When Lexington physician Ardis Lee Hoven, M.D., is inaugurated as the American Medical Association’s president during its annual meeting in June, it will have a new voice to articulate the AMA’s work in support of this nation’s physicians and patients. The organization will have an eloquent and persuasive speaker to express their concerns about the direction of the healthcare industry in this time of legislative change.
But when politicians talk about improving healthcare access to all Americans, then add barriers inhibiting the work of this nation’s healthcare providers, Dr. Hoven will exchange eloquence for plain speaking.
“The fed talks about improving healthcare, then keeps old regulations that limit the numbers of new healthcare providers in the workforce? That’s stupid,” Hoven said. “That’s not the way to improve the quality of healthcare in this country.”
Hoven, an internal medicine physician and infectious-disease specialist at the University of Kentucky, is the third woman president of the 166-year-old American Medical Association. Earlier this year, Modern Healthcare magazine named her one of the 25 most influential women in healthcare. Advocacy on behalf of healthcare providers and their patients has always been an important aspect of Hoven’s professional life.
Even before her official leadership roles with the Kentucky Medical Association in the mid-’90s and the AMA in the last two decades, Hoven was outspoken on a variety of issues affecting physicians and their patients, and remains so.
“I care a lot about access to healthcare for all Americans. I have been passionate about this since early in my career,” Hoven said. “We should be working to ensure that people have access to the right care at the right place at the right time with the right physician or clinician.”
There should be no compromising on this most basic aspect of healthcare delivery, she said.
Hoven applies passion to her regular medical practice. In addition to her active leadership roles as a clinician and professor at UK, she served a term as president of the Kentucky Medical Association and served on many committees and councils at the state and national level. These include an appointment to the AMA’s Group Practice Advisory Council, six years on the Utilization Review and Accreditation Commission, and a seat with the AMA Foundation board of directors.
In 2005, Hoven was selected for the American Medical Association’s board of trustees, and for the past five years she’s been on the AMA’s prime leadership track. In 2010-11, she was chair of the board of trustees and served as immediate past chair for 2011-12. Hoven then became the AMA president-elect.
Coincidentally, immediately following her term as AMA board chair, another Lexington, Kentucky physician, Steven Stack, M.D., an emergency medicine physician with KentuckyOne Health, succeeded her.
While the term of AMA president is one year, the position demands a three-year commitment, Hoven explained. As president-elect she learned the responsibilities and expectations of the position. She has collaborated with the current president, Jeremy Lazarus, a psychiatrist from Denver, Colo. When she succeeds him, Lazarus will fill a term as immediate past president, and Hoven will assume that post in June 2014.
Voice of an entire profession
The main job of the president is to communicate with physicians and be their collective national voice.
“The membership sets the AMA agenda. It is my job to listen to what they say and be the filter of that information to the AMA trustees and board of directors,” Hoven said. The president also needs to make sure that the AMA membership is aware of what the organization is doing on their behalf.
“The most important aspect of the president’s job is communication. Throughout my year as president-elect, I have been traveling the country and speaking to state medical associations as well as national and state specialty groups. You have to be diligent in keeping the membership up to date on the AMA’s strategic plan and how the national association is being an advocate on behalf of physicians and their patients,” she said.
To accommodate the demands of her new position, Hoven will suspend her clinical duties for her presidential term to spend her full time communicating the interests of the AMA membership. The president is a message bearer for the AMA, representing the interests of members, the policy positions set by the House of Delegates and the strategic focus as set by the Board of Trustees. For a year, President Hoven will be the vessel to carry the AMA message forward.
“Being president does give me an opportunity to accentuate some areas of the AMA’s work that are of particular importance to me,” she said.
Removing caps on graduate medical programs
High on the AMA’s agenda is removing federal caps on the nation’s graduate medical programs and restoring funding for these programs. This issue cuts to the core of Hoven’s basic beliefs in removing barriers to healthcare access.
Numerous studies on state and national scales reveal alarming statistics on the impact a shortage of health professionals is having on some areas of the United States. Residents in teaching hospitals across the country are shouldering a disproportionate burden of care delivery to increasing patient populations, Hoven said. But while there is a lot of talk in Washington, D.C., about improving access to medical care, federal actions are moving the nation in the opposite direction.
“It’s not just a physician shortage we have in this country. We suffer from a nursing shortage and an allied health professional shortage,” Hoven said.
In spite of talk about incentives to encourage more people to enter the healthcare profession, federal spending in medical training programs is being cut. Students who have earned medical degrees and demonstrated their competence can’t get into residency programs because spaces are limited.
“It takes from seven to 10 years to ‘grow a doctor,’ ” Hoven said. “Teaching hospitals like UK and UofL are doing their best to put new providers into the system every year, but it takes time and there are just so many applicants they are allowed to admit.”
These imposed limits, which date back to 1997, mean there will be a constant and growing imbalance between the nation’s need for providers and teaching hospitals’ ability to supply them.
The long-term results of such a paradoxical federal policy will be a failure of reform efforts to improve healthcare access because provider shortages will increase, the existing provider population will remain overworked, and that state of being overworked will be a disincentive for others to get into the healthcare profession.
For healthcare reform to be meaningful in the long term, Hoven said, the AMA believes caps on residency and fellowship program admissions must be removed. At the very least, their parameters should be updated because they are more than 15 years old.
“We know this is a huge step to make happen because caps are tied to federal funding, and there is a huge battle being waged over any kind of spending,” Hoven said.
When it comes to federal funding policies, she argues, there is a big difference between wasteful spending and investing in programs that will have a net beneficial effect on the quality of life in this country.
“When I think of how this country can improve on its graduate medical education program and increase the numbers of new providers entering the professional ranks, Washington’s resistance is not the way you want to do things,” Hoven said.
‘Affordable Care Act is far from perfect’
The AMA supports the Patient Protection and Affordable Care Act – also known as Obamacare – because of its general stated goal of improving healthcare access. However, Hoven said, “The ACA is not a perfect piece of legislation by any stretch.”
One the first major issues the AMA would like to see changed in the ACA is the elimination of the sustainable growth rate method as the formula for calculating Medicare reimbursements to physicians.
“The SGR is a flawed formula that has been in place for far too long,” said Hoven. “We have strong bipartisan support to repeal the SGR formula and replace it with something based on the actual costs of delivering care.”
However, concerns about ballooning Medicare costs and their detrimental effect on the federal budget have not gotten traction among U.S. public policy makers. In fact, last February the Congressional Budget Office reduced its Medicare cost projections by about $100 billion.
The AMA opposes the ACA’s provision mandating the creation of the Independent Payment Advisory Board (IPAB) as a means to control Medicare costs and has several concerns about IPAB’s function. Chief among them is that the board’s membership will consist largely of political appointees making decisions about across-the-board payment levels to providers treating Medicare patients.
“IPAB is not the approach. We need to fix a bad situation. One cannot fix a problem by adding another bureaucratic layer to it,” according to Hoven. “It’s not justified.”
AMA backs Medicaid expansion
One of the more contentious issues in the Affordable Care Act is the expansion of Medicaid benefits to families with incomes of up to 133 percent of the federal poverty level. It is a provision that has been upheld in legal challenges, but many states are still weighing the potential benefits against the long-term costs and there is no deadline for a final decision.
The American Medical Association argues states will realize a net long-term benefit as a result of adopting Medicaid expansion.
“The additional people who would qualify for Medicaid benefits are already in the healthcare delivery system,” said Hoven, explaining that these are people accessing care more expensively and inefficiently in the wrong place and by the wrong doctors. The current system encourages the use of emergency rooms as primary care offices.
This population is not getting regular physical exams and now has no incentive to schedule well-care visits that could detect problems early, when care can be rendered at a lower cost. Rather, they wait until problems become emergent or acute, requiring costly long-term treatments that may not be as effective. According to the AMA, fiscal analyses of Medicaid expansion shows states will realize long-term cost savings and improved healthcare quality if it includes establishing expectations for people to get ongoing front-end care and follow through on a prescribed regimen, Hoven said. On this issue, she let her focus narrow to Kentucky concerns in particular.
“When you have folks out there – we’re talking hard-working, wage-earning families who don’t qualify for Medicaid but can’t afford basic medical insurance – then the issue goes beyond a state or federal budget line item,” she said. “It’s simply the right thing to do.
Josh Shepherd is a correspondent for The Lane Report. He can be reached at [email protected]