Physician opinions and feedback are much in demand. We are asked hundreds of questions by our patients, our staffs, physician colleagues and friends. Email links to surveys and questionnaires arrive in abundance and urge us to respond.

But, whether you suffer from survey saturation, opinion overload, or feedback fatigue, I urge you to participate in yet one more request for information.

The Physicians Foundation is seeking input from every practicing physician in the U.S. in a survey designed to provide a “state of the union” report on our medical profession. It will examine the morale, career plans and practice metrics of today’s doctors.

What is the Physicians Foundation? It is a non-profit grant-making organization of state and county medical societies formed to help practicing physicians succeed in a changing health care system. It exists to ensure the physician perspective is presented.

The survey will be emailed in March to every practicing physician in the country. In the words of Walker Ray, M.D., vice president of The Physicians Foundation: “If the survey indicates that the medical profession itself is in jeopardy, then that urgent message must be heard both by policy makers and the public.”

Data specific to Indiana will be provided to the ISMA and communicated back to you in ISMA Reports, so I hope you will participate. We’ll be interested in your perceptions.

“May you live in interesting times,” as the Chinese proverb says. And, we do.

Barely three weeks after reducing insurance coverage for part-time employees and raising premiums for full time workers, Wal-Mart announced it wants to become the “largest provider of primary healthcare services in the nation.”

According to a report on NPR and Kaiser Health News, one wag remarked, “If you get someone in the door, you can also sell them milk and a shotgun.”

At this point the retailer is requesting proposals to help them meet their goal of “managing and monitoring patients with chronic, costly health conditions like asthma, HIV, arthritis, depression and sleep apnea.” This is after Wal-Mart’s previous efforts with in-store clinics slowed as investment capital dried up. Most recently, the retailer turned to leasing space to hospital systems, but that effort, too has struggled, according to media reports.

It will be interesting to watch to see who responds to Wal-Mart’s proposal in this third effort. And will their employees get a discount on care to make up for their increased premiums or lack of insurance?

What do you think about this new attempt at providing health care?

A recent study compared physician fees in the U.S. with those of physicians in dissimilar health care systems in other countries and concluded the U.S. has higher fees and higher health care costs.

Did we need another study to tell us that? We already know that health spending is about 17% of GDP.

The study totally disregards that physician services account for one-sixth of health care costs in the U.S., and this segment is growing more slowly than other segments of health care spending. Yet, across the U.S., physicians’ average incomes have not kept pace with the rising costs of managing an office.

In his article, “How Doctors Could Rescue Health Care,” published in The New York Review of Books, Arnold Relman attributes four-fifths of health care costs to hospital and nursing home care, payment for drugs and other medical products and the overhead of private insurers. Indeed, he points to the Center for Medicare and Medicaid Services’ (CMS) actuarial study that found the insurance industry’s overhead and profits alone add $152 billion to the cost of care.

That said, what we need to focus on in this time of health reform is how we improve our health care delivery system. We do not have unlimited resources. We need to work together to provide the best use of current resources and to coordinate and improve care for all of our patients.

We need your help to urge Congress to repeal the Sustainable Growth Rate (SGR) once and for all. We are all well aware that inaction or “kicking the can down the road” as Congress has done for years leaves doctors stuck with a 30 percent cut in Medicare pay beginning January 1.

Early results from a survey of ISMA members currently available on our website tell us that if the cut occurs, just over one third of those responding will consider not accepting new Medicare patients. Nearly 45 percent say they will opt out of Medicare and require direct payment. While these percentages sound large, our sample is small. We need more of you to respond here.

MedPAC proposal not following doctors’ orders
In early September, the Medicare Payment Advisory Commission issued its own recommendation to repeal the SGR using a broad range of budget offsets. The proposal calls for a freeze for primary care and 5.9 percent cut for all of the other specialties for each of the next three years followed by a seven year freeze. The proposal will be voted on at MedPAC’s Oct. 6-7 meeting.

AMA President Peter Carmel, M.D., says MedPAC’s recommendations are misguided.

The new cuts are inconsistent with MedPAC’s previous recommendations to stop cuts to physicians who care for Medicare patients. The AMA and the ISMA oppose the MedPAC proposal for offsetting the cost of repealing the SGR. The combination of payment cuts and freezes it suggests will reduce patient access and derail delivery innovations just beginning that are key to lowering health care costs.

Joint Select Committee on Deficit Reduction action
The ISMA has joined the AMA and 117 other state and national medical specialty societies in a sign-on letter calling for the Joint Select Committee on Deficit Reduction to include the SGR repeal in its final legislation. The “supercommittee” held its first hearing Sept. 13. Their recommendations are due by Nov. 23. You can encourage the committee to repeal the SGR here.