AMA Interim Meeting

“Together we are stronger.” Our AMA’s new motto was introduced to the House of Delegates at its interim meeting in Atlanta as part of a multi-dimensional PR campaign that highlights the tremendous contribution America’s physicians make to our country. The delegates watched a moving and inspirational three-minute film reminding us all why we are physicians and how much we mean to others. As the House worked through its business of debating and creating policy, delegates were reminded that the likelihood of success in influencing others depends on the unity with which we speak.

Our AMA’s strategic plan calls for greater focus on its top three priorities: tort reform, replacing the SGR (formula for determining Medicare physician payments,) and access to care, including covering the uninsured, reforming healthcare financing, and reducing barriers to care for all patients.

SGR (Sustainable Growth Rate)

Many resolutions addressed the flawed formula by which CMS determines physicians’ Medicare payments. The House adopted resolution 910 that asks our AMA “to assign a top priority to the prevention of further Medicare payment cuts due to the SGR system and to seek replacement of the SGR system with payment updates that reflect increases in the cost of medical practice.” It was clear that the Board of Trustees understood this was second only to medical liability insurance cost relief in the minds of delegates and AMA members. It is unclear how this reform will occur or be funded, but some members of Congress have been quoted as expecting a quid pro quo from the medical community of demonstrable and verifiable improvements in quality (cost?) measures in order to realize any increase in Medicare funding. Since many commercial health plans tie their payment mechanism to some multiple of Medicare, the potential incentive for Medicine to create quality improvement and cost-saving measures may be significant.

Healthcare Finance Reform

The House adopted CMS report 4 that further refines our AMA’s policy of advocating for tax credits for individually selected and owned health insurance (this report and all the actions of the AMA HOD can be found on AMA’s website at www.ama-assn.org.) For the first time, our AMA accepted an incremental approach to accomplishing this in the legislature and consideration of capping the tax exclusion for employment based health insurance. The latter concept is an integral part of CMA’s newly adopted policy (BOT. - EC report 3 of 11/04) advanced by CMA President and San Diego’s own Bob Hertzka. In fact Dr. Hertzka, CMA President-elect Michael Sexton and CMA EVP Jack Lewin had the opportunity at this meeting to present CMA’s concept to both the AMA Council on Medical Services and to a group of national specialty society leaders. The taxes received from employees and individuals with “above the cap” health plans would be used in the CMA proposal to fund individually owned catastrophic and preventive health coverage for a very large portion of the nation’s uninsured.

Also Related to Access to Care

The HOD adopted BOT report 3, which supports a national policy of allowing wholesale and pharmacy, but not individual, re-importation of prescription drugs if the current FDA standards are met.

Delegates heard presentations on HSAs and on pay for performance (P 4P), both expected to increase quality and access to care for our patients. CMA Past President Ron Bangasser is the AMA expert on P4P and made it clear to us that P4P works only if it is new money into the system, both from public (Medicare/Medi-Cal) and private payors.

Other Actions

1. Expert Witnesses

The House adopted BOT report 8 and referred BOT report 27 for further study. The former established a recommended set of guidelines for who should be allowed to be an expert witness, including appropriate specialty, current experience and a requirement for board certification. The latter considered establishing an “Internet listing of expert witnesses.”

2. Confidentiality

The House adopted resolution 922, which asks AMA to “develop and seek federal legislation” to protect all peer-reviewed investigations, proceedings and records. California evidence code 1157 protects our process in this state but not in federal courts.

Resolution 902 was referred to the board “to study the impact of the USA Patriot Act on patient confidentiality.” Unknown to most physicians is the provision of the act that prevents physicians from notifying patients whose records are seized under the act and applies criminal penalties for violating it.

3. Medical Staff Issues

BOT report 9 on medical staff bylaws as a contract was adopted, in which the pros and cons of such a concept were explored.

BOT report 5 was referred back to the Board for further revision. It attempted to establish a set of principles by which hospitals and organized medical staff relations could be governed.

BOT report 15 established AMA policy on specialty hospitals, including a support for “competition of health facilities” and an opposition to any extension on the current moratorium on development of physician owned specialty hospitals.

4. Student Issues

Resolution 705 “asks our AMA to work toward 100% tax deductibility of medical student loan interest on federal and state tax returns.”

Resolution 833 describes the current injunction preventing the U. C. system from midyear tuition increases and asks AMA to assist other states’ students in the same fight

Conclusion

Our AMA speaks for all physicians, but fewer than 30% of US physicians are members. We all benefit when we are able to achieve the goals we set at these meetings. Our patients do, too. We became physicians to do good. Together in Organized Medicine we can do good on a broader, community-wide scale. Together we can change things to make medical practice more rewarding. “Together we are stronger.”