Sermo and AMA sound off on split
July 14, 2009 – 2:52 pm by Gina Monari
Sermo claims that its break with the American Medical Association was driven by physicians’ need for an alternative voice on critical healthcare issues by way of radical transparency. The AMA believes the value no longer warranted further participation and opted not to renew with Sermo in May. At the result of an online poll conducted by Sermo of 4,156 U.S. physicians in the beginning of July — which revealed that that a representative sample of the more than 100,000 physicians who use Sermo no longer want the AMA to represent them and have no intention of being an AMA member — Sermo and AMA terminated a partnership that began in 2007.
According to Daniel Palestrant, M.D., CEO, Sermo, the service first partnered with the AMA when the AMA expressed an eagerness to engage more effectively with physicians. In addition, Sermo was anxious to find an advocacy mechanism for physicians and provide the best possible resources for the physician community.
Dr. Palestrant says during the course of the two-year relationship and after dozens of trips out to Chicago, it became apparent that the AMA would rather spend millions of dollars on their own research than to hear what the physicians at Sermo were saying.
Transparency issues were not the only deal breaker, it seems. According to Mr. Palestrant, early in the relationship between the two organizations, the AMA did not hold up their end of the agreement. Originally, the AMA made a commitment to Sermo members that they would provide free access to journals and the AMA backed out of that after the contract was signed. In addition, the AMA was supposed to help physicians with advocacy by giving physicians a public voice.
“When the AMA didn’t like what the physicians were saying, then Sermo had a tough choice,” Dr. Palestrant says. “One of the funny things about mutually beneficial relationships is they have to be mutually beneficial.”
Sermo is not pursuing relationships with any other physician groups such as the American College of Physicians.
“Sermo’s growth has continued to be very strong and self sustaining and I think at this point we have developed enough of an identity that while we will continue to be open to partnerships we’re excited to let the community grow more organically at this point,” Dr. Palestrant says. “There’s probably enough of a critical mass at Sermo, that it’s not something that we’re actively pursuing at this point.”
The AMA has a different view of how things went down.
“The American Medical Association chose not to renew its participation agreement with Sermo when it expired this past May,” says Rebecca Patchin, M.D., board chair, American Medical Association. “In short, we felt the value didn’t warrant further participation. The AMA continues to engage physicians in a variety of other forums and encourages physicians to stay informed about AMA advocacy through AMA communication vehicles directly.”
According to Dr. Palestrant, there has been an explosion of advocacy organizations contacting Sermo and interacting in the medium. In addition, a grass-roots movement within the community itself has been gaining momentum, called “Take a stand. Tie a knot.” (That particular phrase was used in a letter from Dr. Palestrant about CPT codes that was posted at Dr. Scott Shreeve’s Crossover Health Blog.)
“The exciting thing about Sermo is the transparency,” Dr. Palestrant told Med Ad News. “The power is the voice that is being heard and there’s no way to really squash that voice.”
Declining membership within the AMA is being attributed to longstanding frustration with regard to the AMA’s ineffective advocacy on many issues that are critical to the future of medical practice and healthcare. Physicians have expressed dissent at the AMAs issues with transparency and conflicts of interests.
A small fraction of the AMA’s revenue comes from licensing fees, from insurance companies and pharmaceutical companies –the parties that physicians want to face off on. Another issue is the lack of transparency around the membership numbers. The AMA’s stated number of their membership is 250,000, which is about 20% to 30% of U.S. physicians. More doctors are pointing out that the 250,000 figure that the AMA is using is actually reached by including medical students, retired physicians, and people who are not actually paying membership dues into the AMA.
“If you’ve got the AMA, who is ostensibly advocating for physicians, how can that be done effectively if they have this profound conflict of interest?” Dr. Palestrant told Med Ad News. “That’s what made the physicians so angry.”
Sermo enables 100,000 U.S. physicians to collaborate on difficult cases, share clinical observations, and work together to achieve better patient outcomes than each could individually. Sermo’s platform enables physicians to aggregate observations from their daily practice, then challenge or corroborate opinions.
“The fact is the physicians of this country who are a critical component to being able to provide good care are standing up and saying this organization does not represent our position,” Dr. Palestrant told Med Ad News. “That is a major event in the healthcare of this country.
Sermo’s recent survey culminates more than 2,000 separate AMA discussions at the Website among physicians during the past three years, with the majority of those discussions highlighting frustration with AMA policy stances. Results indicate that 91% of physicians surveyed do not believe the AMA accurately reflects their opinion as physicians, 89% of physicians claim that the AMA does not speak for them, and 75% of physicians surveyed are not members of the AMA.
Physicians debate the aspects of medicine that must change for them to best treat their patients and voice frustration that the AMA has not advocated for them on critical issues. Some of the issues cited most by physicians include limiting insurance companies’ abilities to deny care; restricting the encroachment of nonqualified healthcare workers into patient care; tort reform and caps on settlements; malpractice insurance reform and adjudication by qualified boards; abolition of CPT codes; allowing physicians to negotiate collectively for an equal footing with insurers; and cost of living increases in insurance reimbursements.
During the course of the relationship, Dr. Palestrant claims that the AMA tried unsuccessfully several times to launch competing physician communities. He says that these communities may have been shut down because they were unsuccessful or because the physicians given an open community took exactly the same positions as the Sermo physicians were taking with regard to transparency issues and financial conflicts.
When contacted by Med Ad News, the AMA declined to comment on the specific accusation raised by Dr. Palestrant.
Survey results along with more than 700 physician statements can be accessed via the Sermo Blog, a public-facing dialogue that reflects the Sermo physician community’s perspective on healthcare issues of national importance.
Dr. Palestrant points out that there has been a lot of anger towards the AMA, which has not been able to provide the type of transparency that Sermo has.
“It was such a torrent of feedback that came into our community and to our support desk that ultimately we decided to put the poll out there,” Dr. Palestrant told Med Ad News. “The results are pretty extraordinary … clearly there’s consensus among our community about how they feel about the AMA.”
According to Dr. Palestrant, the more than 4,000 votes in less than a week and about 800 comments on the post show an “outpouring” of opinion from physicians in this country.
Dr. Palestrant says some insights gleaned from the partnership with AMA is that the truth always emerges within a transparent community. As much as the AMA had tried to not discuss its financial conflicts, the physician community “figured it out.”
“They pointed to the fact that showed that less than 10% if the AMA’s revenue was coming from dues and the rest of it was coming from insurance companies and hospitals, and pharmas,” Dr. Palestrant told Med Ad News.
Dr. Palestrant says when large numbers of people are brought together, the people are going to take on a personality and start to advocate for themselves. Sermo’s position has always been focused on transparency. So long as they are a licensed physician, a poster’s information goes out – it’s up to the community to self-moderate it.
“We’ve never, ever screened information,” Dr. Palestrant told Med Ad News. “Perhaps that’s what the AMA found so threatening about this medium. It’s not a hierarchy, anyone who is a licensed U.S. physician can come in and have their voice heard, and as you see from the comments in the blog there’s a lot of voices that aren’t happy right now.
In response to Dr. Palestrant’s “From the Founder” post on Sermo, AMA Board Member Joseph M. Heyman, M.D., posted the following to Sermo on July 2:
“From the American Medical Association
We need to set the record straight on the information in Dr. Palestrant’s post. The truth is that AMA membership numbers are public information, and there has been no precipitous decline in AMA membership over the last two years, as Dr. Palestrant suggests. With about a quarter million members, the AMA is the largest physician organization in the country, and through the AMA House of Delegates, comprised of elected physician and medical student representatives from all state and national medical specialty societies, it is the only physician organization that gives all physicians a voice in the future of medicine.
Twice a year the AMA House of Delegates meets to debate and vote on in public the most important policy matters facing medicine today. Last month, for example, the AMA House of Delegates met to vote on key elements of health system reform. It was a vigorous debate that ended with the following declaration of commitment: AMA supports health system reform alternatives consistent with principles of pluralism, freedom of choice, freedom of practice and universal access for patients.
At that same meeting, President Obama chose to give his major health reform speech to AMA physicians. Not only has President Obama shown that AMA physicians are integral to the health reform process, but a recent Kaiser Family Foundation poll shows that the American people trust physician groups like the AMA to do the right thing on health reform as well.
Our advocacy on behalf of physicians is well documented and unfailing. We are actively engaged to permanently fix the broken Medicare physician payment system and have a big victory on that this week. We also continue to advocate for antitrust reform, medical liability reforms, a streamlined insurance claims processing system, and so much more to safeguard the patient-physician relationship. As for relationships with insurers, we continue our high-profile fight against insurer abuses that hurt physicians and patients. More details on AMA’s advocacy on the behalf of physicians and patients is easily found at the links above and on our Website.
As for Dr. Palestrant’s sudden “change of heart” regarding the AMA, one can only speculate. He ardently courted the AMA when launching his business two years ago, and now he expresses scorn immediately following the end of that business relationship. The AMA door is always open to Dr. Palestrant and all physicians who would like to join with us to make a positive difference in medicine — especially those who feel their views differ from the policies set by the physicians of the House of Delegates. We urge you to join with us to make a positive difference in the lives of physicians and patients in our nation.”
