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A Word from the President: A Long Day's Journey Into Health Care Reform

AAMC President and CEO, Darrell G. Kirch, M.D.

As this column goes to press, President Barack Obama has just delivered his State of the Union address. Renewing his commitment to health care reform, the President urged Congress to "get it done." After the long journey toward health care reform that our nation began a year ago, and with uncertainty about what action if any Congress actually will take, where does academic medicine go from here?

When I reflect upon this journey, I remember how I was frequently asked whether academic medicine would have a "voice" in the debate. I am proud to report that not only have we had a strong voice, but the way in which we have worked together as an association has been extraordinary. Whether responding to a call for action, attending an impromptu meeting here in Washington, D.C., or providing expertise, you willingly gave vital input and supported our efforts. Along the way, I am sure many of you wondered "how does the AAMC decide which policies to support or how to align with key partners?" As we look to the renewed debate in Congress, I thought it might be helpful to provide a broad outline of the collaborative model that has emerged this year.

First, we had a strong knowledge base from which to develop a dynamic working agenda. As early as spring 2008 the peak of presidential primary season we began discussions with the AAMC Advisory Panel on Health Care regarding a core set of health care reform principles. Adopted by the AAMC governance in September 2008, the panel's recommendations included three principles related to the broader issues of coverage, delivery, and financing and three focused on the unique missions of our institutions, the latter being the preservation of the safety net, the development of the physician workforce, and the advancement of research and innovation. Both in meetings with policymakers and in our responses to position papers (such as the fall 2008 "Call to Action" issued by Senate Finance Committee chairman Max Baucus), these core principles have served us well. They have enabled us to achieve the necessary balance between protecting the essential work of our missions, while at the same time striving for innovation.

Second, through the ongoing work of AAMC staff in our mission clusters of education, research, and health care, and their daily interaction with you through conference calls, email, and meetings, we have been able to anticipate a number of closely related issues at an early point. For example, because of the groundwork on comparative effectiveness research developed by our biomedical and health science staff in conjunction with the Advisory Panel on Health Care, I was able to weigh in on this topic early when asked to be a lead responder in the National Journal's health care expert blog.

Because of the daily interaction of our health care affairs staff with member hospitals, faculty practice plans, as well as residents and students, we were able to make recommendations on value-based purchasing and quality measurements. Their work also was helpful to a meeting I had at the Centers for Medicare and Medicaid Services on the definition of "meaningful use" in health information technology. And through the efforts of our academic affairs cluster, we have been able to demonstrate to policymakers the numerous ways academic medicine already is preparing new physicians to meet the demands of an uncertain health care future, highlighting innovative models of education and training. In instances where there have not been preexisting AAMC policies or position statements, we have reached out more directly to members for guidance. The valuable information you provided us whether in person, through survey data, or other means served to further affirm our credibility as a valued and trusted partner within the mix of realms medical schools, hospitals, and academic societies in which we operate. In turn, this credibility has been vital to the inevitable and legitimate policy disagreements that have arisen from time to time.

In instances where some of our most valued partners have taken a different stance, we have been able to make our position clear while continuing to partner on areas where we concur.

Looking back, it is hard to believe a year has passed since I wrote in this column about the "engaging opportunity" awaiting us to help shape the future of health care. I noted that our active participation was vital, and you have responded! We preserved the important payments on which teaching hospitals rely. We fostered new congressional champions Reps. Allyson Schwartz (D-Pa.) and Patrick Tiberi (R-Ohio)and launched the Congressional Academic Medicine Caucus (now at 47 members from both parties, and growing). Looking forward to creating the delivery system of the future, we advanced the concept of healthcare innovation zones (HIZs) in White House meetings and saw legislation on this concept introduced in both chambers. And while the issue of GME expansion is unresolved, legislation lifting the caps was introduced in both chambers, and we have laid important groundwork for future advocacy efforts. (For those keeping a scorecard, between last December and January alone, you sent 10,000 letters to Congress and the administration on this issue!)

But even more than articulating our unique issues, I am pleased with the way we have emerged as a national leader as well as a source of innovation on health care redesign, workforce planning, and other key elements of health care reform. As impressive a track record as this is, however, we need to understand that even with the "help" of legislation, achieving meaningful reform is still a long journey. That is why the model of collaboration that has emerged this year is so important, and why your continued input from the front lines of medical education, biomedical discovery, and direct patient care remains so vital.

Darrell G. Kirch, M.D., AAMC President and CEO