January 1997 Bulletin

Policy initiatives get high marks

A major evaluation of the Academy's health policy activities and positions has found the fellows supportive of the Academy's initiatives. The ratings for health policy activities ranged from "extremely" to "moderately" important. Most respondents reported the Academy's efforts have been effective. The fellows gave high marks to all of the Academy's positions on health policy issues.

The views of fellows, the public and policymakers were researched last fall by the Task Force on Public Education and Advocacy to determine the outcomes and value of the Academy's policy programs. It is the first evaluation since the Academy became proactive on health policy issues in 1993 when the Clinton administration began moving aggressively to change the health care delivery system.

The report includes survey responses from 587 fellows, comments from four focus groups of people between the ages of 24 and 80 and telephone interviews with staff persons at House and Senate committees and federal regulatory and granting agencies.

The survey found that fellows believe the most important Academy policy functions are to represent their interests with legislators in Washington, D.C.; at the Health Care Financing Administration; and on the AMA/Specialty Society Relative Value Scale Update Committee (RUC).

Ninety-one percent of the respondents are aware of the Academy's Washington activity; 84 percent of activities with HCFA; and 67 percent with RUC. The interest in Washington activity is expected. Although HCFA and RUC activities affect reimbursement, many fellows don't understand what the Academy does in these areas, said Alan Morris, MD, chairman of the Task Force.

Most respondents-in the range of 90 percent and higher-said the Academy has effectively informed members on positions, legislation and managed care issues; on building coalitions with other organizations; and on representing their interests with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), regarding research funding. But building coalitions and NIAMS were rated the least important activities by the fellows.

Seventy-nine percent of respondents believe the Academy has been effective in its efforts to represent members' needs in Washington, which was the area of greatest importance to the fellows. Dr. Morris believes that "given the expectations and hopes of fellows to get a legislative solution to their problems," it is not surprising that the response about effectiveness is short of the level of importance they gave to Washington activity.

The fellows gave a 70 percent effectiveness rating to activities with RUC, 70 percent with state legislative and regulatory agencies and 64 percent with HCFA.

Analysis of the fellows' responses requires that the reader examine what members of various practice settings said. For instance, fellows with less than 15 years in practice were less aware of representation with NIAMS than those fellows who were in practice for more than 15 years. The same is true about awareness of activities with RUC.

Fellows in an academic setting- 10 percent of the respondents- gave a higher importance rating to NIAMS representation than those in nonacademic practices. The same split is seen on issues involving "gag" clauses, information disclosure and Medicare issues such as funding for practice cost payments. Academics perceived medical liability reform, antitrust reform and medical savings accounts as less important than nonacademics.

Another breakdown of the survey respondents shows fellows who have served on Academy committees give a higher importance rating to NIAMS representation than those who have not served on committees. Fellows with committee service are more aware of Academy policy activities than those without committee service.

Both academics and fellows who have served on committees rate funding for graduate medical education more important than nonacademics or those with no Academy committee service.

Overall, the fellows were very satisfied with the performance of the Academy which included the quality of continuing medical education, staff helpfulness and responsiveness to members.

The focus group sessions found that the public was generally well-informed about the type of disorders orthopaedic surgeons treat. The groups knew that orthopaedic surgeons did specialty training after medical school. The participants knew that chiropractors were not medical doctors, did not perform surgery or prescribe drugs and had less training than orthopaedic surgeons. They believe podiatrists treat only feet and ankles and generally less serious problems, "whereas orthopaedic surgeons treat backs, legs and arms, as well."

The policymaker interviews disclosed that they thought the Academy staff had done an excellent job, that the information provided by the Academy was useful. Most of the policymakers had contacted the Academy staff for assistance and found the Academy responsive to their requests.

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