By Christopher Guadagnino, Ph.D.

Published August 2000

• React to this article in the Discussion Forum.

Paul D. Siegel, M.D., is the president of the Philadelphia County Medical Society (PCMS).

PND: What are your primary goals as president of PCMS?

PDS: First, we want to continue the block captains program, a program of public health advocacy and public access to physicians. There are 6,300 block captains in the city of Philadelphia. We meet with 50 to 100 of these block captains at any given time in separate meetings every three or four months, together with the Philadelphia Health Department, and we educate them as to the health resources available to the people on their blocks in Philadelphia. We have published, for many years, a community guide to health care resources and a senior citizen’s resource directory. We distribute and discuss these and other resource materials at these meetings and we’ve made them available on our website. The Free Library has agreed to provide Internet-capable computers at their branches throughout the city so citizens can access this information at their local branch libraries. Resources include a list of immunizations at city health centers and specialized clinics, the corporation for aging and the state senior citizen council.

The Society has changed its bylaws. The entire board of directors is now elected by the general membership, except for two positions—the young physicians and medical students—who elect their own representative to the board. The board is about half the size of what it was, committee structure is streamlined. Previously, people had positions on the board by virtue of committee chairmanships or interest groups they represented. We want to be more responsive to the general membership, the average physician. Also, in the past year we’ve established very close relationships with our neighbors: Montgomery, Bucks, Delaware and Chester County medical societies. The presidents and the chairman of the boards meet and discuss areas of common interest where we can work together to explore joint efforts on behalf on our patients and our physicians. One area we’re looking at working on together is reaching out to the business community, especially small businesses who don’t have a full-time human resources department, to help them sort out the benefits offered by all the different health care plans. People who aren’t involved in this every day like a full-time benefits manager really don’t know whether the benefits being offered are worth the price. We think we could be helpful in that regard because health care, of course, is our bailiwick. Bucks County has instituted this type of approach and we’re waiting to see how they do and get them to show us how we can do it. This would be the first major communication between businesses and organized medicine where we think we could be of service to the business community. Then, if other areas of common interest arose, we would certainly explore them.

PND: Is there possibility of discussing direct contracting arrangements with businesses?

PDS: In the Delaware Valley the health insurers are so concentrated and the physicians are so dispersed among the four or five different health systems, that to get them together to form an IPA that could contract with industry would be a formidable task. You don’t have a critical mass of independent physicians in Philadelphia that can form or are willing to form an association.

PND: Wasn’t that one of the goals of Physician Association of the Delaware Valley (PADV)?

PDS: Right. And we who remain on the board feel that’s one of the reasons PADV didn’t go anywhere, that there wasn’t a critical mass to make it worthwhile to go out and seek independent contracts. Since I was not a part of the PAVD experience, I can’t really know why it never took off. It’s never been discussed in the last three and a half years by our board.

PND: What about the possibility of forming a regional medical society, something that Allegheny County Medical Society recently considered?

PDS: We may evolve into that over a period of years, but that is not an option at the moment. But because of our good relationships we were able to discuss it openly. Everybody agreed that maybe it’s something that should be done later, but certainly this is not the time.

PND: What other goals is PCMS pursuing?

PDS: We are very interested in improving communications. I’m chairman of the Communication Technology Commission of the Pennsylvania Medical Society, and we’ve taken advantage of that to do several things. We now have established video conferencing, so that a lot of our state medical society committee meetings are much better attended at a remote site. As a result, we’re much more up-to-date with what’s going on in the Pennsylvania Medical Society. People from Montgomery, Delaware and Bucks County have used our video conferencing to attend state committee meetings. In addition, our website has come of age: Philamedsoc.org. Our goal is to have information updated at least weekly. We now have CME available over our website for a ten percent discount. We also have the capability to poll our membership on various questions.

PND: Why did PCMS discontinue Philadelphia Medicine?

PDS: It changed format from a magazine to a monthly newsletter. The advantage is that it’s quicker to read and more up to date. We can put information into it ten days before publication. We have an editorial board that approves and reviews the content and sees to it that the website and the newsletter are integrated and complement each other. The older print publication had a certain style to it that you can’t duplicate, but it didn’t fit the needs of our members, according to our surveys. The bulk of the members seem to want short, sound-bite, USA Today-type information. If the sentiment comes back for having a more extensive publication with longer articles and more detail, such as in the old Philadelphia Medicine, we will go back to it.

PND: What initiatives does PCMS plan to address physician complaints about activities of health insurers?

PDS: We’ve established liaison with Independence Blue Cross (IBC) and Aetna U.S. Healthcare and we’re meeting with the senior management on a regular basis. An area where we think there’s progress to be made is at IBC: it’s in the process of converting—it may take several years—to a largely web-based electronic claims processing interface with physicians and health systems. I’ve been meeting with them as the process goes forward. Our goal is to try to ensure that the systems being developed will be more physician-friendly than in the past and eliminate much of the hassle factor. We will supply some physicians to beta-test the product before these systems are generally released to see that that they are compatible with and have good functionality for our physicians. In this particular instance, I think our incentives and the insurers’ incentives are aligned. Every time we have to submit another electronic or paper claim, they have to get someone to review it, and I think they’d like to get rid of that. Eliminating these wasteful endeavors will save both of us money. We’ve had three meetings with IBC, but Aetna so far has not been as forthcoming as IBC in working with us. But they all have to revamp their systems by 2002 to comply with the Healthcare Portability and Accountability Act. The current electronic systems they have are all cumbersome, they’re two generations old, they’re slow, they require very specific software that has to be different for each insurer in a physician’s office. In a good web-based system, whatever software you have should be compatible.

PND: Philadelphia has one of the nation’s most highly consolidated health insurance markets that permits IBC and Aetna to essentially dictate contractual terms, resulting in the region having the lowest physician reimbursement rates in the top ten markets in the country, according to Stephen Forman, the health care economist commissioned by the PMS. What role, if any, can PCMS play in redressing this situation?

PDS: That’s a very good question. I wish I had a very good answer, but the way we’re addressing it is through the state, cooperating with PMS on its request that the U.S. Justice Department investigate the market dominance of IBC and Highmark Blue Cross Blue Shield. We do not feel that we have enough muscle or clout to really influence that. It has to come at a legislative or regulatory level. Just talking with them or exerting whatever pressure that we can exert, we don’t really feel will be effective. But we’re willing to do whatever will help the state to accomplish that goal and we’ll work very closely with them.

PND: What else can the PCMS do to shore up physician clout?

PDS: By increasing membership. In order to do that, we’re looking to attract young members to stay and be active and interested. Current and future graduates of medical schools are very likely to be double-income families with both spouses working. They’ll be very busy and not have time for many of the routine tasks that they have to do during the day, such as arranging household and personal services. We’ll be soliciting opinions from members and non-members to determine the feasibility of a program in which we could serve as a members’ concierge and contract for these services when our members need them. If, for example, a physician and their spouse want to travel for several weeks but need somebody to check their house, there are plenty of medical students around who would love to leave their poorly furnished rental apartment to live in a nicely furnished house for several weeks and get paid in the bargain. We could be the contact point for that type of thing. This is something we think could stimulate membership. It sounds like a strange idea, but it isn’t because large companies are doing this with baby sitting services, grocery shopping, and other services.

PND: What is your current membership?

PDS: It’s somewhere around 2,600, not counting medical students. Compared to ten years ago total membership is probably down 30 to 35 percent. This is not out of keeping with most associations. I think there are several major causes. The first one that comes to everybody’s mind is the cost of dues. In Philadelphia especially, young physicians who are employed by the health systems get a certain fixed allowance per year for all society memberships, so their preference is to join their specialty society. How do you make PCMS more relevant to these people? It’s difficult for them to understand that the Society’s clout depends upon membership. While we think there’s a lot of relevance, it’s clear that a lot of the young physicians do not feel the same way. In addition, whatever we and the state medical society do accomplish to improve the lot of physicians and patients, those physicians who are not members benefit just as well as members. We’re hoping that, by offering this range of services, we’ll make it relevant to them: "You join your Society. We will take care of you."

PND: Given the radically changing character of our health care system and reduced resources of county medical societies, how has the mission of the County Medical Society changed?

PDS: What we’re looking at would be a very big change of mission. We’re looking at being an organization that could be of service to physicians and, through them, to patients. The type of service we offered to physicians a number of years ago is quite different than it is now. Let’s take one very easy example. When I first joined almost 40 years ago, you couldn’t be on the staff of a major hospital in Philadelphia without being a member of the County Society. It served as a credentialing organization, in essence. If you passed the Membership Committee and the Board of Censors, as it was called, and you could join the society, then any hospital would accept you on their staff. Now, every organization wants to do their own credentialing and those types of activities are just being monopolized by the hospitals and health systems. That was a big area we used to do. When I first got active in the Society—my specialty is pulmonary medicine—I got involved in a respiratory disease and air pollution committee. We met every month with the acting commissioner of health and air management services, who were the engineers who measured air quality levels. They used us as a resource as to what was the appropriate level for asbestos and for other pollutants in the air. Now they have their own engineering department and they don’t even come to us for that anymore because they have their own resources. Those types of activities are no longer germane to the current situation. Those are just two examples.