain on the table. "Important issues that need to be resolved in the House-Senate conference committee include the creation of a Medicare payment board, quality improvement and Medicare data release initiatives," said Wilson. The AMA opposes the idea of creating a new Independent Medicare Payment Advisory Board that could make reimbursement decisions with minimal Congressional oversight, even though physicians would not be subject to its dictates for a decade. The association also has problems with basing a portion of physician Medicare payments on quality and efficiency data, asserting that "risk adjustment"-adjusting for the relative sickness of patients-isn't reliable enough yet to make fair comparisons among physicians. It's unlikely to win on these points, though, because both approaches are considered vital to cost control.
Ultimately, the AMA seems to be betting that physicians will be better off under reform, but it wants to make sure that their interests are advanced as far as possible within the limits of political reality.