I recently attended the American Medical Association House of Delegates in San Diego where the theme was "helping doctors help patients."

It dealt with a wide variety of issues related to improving patient care, from information technology to immunizations to HIV testing and hospital discharge planning.

The overarching worry of the more than 500 delegates, however, was about the pending Medicare payment cuts.

There has not been an increase in payments for physicians’ services for more than 20 years, despite inflation and progressive increases in training costs, overhead expenses, regulations, and malpractice premiums.

In 1997, Congress addressed the rising Medicare costs by implementing the "Sustainable Growth Rate" (SGR) formula for physician payment. This called for cuts in physician payment since 2001, but every year the cuts have been deferred, without fixing the SGR formula. The plans are now scheduled to cut physician payments by 30 percent as of Jan. 1, 2011. This would reduce the estimated $250 billion debt that has accumulated in health care.

Physicians also face problems with all payers regarding paperwork and regulations that are increasing steadily, in large part due to administrative intermediaries who demand more justification for tests and procedures and medications in order to avoid or slow down payments.

A recent survey of physicians in Honolulu noted major problems with late payments, poor responses to inquiries, increasing prior authorization requirements, changes in insurers, varying formularies and in helping their subscribers understand the new and ever-changing rules.

Access to care is a particularly acute problem in Hawaii, with a shortage of more than 600 physicians by national standards. Medicare payments are also among the lowest in the nation, despite the high cost of living.

Our current health care financing system is breaking down. Major changes will be required to fix it. The AMA is lobbying as hard as it can to stop the SGR payment cuts and "Help doctors help patients."It also has proposed legislation to allow doctors to bill patients beyond what Medicare can provide so that they can continue to afford to care for them.

So how can you help your doctor help you?

The first is to make sure your congressional representatives understand the problems. They must block the impending crisis or tell us how to care for the needy with what they provide.

The second is to be aware of the pressures your doctor is under. Help your doctor and his or her office staff by carefully scheduling and keeping appointments, assisting with paperwork,prioritizing your problems, bringing your medications with you, and paying any bills promptly.

The third is to take care of yourself as well as you are able, as your doctor may not be able to help you as has been possible in the past. Stopping smoking, weight control, exercise and independent learning about your health care issues may be critical.

The best solution for Medicare is for you to live to be 100 years old with optimal self-care. It will limit the costs of health care to taxpayers as well as your children.