Dr. Ardis Hoven, President of the American Medical Association

Mark Masselli: This is conversation on Health Care, I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well, Margaret here we are another year over and a new one just
beginning.

Margaret Flinter: And it’s expected that by the end of 2014, there will be millions of
Americans newly insured and many of them newly entering the Health Care system.

Mark Masselli: Margaret, I think it’s also interesting to know that part of the story that
isn’t getting mention ed as of – it’s expected some 15 million low income Americans
will be covered by Medicaid expansion that will be significant number of new fully
insured American citizens.

Margaret Flinter: And perhaps w e’ ll have a profound impa ct on things like use of the
emergency room and bed outcomes to chronic illness the consequence of lack of
prevention so, a terribly important aspect to the health care law because it really
aims at protecting the most venerable populations and I do believ e th is will have a
impact on the public health.

Mark Masselli: The W hite H ouse also announce another option for those Americans
who insuran ce plans have been cancelled and they can’t find coverage at a similar
cost they will not be charge d a penalty and can opt for catastrophic coverage plan
that was res erve for Americans under 30 years of age.

Margaret Flinter: It’s kind of a short term pleasure I think because I want to remind
people that you really are much better off finding a plan that cover s all t he essential
benefits that the health care l a w cost for that where you really get value for the dollar
and much more comprehensive coverage including prevention.

Mark Masselli: All of these changes in he alth policy are effecting the medical
profession as well in our guess today have a k een insi ght int o that side of the
equation.

Margaret Flinter: We ’re re visiting our conversion with Dr. Ardis D Hoven President
of the American Medical Association should be talking about the policy initiatives on
the way to help practitioners get up to speed with all of the changes impacting health
care in this country from h ealth IT ad option to changes in payment to really the
transformation of delivery . And AMA along with other professional groups working
very hard on the policy si de to try and protect the interest of folks and the ir
profession as well of course as their first obligation protecting their patients.

Mark Masselli: Lor i Roberson managing editors of FactCheck.org stop s by .

Margaret Flinter: And no matte r what the topic you can hear all of our s hows by
Googling CHC Radio.

Mark Masselli: And as always, if you have comment email us at chcradio.com or find
us on Facebook or Twitter, we’d love hearing from you.

Margaret Flinter: We’ll get to our conversat ion with Dr. Ardis Hoven in just a
moment.

Mark Masselli: But, first here’s is our producer Marianne O ’ Hare with this week ’s
Headline News .

Marianne O ’ Hare: I’m Marianne O ’ Hare, with these Health Care H eadlines. 2014 is
barely under way and the changes continue to the health law open enrolments start
date is being delayed to November in this year. And, well only half a number of folk s
sign ed up for insurance in the online market places during the current enrolment
than the White House had hope f or . B usiness will continue to be b risk according to
analysis and should continue to keep a st eady pace , young invisibles not turning up
as much as they had hope d either those young folks under 30 who would meet
health coverage and could qualify for a cata strophic health plan, so far those
numbers are fallen short of pa ce and expectation. And a view around the states
well, it depends on where you are, if it’s California, New York, Kentucky,
Pennsylvania or Connecticut the numbers show robust activity o n th ose state base
exchanges . But , the states without exchanges or seeing many more challenges for
folks interested in shopping for health coverage online . In Colorado the sign up is
been has been slow even though they have set up their own exchanges there
sending mobile unites around to grocery stores as one method to capture folks who
need to sign up for health coverage. And in Iowa distance is an issue a lot s of rural
folks are far from any center where they mig ht gain assistance helpi ng them with
those online insurance market places . The multibillion dollar vitamins supplement
market has taking a hit, a recent study out shows that day for the most part do very
little good for someone ’ s overall health and may ac tually do harm in case s. The
study sites the importance of gaining nutrients directly from the food you eat. I’m
Marianne O ’ Hare, w ith these Health Care H eadlines.

(Music)

Mark Masselli: We are speaking today with Dr. Ardis D Hoven a 168 P res ident of
the American M edical A ssociation and the third woman to hold that position in the
nation’s oldest and largest physician organization . Dr. Hoven serves as the AMA
representative on the board of directors of the national quality form with seeks to
improve h ealth care delivery in this country . Dr. Hoven is an intern ist in infectious
diseases specialist focusing on HIV, AIDS in Kentucky . Where she also s erve as
P resident of the Kentucky M edicals A ssociation from 1993 to 1994 she is a member
of the American C ollege of P hysicians and I nfectious D iseases S ociety of A merica
Dr. Hoven w elcome to conversations on health care.

Dr. Ardis D Hoven: Thank you.

Mark Masselli: You know we are in a new phase of the implementation of the
Affordable Care Act in your orga nization of the American Medical Association has
over 200,000 members since taking office in June, you have said that it's time for the
medical profession to embrace the Affordable Care Act and start to exploit the laws
potential for improving public healt h and the health care profession. So can you give
our listeners an assessment of where your membership stands?

Dr. Ardis Hoven: As you are aware, we knew at the frontend that the Affordable
Care Act was not a perfect piece of legislation. But in fact i t had some very
important elements that w e thought are v ery important to support . And would
continue them to work on making adjustments and changes to correct the things in
the legislation that we felt we re not in the best interest of the American people.
Having said that for the physician community is actually been leading in much of the
change in some ways out there . I f you think about what is happening now and w ork
around model, models of care, delivery of care so the p hysician community has
tak en up a significant lead here in helping to enact many of th ese changes.

Margaret Flinter : Well Dr. Hoven I think we ’d all probably agree that the our end
signs of medicine are undergoing some significant changes in the way we are
delivering it to the public a nd so you talk ed a little bit about some of the changes
around things like care coordination and the changes in how teams are arrange d that
are beginning to make a difference . But what do you think the most dramatic
changes for the medical profession are going to be and particularly for a physician s
on the frontlines.

Dr. Ardis Hoven: Well what we see is that we know we have to innovate and change
the way we deliver care in this country . It's not just about delivering care, it's also
about the cost of c are, the quality of care and the health of our patients . And so we
see one of the most important pieces of this is looking at how health care is being
deliver ed various models of care, for example, we have seen work around something
called Accountable Car e Organization s , we talk about the primary medical home
model . Another way in which particularly folks with chronic diseases are well
manage d to their bett erment and to, to improving the quality and cutting down the
cost. So there are a lot of different models and play out there. This is where the big
chang e s going to take place and the physician community is ready to embrace this.
So those changes are out there are under way and we will direct our attention to
them and be appropriate in our responses to them.

Mark Masselli : Dr. Hoven we’re going to see millions of mor e American s enter in the
health care arena and where there is predicted to be shortages in the primary care
providers . I know the AMA s liaison committee on medical education has advocat ed
strongly for an increase at medical schools and there are a number of new medical
schools opening up across the country. What vision does the AMA have for
responding to the growing health care needs in m aking the g round more fertile for
enticing medica l students to choose the path of primary care?

Dr. Ardis Hoven: Specifically the AMA ’s work has been directed in many ways
around one of our new strategic direction as you alluded to which is medical
education reform . And we know that in this country, w e have more medical student s ,
we have more medical schools, we have more patients to be seen and yet we have
an obstruction if you will in the whole concept of graduate medical education , which
is th at training p iece which occurs between graduating for med ical school and then
going out into practice. So the AMA has been very specific in looking at GME
funding how that’s going take place but it is also now looking its part of its strategic
focus on ways of changing educational innovation. Team base care is going to be
taught in medical school, it's being taught now, team base care being p hysician le d

care but at the same time allowing all health care professionals to function at their
highest level of training and expertise . And i t's that team care that’s going to afford
us the ability to manage the care that we want ed provide d in this country in a more
efficient and timely manner.

Margaret Flinter: Well Dr. Hoven, it's my understanding I think that the counseling
graduate medical education has once again convene d t o really take a look at what
might need to change . C an you give us any window into the kinds of changes , are
there other changes in terms of distribution or investment of resources or strategies
to get things right in this country that you expe ct to see or to a t least be consider ed ?

Dr. Ardis Hoven: What we are looking at now if we look at th ese various innovation
models and there have been 11 schools that we have award ed grant money due to
look at this . So that we have competency based training as op pose to just calendar
training that we are looking at pathways that are more efficient in the use of
educational time and exposure that young man and woman need. And most
importantly being able to develop and continue to maintain if you will , their
excitement and enthusiasm about doing primary care for example. We are going to
see change occurring and we’re looking all with great excitement to this.

th
Mark Masselli: We’re speaking today with Dr. Ardis D Hoven the 168 Presidents,
The Americ an Medical Association. Dr Hoven the AMA has been very active in
promoting a better system for Medicare reimbursement and the so called SGR
formula which stand for Sustain Growth Rate. And I think our listeners might be
familiar with this annual fix that goes on to sort of called the doc fix. And our current
congress there was quite a contentious lot, but there’s talk that they may actually
come to some type of agreement on SGR reformed soon. So can you tell us the
efforts that are under way and what yo u think would be the ideal solution for fixing
the broken Medicare reimbursement system?

Dr. Ardis Hoven: It's a very important issue and the one reflects over the last ten
years we’ve had 15 patches to the SGR. Now what we mean by that is thread and
cuts based on a formula that doesn’t work anymore it's based on the GDP not on
providing car e. Thread and cuts to physician reimbursement and that has been a big
destabilize if you will within Medicare. And it's threaten many practices and it's very
disconcerting for our seniors out there every year to see congress debate these and
th
then at the last minute at the 11 hours patch it kick the cane down the road and wait
till one more year appears. This years the AMA, along with our p hysician colleagues
in the state and specialty society throughout the United States c ollaborated together
and came up with a plan to tell or help congress fix the problem. And it's not only to
repeal the S G R which is the first step, but it is then the second part of this which is to
provide five years of stable reimbursement of physician practices so that they could
then begin to work on the infrastructure to moving towards innovative models of
Health Care Delivery a s we were talking about earlier. I t’s th ese models of delivery
of care which are going to be best for patients , improve health outcome s in this
country. And at the end of the day going to save on the cause of health care , and so
this is what we have presented to c ongress, we have been very pleased with a
positive uptake both sides of the isle looking at this and saying yes this is something
we should do, we must do . And I am much more optimistic than I have ever been in
the years past , about or ability to see this change. Now, again the climate is difficult,

but this is something that is fiscally responsible, if you think about it we’ve spent over
the la st ten years $146 b illion patching Medicare. It’s the right thing to do for this
country and it's the right thing to do for health care in this country.

Margret Flinter : Well Dr Hoven, when we look at how we are going to increase both
the capacity of al l primary care providers as well as influence those outcomes,
whether you look at Virtual Visits or Telehealth other members of the health care
team serving enrolls this primary care providers as well as ensure every staff
community health workers . I am sure with 200,000 members and in state all across
the country you’ve – these things have to be met with a some -- equals parts of
enthusiasm and resistan ce . And I wonder from where you sit how you work with the
different regions and the states and the sta kehold ers. What ’s your structure to try
and built a consensus and I guess the second part of that would be do you see a
generation al shift kicking in where a new generation is sort of rising up within
medicine that sees things differently?

Dr. Hoven: Le t me start first with how we get the work done , and how we determine
our policy. The AMA actually represents about a 185 states in specialty organisation
so all 50 states and then the balance being the rest of the special ty and sub -
specialty societies in the United States are represented by delegates to the health
delegate s at the AMA which is the policy setting body of the organization. It's a very
democratic organization, it's done by consensus votes . W e have supporting
carcasses that provide informati on and input into the organisation as well. So at the
end of the day the work product has been very carefully look ed at by a variety of
individuals and a variety of practice s ettings, special t y s etting and at the end of the
day, we come out of the room ha ving join together using our tools and expertise to
good use and to good policy. The AMA then takes that policy and advocates on
behalf of physicians and patients in this country. On Capitol Hill with CMS other
groups such as American Hospital A ssociatio n the payers those folks who we have
very good representation and very good working relationship throughout the country.
Youngman and women coming in to this arena now actually come with great passion
and enthusiasm. And I am very optimistic, they will c ontinue to be our leaders they
bring a view of health care which reflect s change and unsupportive of changed. And
they are going to be those taking care of us in the future not only politically but in
policy setting and at the b e d side and I’m very optimistic about th eir enthusiasm and
their knowledge. And I will tell you they are the brightest and the best we have ever
seen.

Mark Masselli: You don’t wanted to get back to reimbursements and you talked on
Medicare and the need to probably stabilize those rates. And putting in our head on
is a community health centre where we’re engaged in providing services especially
populations. We know the private physician community also does a tremendous job
in this area and as part of the Affordable Care Act , the rates were increased, they’re
often times the lowest that a practitioner will received. But all across the country
states were allowed to sort of nationalized their Medicaid rates by going up to the
Medicare levels. Any sense of how the adoption ha s gone and whether or not
physicians across the country are adding more Medicaid patients to the roles?

Dr. Ardis Hoven: I will tell you this -- the sense in the country right now amongst
physicians is they’re very concerned about Medicaid expansion only b ecause they’re

worried about obviousl y the reimbursement part of it but are they going to be able to
handle the volume . And I say that only because that’s what I keep hearing and my
responds to this frequently is you know these are patients that are alrea dy in the
health care delivery system, they’re getting their care at the wrong place at the
wrong time by the wrong person and we need to flip that formula and make it look
better. Having said that I find amongst my physician colleagues a willingness to s ee
medicate patients, a willingness to work with the system and a willingness to work
with their s tates to help make Medicaid delivery in their s tates, the best th ey can
possibly be. It isn’t easy sometimes, it ’s fiscally troubling issue for many s tates a s
you know but our physician colleagues out there works at the s tate level with
Medicaid programs and are trying to be very creative and helpful in getting access
improved for these patients.

Margaret Flinter : Well Dr. Hoven, we appreciate that and I wan t to appreciate the
fact that you in your practice career chose to specialize in HIV - AIDS care and
became and – are just a tremendous advocate for the underserved and very well
where the health disparities in our country . I know that something that the A M A is
concerned with as well, perhaps you can share with us a little bit about the A MA’s
initiatives to address he alth disparities and how do you see that work reflected in
training and practice in research across the country?

Dr. Ardis Hoven: The A MA act ually has done several things and continues to do it
over the last decade. One of the most important is probably been the A MA’s
minority affair section, which serves as a grassroots forum if you will for increasing
the voice of minority physicians in the A MA itself. This is important because it's an
important link to the minority patient population, so what it does is it brings to the
A MA a very important perspective to our discussions around issues around disparity
and professional concerns . So it provi des us real life, real time information that
enables us as an organization to be much more appropriately reactive to the issues.
The commission to end health disparities, another entity is co - chaired by the A MA
and the National Medical Association again r ecognizing that health care disparities
exists due to multiple factors including race and ethnicity and this group works
together to increase awareness a mongst p hysicians . You know the other thing
we’ve been very active in, is our doctors back to school p rogram and I’m not sure
whether you’re aware of it . But p hysicians in medical schools students across the
country visit school s and community organizations to help young minority children
realize that they can pursue a career in medicine. And it's an exciting thing, the
feedback is wonderful, this is not only African - Americans but Hispanics American
Indians and so we’re trying to look and get the percentage of the physician
population to represent th ose the people they served and so this i s something we
talk about and work about.

Mark Masselli : We’ve been speaking today with Dr. Ardis D Hoven, President of the
American Medical Association, you can learn more about her work and the work of
the AMA by going to ama - assn.org, Dr. Hoven thank you so much for joining us
today on Conversations on Health Care.

Dr. Ardis Hoven: Thank you I’ve enjoyed it.

Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care refo rm and policy. Lori
Robertson is an award - winning journalist and managing editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim to reduce the level of
deception in US politics. Lori, what have you got for us this week.

L ori Robertson: Well in late October Health & Human Services Secretary K athleen
Sebelius testified on Capitol Hill about the troubles with the health insurance
exchange website. She said it was illegal for her to obtain insurance herself on the
exchanges which led Colorado representative Cory Gardner to accuse her of lying.
It turns out Sebelius is right, she didn’t explain this to Gardner when he was
questioning her but the exchange plan can’t be filled to Medicare and relief. And
Sebelius in addition t o having insurance through the federal employees health
benefits program is a Medicare enrollee. Gardner ask Sebelius why she wasn’t in
the exchange and she initially said she has affordable coverage through work so
she’s not illegible. That’s not correc t those getting employers sponsored insurance
could buy exchange plans but it wouldn’t make financial sense in those cases as
employers often makes sizeable contribution toward workers premiums. Gardner
urge Sebelius to find a way to join the exchange and she blurred it out it’s illegal with
no explanation. Gardner later accused her of lying but as HHS explain she also had
Medicare part A making it illegal for an exchange plans to be sold to her. Meanwhile
Gardner and other members of congress and their staffers are required by the
Affordable Care Act to get insurance on exchanges in 2014 . And that’s my fact
check for this week I’m Lor i Robertson managing editor of F act C heck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us
at www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for
you here on Conversations on Health Care.

Mark Masselli: each week conversation highlight s a bright idea about how to make
wellness a part of our communities and everyday li ves. Outgoing New York C ity
M ayor Michael Blumberg is l eaving his post with another public health f eather in his
cap . Launched in May of 2013 the city bike, bike sh aring program has in a few short
months reach the milestone . In the first five months since the program launch ed city
bike users have lo gged o ver ten millio n miles in over five million rides . T he program
funded by city bank allows subscriber to join either on an annual fee of $ 95 or for
daily or weekly rates at a far reduce price . M ember s are given a key that will unlock
any of the 6000 bikes found at the 330 city bike station s in Manhattan and Brooklyn
how popular is the bike sharing program? Very, they’re reaching an average daily
ridership of 35000 the estimated number of calories burn since the program begin in
May 403 million the equivalent of 732 , 000 big ma x or nearly 419 ,000 pines of B en
and Jerry’s – Jerry Garcia ice - cream. Since taking off as M ayor Blumberg has
launch the first city wide smoking ban in building and launch the fis t in the nation ban
on trans fat in restaurant s. The bike sh aring program has been so successful the
city has plan s to sca le the program up to all five borrows adding hundreds of miles of
bike trail and thousand of bikes to newly develop bike stations . A nd another bonus
the program will over time have an impact on the CO2 adm ission from cab s and cars

Chicago and Washington DC have similar programs and have plans to scale up their
effort a s well . An affordable bike sharing program that has encourage hundr eds of
thousands of city dweller and visitor s to exercise their way to their destination
enhancing their he alth in the process , now that’s a bright idea.

Margaret F linter: This is C onversation on H ealth C are , I’m Margaret Flinter.

Mark Masselli: And I’ m Mark Michelle peace and health .

Conversations on Health Care, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.