AMA Endorses Right to Independent Judgement

Physicians from around the nation endorsed the physician’s right to exercise independent judgement and self-governance during the American Medical Association’s Interim Meeting held in New Orleans, Nov. 12–15, 2011.

Numerous issues were discussed, and AMA actions taken are available on the AMA website (www.ama-assn.org). We have summarized some of the issues we believe are of greatest interest to our MSMA.

The Reference Committee addressing Medical Service heard a large amount of testimony on medical care financing. One of the most significant is financing of the Medicaid program. Currently, it is a federal-state partnership, with the Federal Government assuming two-thirds of the cost, but allowing state flexibility within certain federal constraints. These have become more numerous with the adoption of the federal Affordable Care Act (ACA). Currently, Medicaid covers 66 million people in the country, with the largest percentage being children. The ACA expands eligibility to an additional 16 million people, primarily adults. With many states facing major budget problems, and Medicaid being the fastest growing cost, efforts have been made by states to reduce that cost. The House of Representatives recently passed a bill changing Medicaid to block grants to states, allowing maximum flexibility. The AMA did not endorse this proposal, but reiterated its preference for tax credits, and a desire for maximum state flexibility, assuring adequate access to quality health care for the disadvantaged. A further report will be presented at the AMA Annual Meeting in June 2012.

Given the frequent (and current) threats to physician payment under Medicare, the AMA again asserted its support of the Medicare Empowerment Act. This would allow physicians to bill patients an additional fee for services for which the Medicare reimbursement is too low. This has been vigorously opposed by the Federal Government, but has strong support from the AMA. It was felt that this is urgent, as we may be facing very significant reductions in support for physician payments, either from the fatally flawed SGR, the deficit reduction effort in Congress, or both.

Among other issues addressed were the needs for physician oversight of “Patient Navigators.” These are individuals designated to help patients access for complex medical problems. Related to this, was strong endorsement of the importance of physician independence and self-governance, and the physician’s right to exercise independent judgment in all organized medical staff affairs.

The House of Delegates adopted a proposal for a new section on “Integrated Physician Practices,” even though several delegates pointed out that it was unclear just which physicians and/or practices would be eligible for membership. The House passed somewhat similar proposal about employed physicians, but without establishing a new section. The intent of both proposals was to give a larger voice to physicians in group and/or employed practice.

The House modified a previous resolution concerning electronic access to membership for medical students. Students (and all members) are now able to pay their AMA dues on line. Links will be placed to enable all members to access state and local payment sites. Appropriate information will be given to students regarding the advantages of membership in state and local medical societies

The House adopted a policy to ensure consistent usage of the term “Physician” in the CPT books published by the AMA. Lastly, the House adopted reports on Core Values, Mission and Values, Strategic Plan, Review of Policies, Alternative Membership Models, and Compensation of the Officers.

In that a major focus of the Interim Session was the current shortage of critical drugs, it was the subject of a special session and of a Council Report. Over 230 drugs, primarily for injection, are in critical supply or unavailable. It is clear that the causes are complicated; production problems being the most common, but, additionally pricing difficulties and a lack of potential profit being among the most significant additional causes. The House instructed our AMA to treat this as a critical priority, and urged that at the very least, the companies notify FDA of any pending interruptions. Efforts to sanction companies who cease production were rejected, as this would simply discourage companies from production of future products. Interestingly, while the generic drugs were most numerous, 11% of severe shortages were in brand name drugs.

There is considerable interest in bio-similar generic drug availability. The House established a policy to ensure increased access to these important therapies, but maintain physician control of prescribing.

The medical education issue, which continued to dominate the concern of our AMA, is the ominous threat resulting from limitations on resident positions. With an anticipated increase of 30% in medical school graduates in the United States, and no increase in GME positions, the likelihood of increasing number of medical school graduates not finding residencies has increased. Additionally, at the time of this meeting, there is serious concern that GME funding from Medicare, our main revenue source, will be on the table in the Congress. The House placed this issue on the front burner of priorities.

The medical students were supported in their request for access to the electronic medical record in teaching hospitals, transparency in the policies on NBME violations, and support for the well known problem of burnout.

The Reference Committee on Constitution and Bylaws entertained lively discussion over a wide array of topics. Adopted resolutions predominantly focused on the restructuring of delegates within the HOD: the Medical Student Section received two more delegates; there will be an audit of specialty society representation; and there will be further clarification of the newly developed Minority Affairs Section.

Several resolutions were amended at the reference committee before adoption. In particular, the AMA will now advocate that pregnancy counseling centers be licensed, and require that personnel disclose which medical and referral services they provide.

There was contentious testimony regarding a report from the Council on Judicial and Ethical Affairs regarding the physician’s responsibility to promote cost-effective use of technology. The central concept was that physicians, through improved stewardship of medical technology, could decrease the cost of health care. However, as the debate progressed, the complexity of the situation became apparent; this was referred for further refinement for a future meeting of the House.

The AMA is concerned about care being administrated by non-physicians without the oversight of physicians. The AMA strongly supports integrated care, a team approach in which there is physician leadership. Given the projected severe shortage of nurses, exceeding the shortage of physicians, there must be an appropriate role for all care providers, but one in which physicians take leadership. The AMA will monitor states where physician leadership of the team approach is being threatened, and urge state medical societies to be alert to legislative efforts to do so. In addition, the AMA will advocate that interventional chronic pain management employing fluoroscopy or CT, is within the practice of medicine, and should not be conducted by other health professionals in the absence of physician supervision. With respect to medical spas, the AMA is working to make sure they are utilizing properly trained and credentialed personnel to ensure the safety of their clients.

The AMA will work with the Centers for Medicare and Medicaid to help establish guidelines for electronic audits. It will continue to push for a level playing field with respect to antitrust actions. There was considerable discussion on ICD-10 coding. The concern is the cost for physicians to adopt this versus minimal benefit for most offices. The AMA was urged to stop its adoption, though it appears that “the train has left the station.”