The Presidential Update
The Presidential Update: Usually written twice a year but more frequently if appropriate, this is a forum for direct communications between the NAMDRC President and the membership. It traditionally addresses issues that are absorbing a significant amount of time for the NAMDRC President.

November 2009

I am sending this update and greetings eight months into my two year term as President of NAMDRC.  There has been a great deal of activity addressing legislative and regulatory issues, and some restructuring at the NAMDRC Executive Office. I report with enthusiasm that we are headed in the right direction, but there are serious challenges ahead, and many unknowns.

Health Care Reform:  Perhaps one area of agreement within the healthcare debate is that the current system is financially unsustainable.  The US health care system spends or costs more than any other country, yet outcomes, quality and value of care are not commensurate. Much of the “healthcare debate” has little to do with health, but rather has focused on insurance reform and redistribution of resources. While many could benefit from proposed changes, those who do have insurance and access to care fear a decrease in services.

The NAMDRC office has done a heroic job monitoring and summarizing thousands of pages of proposals and regulations. However, the historical strength of NAMDRC has been a focused targeting of a narrower range of legislative issues that directly impact our clinical practice and our patients.  For example, as a professional society we have not stressed matters such as the physician payment formula and the SGR (sustainable growth rate), leaving those political fights to others.  When health care reform raises issues most important to us, we keep a watchful eye. As an example, numerous provisions within the House and Senate bills focus on ways to reduce costs for the chronically ill, certainly gaining our attention.

Pulmonary Rehabilitation:  We have been working for years with our sister organizations for passage of legislation that specifically authorizes coverage; we now have final rules that are described in this month’s Watchline.  Unfortunately, the expected reimbursement for rehabilitation in physician offices may hinder rather than facilitate access for patients in that venue.  Hospital based payment appears to be workable.

CMS elimination of consultation codes: Effective January 2010, CMS will eliminate recognition and payment for consultation codes, allowing that the savings in RVU will be distributed across other Evaluation and Management (E&M) codes for new and established patients, thus favoring primary care over subspecialties. The impact is difficult to predict, but we expect that consultative practices will see a measurable decrease in reimbursement across a typical spectrum of patient visits.  We will also monitor closely any proposed changes to critical care coding that would have a major impact on our members.  The coding and reimbursement for critical care telemedicine (physician work currently a CPT category III tracking code) remains a topic of debate among our specialty societies, and we are participating in the discussion.

Executive Office:  In late spring Aslan Deacon joined NAMDRC as Director of Membership Services.  She has been diligent in updating our membership renewal process and moving us to an on-line annual meeting registration.  The system upgrade required a total revamping of our membership database, which is now complete and hopefully had no effect on individual members.   Dues notices and annual meeting registrations are now possible through a secure on-line process.

Annual Meeting: Our Program Chair and President Elect, Lynn Tanoue, MD, has created an outstanding program for the 2010 meeting in California.  Two innovative features of this meeting are worth highlighting. First, if you have attended an annual meeting in the past three years and bring a registrant who has not attended in the past three years, your registration fee drops to $100.  We hope to see many old friends and new faces March 17-19 at the Hilton Torrey Pines, La Jolla, CA.  Details of this special opportunity are on our website and also available through our Executive Office.
The other new feature of the meeting will be an interactive audience response system. NAMDRC has purchased, supported by a generous grant from Philips/Respironics, a wireless system that will permit each speaker to pose questions to the attendees and immediately display responses.  We are confident that this will enhance participation and the educational experience.

In this time of uncertainty in the economy and in health care policy, we believe the NAMDRC Annual Meeting is more relevant and important than ever. Our size allows for an informal and relaxed atmosphere for direct interaction among the attendees, speakers and colleagues, along with corporate sponsors from device, pharmaceutical and home care arenas.  The educational content will be outstanding. The physical surroundings are spectacular.  We look forward to seeing you at Torrey Pines this March.

Steve G. Peters, M.D.
President