Next year, the hand surgeon from Hollidaysburg, Pa., will become president of the AMA, the nation’s largest physician organization, after long representing the interests of his state’s orthopaedists in the AMA House of Delegates. In his new role, Dr. Gurman will draw on decades of experience in orthopaedic practice to help guide the AMA as it continues its efforts to advocate on behalf of physicians and patients.
During a recent interview with AAOS Now, Dr. Gurman explained the contributions he and other orthopaedic surgeons make as members of the AMA and urged AAOS members to become actively involved with the nation’s largest physician organization.
AAOS Now: In what ways have you served the AMA? How has being an orthopaedist shaped that service?
Dr. Gurman: I’ve been a member of the AMA House of Delegates for 20 years, representing the physicians of my state. During that time, I have served as speaker and vice speaker.
The AMA House of Delegates makes the policies that govern what the AMA does. For example, if the House of Delegates adopts a policy opposing tobacco use, the AMA will issue a press release that says the AMA opposes tobacco, and we would advocate on behalf of that policy.
Many different constituencies meet in the House of Delegates, which represents every practicing physician in the country as well as medical students. Delegations come from more than 185 different entities, including the American Association of Orthopaedic Surgeons (AAOS), as well as from geographic areas and medical specialties. I am actually represented in the AMA House of Delegates by five different entities: the AAOS, the American College of Surgeons, the Pennsylvania Medical Society, the American Society for Surgery of the Hand, and the American Association for Hand Surgery.
Within the House of Delegates is an orthopaedic section council, of which I am a member. The orthopaedic section council enables orthopaedic surgeons from various constituencies to meet and pool our thoughts and ideas. We discuss the various issues that come before the House of Delegates from the orthopaedic perspective, and bring that perspective back to our deliberations within our delegations and to the way we vote in the House. It is also a chance for orthopaedists to get together and propose policy. If, in our discussions, we find that something needs to be addressed, either on behalf of our patients or from our perspective, we might draft a resolution that could become policy.
AAOS Now: What are some of the AMA’s key priorities?
Dr. Gurman: The AMA’s strategic plan has three key areas: transforming medical education so that physicians can meet the needs of our changing healthcare system; enhancing physician satisfaction and practice sustainability; and improving health outcomes, with a current focus on the 86 million Americans who are prediabetic, and the 70 million Americans with hypertension.
Many other critical issues affect these three main areas, such as implementing and using electronic health records (EHRs) and meeting the criteria for meaningful use, both of which are related to practice sustainability and physician satisfaction. Overall, orthopaedists and other physicians want EHRs to not be impediments to care. We want these systems to be tools for providing quality care.
A couple years ago, the AMA commissioned a study conducted by the RAND Corporation, a nonprofit research organization. The results indicated that many physicians are dissatisfied with EHRs, citing problems such as poor usability and the time-consuming nature of data entry. And yet, 87 percent of those surveyed did not want to go back to paper. So, the AMA is working with industry to try to promulgate best standards and best practices for the next generation of EHRs.
AAOS Now: What should orthopaedists know about the AMA?
Dr. Gurman: I’m sure there are a lot of misconceptions. Some primary care physicians think the AMA is run by the surgeons, and the surgeons think it’s run by primary care providers. Both sides are wrong. The AMA is truly a democracy. As I mentioned before, more than 185 different entities contribute to its policy.
The AMA is important for a number of reasons. First of all, it’s the unified voice of the “house of medicine.” And that carries with it a number of possibilities, responsibilities, and opportunities. The AMA can serve as a convener, meaning that when different groups need to come together—such as different groups of physicians with other entities—the AMA can help facilitate that communication. The AMA is also very important in advocacy, not only on behalf of orthopaedic surgeons, but on behalf of all of our members and our patients. The AMA has a very large advocacy office in Washington, D.C., which interacts well with the AAOS office of government relations. In addition, the AMA is the custodian of the Code of Medical Ethics, which outlines standards of conduct for all physicians.
Perhaps most importantly, the AMA speaks on behalf of all American physicians and our patients. When the AMA advocates for professionalism or patient safety, it carries a different weight than when one particular group advocates for something that relates specifically to it. That’s why I’ve chosen to get involved with the AMA.
AAOS Now: Why should AAOS members be actively involved with the AMA?
Dr. Gurman: Some issues of concern to the AMA are of tremendous importance to orthopaedists. These include, for example, narrow networks (health insurance plans that restrict the hospitals and doctors available to subscribers); bundling services and payments; quality initiatives; and the Merit-Based Incentive Payment System (MIPS) program, which is replacing the Physician Quality Reporting System, Value-Based Modifier, and Meaningful Use programs.
To address narrow networks, we are working with the federal government and with payers to at least ensure that these networks are broad enough to meet patient needs. A patient who needs to see someone in a particular specialty should not have to drive hours and hours to see a network physician if a nearby physician is credentialed to provide the kind of care needed.
The AMA is also working with the administration to mitigate the penalties and also the requirements for quality initiatives. We are finally getting the administration to understand that many quality initiatives don’t have a whole lot to do with quality—they have to do with checking boxes that don’t necessarily translate to improved patient care or improved outcomes. So we’re looking to refocus the discussion in those areas.
In addition, the AMA and AAOS are working on MIPS because the ground rules, the parameters, and the penalties that fall under MIPS are yet to be determined. These are the things that are on the horizon right now, and everybody needs to be involved in them, through the AAOS and also through the AMA.
Another example of the important work performed by the AMA involves its efforts to engage the Centers for Medicare & Medicaid Services to help healthcare providers prepare for using the International Classification of Diseases–10th edition (ICD-10) diagnostic coding system. These efforts demonstrate the many ways in which the AMA continues to be relevant to physician specialties groups.
I also want to make a point about advocacy. It’s really important that all physicians see advocacy on behalf of ourselves, our practices, and our patients as an important professional responsibility. Just as we have a responsibility to stay current with what’s going on in our field or our subspecialty, it’s important to stay current with what’s going on in Congress and in state legislatures, and to be involved in those processes. As the old saying goes, “If you don’t have a seat at the table, you’re probably on the menu.” That is certainly true in these times.
It’s important for us to engage legislatures at all levels from the start of our practices—when we don’t have anything in particular to ask for, other than to say, “I’m in this community, I plan to practice here for a while, and I’d like to get to know you.” As physicians, we need to get involved with campaigns, go to fundraisers, perhaps host a fundraiser to get to know people, and build relationships. That’s what advocacy and politics are all about. It’s important that we know somebody well enough that we can explain why a particular issue or regulation is going to make it difficult for us to care for patients.
AAOS Now: Would you like to share any final thoughts?
Dr. Gurman: Being actively involved with the AMA and representing the orthopaedic perspective has many benefits. Ultimately, the AMA will speak on behalf of orthopaedists, whether or not they are members of the organization, so why not be involved and help influence policy? All of America’s doctors are welcome to help shape what happens by being involved with the AMA and taking part in the conversation.
Jennie McKee is a senior science writer for AAOS Now. She can be reached at email@example.com