The AMA is sharpening its focus with a new strategic direction, concentrating on these three areas:
Improving health outcomes
Accelerating change in medical education
Shaping payment and delivery models to enhance physician satisfaction.
The one hundred and sixty-first meeting of the American Medical Association House of Delegates met in Chicago June 15 through June 20, 2012. It signaled a new era, under the leadership of new CEO, James Madara, MD. He outlined a new strategic plan focusing on improved patient outcomes, transforming medical education, and improving physician satisfaction. Linked to his optimism for the future of the organization was the knowledge that in a significant reversal, there was an increase in AMA membership in 2011, and a substantial indication of a further increase for 2012. Below is a summary of some of the important actions at the HOD this year. You can access the actions in more detail at www.ama-assn.org.
All of us in Missouri are excited to welcome the election of David Barbe, MD, Mountain Grove, to the position of Chair-Elect of the Board of Trustees. Dr. Barbe is a former President of MSMA, and is completing his first term on the 21-member Board (sixteen of whom are elected). Additionally, Sarah Dyrstad, MD, St. Louis, was elected to the Governing Council of the Resident-Fellow Section.
Issues that affect medical practice and financing were prominent during the session. Thirty resolutions and reports were considered. Some significant issues included Medicaid financing reform, ambulatory service payment discrepancies, and patient expense transparency. However, the most discussed issue was a proposal to transition Medicare from a “defined benefit” program that is standardized for all older Americans to a “defined contribution” program in which Medicare-eligible Americans could choose between traditional Medicare and competitive Commercial Insurance programs, with the Federal Government contributing a set amount to the program chosen. This reflects the proposal of Rep. Paul Ryan. Strong arguments were heard for this approach vs. the status quo, but it was agreed by all that some type of change is essential as Medicare insolvency approaches. At the AMA House of Delegates, it was decided to encourage further study of this issue, with a revised report to be presented at the 2012 Interim Meeting in November.
The actions from the Medical Service Reference Committee addressed the importance of local control of hospitals. This policy advocates for continuation of local governing boards, even for hospitals that are part of a multi-hospital system, thus insuring that community, local medical staff, and patient needs are maximally represented. This is timely given current trends in Missouri for consolidation of hospitals and practices into integrated systems.
Additionally, the House directed the AMA to find ways to increase transparency in the recruitment processes used by hospitals, clinics, and health plans, and to develop better resources for physicians to make career choices. It was emphasized that private practice should be included as a viable option in any models proposed.
The Missouri Delegation enjoys an al fresco reception in front of the new AMA headquarters. From left, David Barbe, MD, Board of Trustees Chair-Elect and wife Debbie; Sandra Ahlum, MD, Lent Johnson, MD, and Rebecca Hierholzer, MD.
Missouri cardiologist Jerry Kennett, MD, and member of the AMA Council on Legislation, testifies before the House of Delegates.
Chairing Reference Committee B, Missourian William Huffaker, MD, leads the report to the AMA-HOD.
The House addressed several issues relating to use of electronic records. These included problems encountered by physicians who are required to use multiple systems at several hospitals and the potential for significant errors that can arise due to the lack of compatibility between those systems. There was also consensus for a more comprehensive review of the benefits of electronic health records considering potential pitfalls and safety concerns. This includes the impact of electronic health records on physician patient interactions.
The Liaison Committee for Medical Education (LCME) is sponsored by the AMA and the Association of American Medical Colleges (AAMC). However, the extent to which the AMA can oversee the activities of the LCME has been poorly defined. The House supported the formation of a separate oversight council made up of nominees from the AMA, the AAMC, and the LCME itself. Within the AMA, the Council on Medical Education will be responsible for monitoring and communicating with this new council. The intent is to provide better oversight of the LCME by the two sponsors, while the LCME will remain the final authority for accreditation decisions.
As in previous meetings, maintenance of certification, osteopathic continuous certification, and maintenance of license were major issues, especially concerning the time and expense required. The AMA will work on streamlining these processes wherever possible. Regarding state licensure, the Federation of State Medical Boards noted that they have only begun to discuss how to incorporate MOC and OCC into maintenance of licensure. Outside of pilot programs, it will be five to seven years or more before there will be any consensus on how best to proceed. It was brought out during the discussion that a significant number of physicians, as many as one-third in some states, are not board certified. Because of that, maintenance of licensure will never be completely coordinated with maintenance of certification, but MOC may become an element in maintenance of licensure for those who are board certified.
Training programs which require a separate preliminary year were asked to coordinate their required preliminary year with the specialty training program, so that students do not have to apply for the two separately. Not having done so has been a significant burden on some students going into such specialties as radiology and neurology, and better coordination would relieve that burden.
It is clear that students from proprietary international medical schools, largely in the Caribbean, have been displacing students at U.S. medical schools from teaching hospitals in the U.S. This has become more widespread, occurring in places as far apart as New York and Texas, New Jersey and California. The issue here is that the proprietary schools can afford to pay significant amounts to hospitals. It was noted that New York Health and Hospitals Corporation has a $100 million contract to provide training sites for one of the proprietary schools over 10 years. To the extent that this practice displaces students from U.S. schools, it is deleterious to medical education, and the AMA opposes it.
Issues regarding the Constitution and Bylaws of the AMA might appear to be pretty technical, but, in fact often have significant effect on the actions of the organization. For example, a report from the Council on Judicial and Ethical Affairs entitled “Physician Stewardship of Health Care Resources” received a lot of discussion, as might be expected. The Council tried to “set guidance to support physicians in making fair, prudent, cost-conscious decisions on care that meet the needs of individual patients, and insure availability of health care to others.” A very interesting report; it received strong support from the House.
Organ donation also received considerable attention, with proposals to increase the availability of organs by removing financial barriers for living donor donation approved by the House. There was considerable discussion, but no action, on possible remuneration for people to donate, and making organ transplant an entitlement under Medicaid.
The House addressed a number of issues promoting health promotion, and disease prevention. There is increasing use of bottled water by young people, thereby avoiding the benefits of fluoride for children’s teeth. It was recommended that fluoride be added to bottled water in amounts equivalent to that in public water supplies.
There was considerable debate on the proposal that sweetened beverages be taxed, in an effort to help with our epidemic of obesity. One-half of the revenues are to be used for nutrition education, with emphasis on prevention of obesity. Additionally, this included promotion of research on long-term consumption of artificial sweeteners. The resolution passed overwhelmingly.
Related to that was a recommendation passed by the House that the AMA recognize and promote fifteen competencies in preventive health, both to prevent and treat chronic diseases. These included addressing physical activity, nutrition and obesity, alcohol abuse, and tobacco cessation, as well as other lifestyle changes essential to healthy living.
Tobacco received considerable attention, as usual. The House urged that tax incentives be denied to motion pictures that depict tobacco use, that tobacco products be labeled with nicotine levels at the time of purchase, and that the AMA work with other organizations to “develop a recognition program for pharmacies that voluntarily agree to eliminate” tobacco sales and to disseminate this information to physicians by working with local and state medical societies.
The AMA House of Delegates took a firm stance supporting mammogram screening of women beginning at age 40 at the discretion of doctor and patient. Additionally, insurance coverage should be continued. The HOD also expressed concern regarding the United States Preventive Services Task Force (USPSTF) recommendation on PSA screening and the effects of USPSTF recommendations which could limit access to preventive care for patients. They also encouraged the USPSTF to implement better procedures to allow for more meaningful input by specialists prior to making their recommendations.
A related resolution came from MSMA and called for proportional representation of clinical specialists on the USPSTF. The House reaffirmed comparable existing AMA policy in lieu of adopting this resolution.
A major time-sensitive issue taken up by the HOD this year pertained to national drug shortages. The AMA supports the recommendations of the 2010 Drug Shortage Summit, and requiring all manufacturers of FDA-approved drugs, including those with recognized off-label uses, to give the agency advanced notice of anticipated voluntary or involuntary, permanent or temporary, discontinuance of the manufacture or marketing of such products. Additionally, the AMA will now advocate that the FDA and/or Congress require drug manufacturers to establish a plan for continuity of supply of vital and life-sustaining medications and vaccines to avoid production shortages whenever possible.
The AMA has not raised dues since 1994. The decision to not raise dues again this year was much welcomed, as was the news of increased membership. It is important for the members to know that revenue is used prudently by the organization.
From left: Nathaniel Murdock, MD, and wife and President of the MSMA Alliance Sandra Murdock, and MSMA President Stephen Slocum, MD, and wife Aillene, enjoy the Heart of America Route 66 Reception.
Missouri doctors Charles Van Way, MD, and Rebecca Hierholzer, MD, are appointed to Reference Committee C and hear testimony.
Missouri’s Delegation is ready for the 700-member AMA-HOD to start.
The number of delegates to which each specialty society is entitled depends on the number of AMA members who have designated that society for representation. This process has not functioned as had been anticipated. The number of AMA members who have designated any specialty society has been about 38%. This was true in December 2006, and five years later, in December 2011, it is still 38%. It was recommended that the Speakers, working with specialty societies, examine the options to make sure each AMA member is adequately represented by both a state medical association and specialty society.
For many years, the AMA House of Delegates has had two meetings a year, an Annual Meeting in Chicago in June and an Interim Meeting on advocacy with varied location, each fall. Additionally, there has been a National Advocacy Conference each year in Washington. Following considerable discussion over the last several years, the House voted for a pilot program, with only one regular meeting each year, and a combination of the interim meeting with the annual national advocacy conference. Because there are a number of future contracts for the interim meeting, it is unclear when the combined meetings will begin.
As with our MSMA, all reports and resolutions are first sent to reference committees. The committees, in turn, report to the HOD, where debate and final action occurs. Last year, the AMA piloted a virtual reference committee, which allowed written comments to be posted electronically prior to the meeting. That quickly expanded to all of the committees at the Interim Meeting last year. That action has been very successful, in that has allowed wide input. This, in turn, resulted in the generation of preliminary reports for the reference committees. A member of one of the committees commented publicly that the comments in the virtual committee influenced him more than those at the actual meeting.
It is important to know that any AMA member can participate in the virtual committee, not just those who are delegates. It is our intention to notify MSMA members who are also members of the AMA when the virtual committees are available. We really encourage everyone to participate in this very effective way to influence AMA policy.
Biography
Ted Groshong, MD, Columbia, MSMA member since 1976, is a pediatrician and a Missouri Delegate to the AMA.
Contact: GroshongT@health.missouri.edu
