The table “Analysis of the AMA Agreement vs. AMA negotiations objectives” illustrates that many objectives the AMA established for a new agreement with government have been met. How well the AMA Agreement will perform against those targets depends on various factors, some of which are controlled by the AMA and some by others.

One consideration is the lengthy and often tortuous road these negotiations travelled. Events have tested the relationship between the parties. The AMA Agreement and three Consultation Agreements now provide a vehicle to begin rebuilding the relationship, but it will take time. In the end, it is not the group of agreements that will restore confidence; it is the parties themselves who have to make it happen.

Fundamentally, the AMA Agreement and three Consultation Agreements do two things. They:

• Form a strong consultative framework.
• Provide processes for managing rates and programs.

The opportunity and value arise from the way these two building blocks work together. Can we help to identify clear strategic requirements and objectives for the system? Can we align our programs with those of AHS and AH towards these objectives?

AHS is a signatory to only one of the Consultation Agreements (System-Wide Efficiencies and Savings). That being said, it is critical that AHS be viewed as a full partner. The overlap of AHS’ mandate with that of physicians is large and affects all levels of care. Note that AHS is involved in other aspects of the AMA Agreement and Consultation Agreements. We will need to take full advantage of this.

The AMA has had its own challenges and the agreement provides a means to begin addressing them. Issues include:

• Fee relativity (both within and among sections).
• Measurement and recognition of overhead.
• Accountability for and measurement of output and performance across all payment methods.
• Allocation of new funds not only to physician requirements, but also to system objectives of access, quality and productivity.

The agreement does not determine whether we will stand up and face these or, alternatively, allow them to divide and weaken us. We must make that choice on our own.

Finally, the AMA Agreement and three Consultation Agreements are different than the previous Trilateral Master Agreement in terms of decision-making methods and the way roles and responsibilities are allocated. The AMA will have to look at our own structure to get optimal value from the agreements. For example:

• What roles and responsibilities should the Board of Directors assume? The Representative Forum? Sections? Zone Medical Staff Associations?
• How might we work differently with physicians in primary care? Secondary and tertiary? Academic centers?

Patients will be the most important partners for the medical profession in all these matters. Physicians work with patients every day; increasingly the AMA is working with the public, getting their input through surveys and initiatives like the Primary Care Summit Series. Advocating for and with patients is a direction that will flow into our work with AH and AHS.

A ratified AMA Agreement would not only conclude a lengthy period of negotiations. We hope it can mark the beginning of a productive and longstanding relationship with government and AHS that will allow us to put Patients First^® in new and positive ways.