“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?

I joined organized medicine because it seemed that it was the thing to do. I thought it was kind of the norm.

Now our ranks are diverse… not only in our specialties and interests, but also in our employment models.  The day of the single practitioner is almost a thing of the past. More and more we see our colleagues becoming the employed rather than the employer.  But we are all still trained the same, and we still have common concerns, fears and aspirations for our profession.

Recently I read through some interviews that were conducted with several young physicians around the state.  There were only a handful of questions.  One of them asked how you describe the ISMA to a colleague.  Answers included “an organization in the state that helps educate physicians”, “an organization that distributes legislative news” and one individual that stated they didn’t know enough about the ISMA to describe it.

Another question asked, “What professional issues concern you?”  The answers were diverse but not surprising.  Concerns arose about the health care bill, loan repayments and the future role of health care. But the point I wanted to make is that while we are all physicians, we find ourselves in different situations and work models.

It is for this reason that I feel one of the tasks at hand this year is to look inward on our organization and see what we need to do to continue to make the organization appealing and viable, not to a few, not to just primary care, not to just solo or private practitioners, but to each and every physician in our state. 

In short we need to make joining our medical association the thing to do again!

At a spring retreat, the ISMA Board will consider the changing landscape of medicine and the ISMA’s role in it. If you have thoughts, please share them.

As I take office as President of the ISMA, we face unprecedented challenges in our profession from health reform to reimbursement… from malpractice to membership…from competition by non physicians to changing practice models.  But challenges will create innovation throughout the tumultuous times ahead, and we need to keep our eyes open to opportunities. 

That said, a daunting task confronts us: Fixing the Medicare payment formula. There is no agreement in Congress on how to fix it or on how to pay for it, and each band-aid increases the cost of a fix by billions of dollars.

We appreciate that the 21% cuts were delayed in June, but we still face the same crunch in November.  If the law is not changed, 2014 rates could be 40% less than 2009 payment levels.

Access to care for Medicare patients is already an issue in Indiana.  Fourteen percent of Hoosiers are Medicare patients, which is above average when compared to the rest of the country. And our ratio of 15 physicians per 1000 Medicare beneficiaries is well below the national average.  

So, I see an opportunity for all of us.  We have a potentially historic midterm election coming up this fall.  I urge all of you to make sure you use your voting status and remind Congress that they work for us, not the other way around.  And keep up the pressure to spur them to act on Medicare payment reform.

The ISMA will be doing its part, but it would help us to know how you will handle further Medicare reimbursement cuts in your practice. Will you stop seeing Medicare patients? Limit new Medicare patients? Reduce services you provide? Have you talked to your patients about this problem and how it affects their care?  Congress needs to hear from all of us.

This is the initial episode in a new adventure for the ISMA leadership. At the urging of some past presidents and with the help of Adele Lash and the Technical staff, we are launching this new feature for the ISMA website. It is my plan to have it become a blog that is alternately written by various leaders of the ISMA, and we will also call on the past presidents to offer some blog columns ... thereby, proving once and for all, that no good deed goes unpunished.

One of the first things we need to address is what are we going to call this blog. The AMA calls its blog “On the road with Dr. Wilson.” Last year, it was “On the Road with Dr. Rohack.” I think you see the catchy method behind their blog name. However, I seem to remember that there were a couple of other people using the  “On the Road” theme. Anyone remember Charles Kuralt, Jack Kerouac, or Willie Nelson?  

We had considered “What’s up Doc” but felt that Bugs Bunny or Warner Brothers would object; however, I have since discovered that there are two TV shows, one movie starring Barbara Streisand and Ryan O’Neill, a song, and a segment of “The Daily Show” similarly named, so. ... Maybe there is still hope for that title because it seems to have become part of the public vernacular and not the province of any one person or organization.

“Interesting Times” comes from my inaugural address when I offered one of my favorite Chinese proverbs that can be taken as a blessing or a curse. It is: “May you live in interesting times." I think there is no doubt that we live in interesting times. The challenge is for each of us to make this a blessing and not a curse.

Please fill free to comment and help with the naming of the leadership blog. 

I also recommend visiting the "On the Road with Dr. Wilson" blog here.