AMA I09 Report
The AMA Interim meeting was held in Houston November 6th through the 10th. Over a thousand delegates and alternate delegates debated 66 resolutions and 25 reports and heard many informational presentations. It was one of the most important meetings in more than a generation, because of the simultaneous discussion in Congress about health system reform. Clearly that reform effort and the House and Senate bills that will make it happen were the major items of business at this meeting. Highlights of the meeting written by CMA’s extraordinary staff, Ginnie Yee, can be accessed by clicking here. This report will attempt to address the subject most on everyone’s mind, reform, and only a few others.
Health System Reform
AMA — and CMA for that matter — has attempted to place itself in a balanced position between full supporter and constructive critic as it has met with congressional and administration leaders crafting the legislation in Washington, DC. The nuanced use of the word “support” as used by AMA has been misrepresented by some legislators and by the media to imply AMA’s 100% endorsement of HR 3962, the House bill awaiting action as I write. Many physicians at AMA as well as some of you here in San Diego County feared AMA had gone too far in supporting legislation that includes parts that may be harmful to patients, physicians, and the physician-patient relationship. AMA President James Rohack, MD, spent much of this meeting reassuring delegates that AMA supports, but does not currently “endorse,” the legislation being considered. He and others reminded attendees many times that the process is in its very early stages and that much is yet to come.
By the time of this writing, the Senate will have introduced a bill for consideration as well. If and when it is passed in the Senate, the two bills will then be considered in a “conference committee” of legislative leaders from both houses and a compromise bill reported out, which will then need passage by both the House and the Senate before it can be sent to the president’s desk for signature. Prior to the meeting of that conference committee, AMA leaders and lobbyists (and CMA) will be informing the legislature about the parts of the legislation that will be harmful to patients and physicians and which would need to be amended if AMA is to support the final language.
The AMA House of Delegates engaged in lengthy debate about what constraints it wished to place on the AMA board of trustees and staff as they proceed with this effort. While a substantial minority wanted greater limits on what AMA could support, in the end, the majority voted for an amended set of principles that must be considered in order to support the effort at reform. First and foremost AMA does want a good reform bill to be written and passed. Much can be made better in our healthcare system. However, it must not carry with it unintended (or intended) consequences we and our patients will regret after the legislature has moved on to other things. The things we want are enumerated in the “seven critical components:”
- Health insurance coverage for all Americans.
- Insurance market reforms that expand choice of affordable coverage and eliminate denials for pre-existing conditions or due to arbitrary caps.
- Assurance that healthcare decisions will remain in the hands of patients and their physicians, not insurance companies or government officials.
- Investments and incentives for quality improvement and prevention and wellness initiatives.
- Repeal of the Medicare physician payment formula that triggers steep cuts and threaten seniors’ access to care.
- Implementation of medical liability reforms to reduce the cost of defensive medicine.
- Streamline and standardize insurance claims processing requirements to eliminate unnecessary costs and administrative burdens.
The House adopted 13 additional clauses to more specifically outline for the leadership what it wanted to see and not see in legislation. These addressed outlawing payer coverage rescissions, maintenance of pluralism in the system, freedom of choice and practice, the right to privately contract, and support for comparative effectiveness research only if it is for improvement in patient care and not in the interest of reducing payments or access. They specifically oppose an “Independent Medicare Commission” or anything like it that would take the control away from Congress and give it to unelected officials. They outlined what an insurance “exchange” must look like, including being self-supporting, not funded by government, paying at negotiated rates, and being entirely voluntary for both patients and physicians.
Finally, the House specified what must be opposed, including any reduction in payment for failure to report quality data until systems are perfected for the collection of that data; any system that mandates automatic payment reductions; reduction in payments for higher utilization unless data is properly attributed and risk-adjusted; redistribution of payment among physicians based on faulty unscientific data; transfer of payments from one specialty to another; and arbitrary restriction on referrals to facilities the referring physician may have an interest in.
Like it or not, AMA is our voice in Washington, DC, and speaks for us as this potentially profession-changing legislation goes forward. Our specialty societies are in many cases advocating for positions opposing each other, a circumstance guaranteed to allow those who would harm our profession and the care we can offer our patients the opportunity they crave. Never has AMA’s motto been truer: “Together we are stronger.”
Other Business, Consultation Codes, Medicare Participation Options
Yes, there actually were many important issues other than health system reform discussed, including 18 resolutions and 10 reports on subjects relating to public health and education.
Of note was resolution 807 that was adopted and calls on AMA to “oppose all public and private payer efforts to eliminate payments for inpatient and outpatient consultation service codes, and support legislation to overturn recent CMMS’ action to eliminate consultation codes.”
A nine-page “Medicare Participation Options for Physicians” paper was distributed and included language of a sample Medicare private contract for those who might want to consider that option.
The Speaker’s Advisory Task Force Report recommended elimination of the Interim Meeting and consolidating some of the business traditionally done there with the spring National Advocacy Conference. The House referred that recommendation for further consideration and San Diego will host AMA as planned November 5–9, 2010.
Finally, San Diego’s own Al Ray, MD, was elected vice chair of the California delegation to AMA. Congratulations, Al.
Conclusion
Your San Diego County delegates, Bob Hertzka, MD, and I, and alternate delegates, Al Ray, MD, and Lisa Miller, MD, are there to speak for you. We welcome your feedback and input.