News

Some clarity on the economic stimulus law
Last week you should have received a special e-mail message from the AMA about the economic stimulus package—known as the American Recovery And Reinvestment Act of 2009—that President Barack Obama signed into law Feb. 17. The message included a letter from AMA President-elect J. James Rohack, MD; Board Chair Joseph M. Heyman, MD; Chair-elect Rebecca J. Patchin, MD; and me that clarifies where the AMA stands on the law's health information technology (Health IT) and comparative effectiveness research (CER) provisions. And it reiterates the objectives the AMA is using to guide us in the ongoing debate about health system reform.

It's important to note that the AMA did not endorse the entire stimulus bill and should notbe heldresponsible for every provision in it. The AMA did express support for investments in Health IT as well as provisions to cover the uninsured and increase Medicaid funding. And we are comfortable with language calling for an increase in government support for CER, which made clear that such research was clinically focused and did not create new authorities for coverage, payment or treatment provisions. We also emphasized to Congress that long-term reform of the Medicare physician payment system will be an essential component of a strategy to stimulate physician adoption of Health IT.

While the process Congress followed in developing this legislation left much to be desired, these provisions represent positive steps toward the overarching goal of reforming the nation's health care system. I strongly encourage you to view a summary of the stimulus law, which includes explanations of the Health IT, CER and privacy provisions that the AMA has posted online.

The AMA received many e-mail replies to last week's letter, some in support of our stance and others in disagreement with it. I'd like to share portions of a few.

Dr. Nielsen's letter notes the $19 billion for IT [within] the stimulus package, but it does not specify how this will be used. Can you please clarify and perhaps detail how the $19 billion … will be used?

Among other things, the law calls for financial incentives to be offered through Medicare to encourage physicians and hospitals to adopt and use certified electronic health records (EHR). Medicare incentive payments would be based on an amount equal to 75 percent of estimated allowable charges, up to $15,000 for the first payment year. Incentive payments would be reduced in subsequent years—to $12,000, $8,000, $4,000 and $2000 after 2015. Physicians who report using an EHR that is also capable of e-prescribing would be eligible for EHR incentives only. For eligible professionals in a rural health professional shortage area, the incentive payment amounts would be increased by 10 percent.

On the other side of the equation, those who fail to adopt EMRs will experience reductions in their Medicare payments of 1 percent in 2015, phasing down to 3 percent in 2017. In that regard, we have made it clear to Congress that these timelines may have to be revisited if there are delays in development and marketing of Health IT systems that are appropriate across the broad spectrum of medicine.

Electronic medical records (EMRs) have significant advantages for the patient and, ultimately, the doctor. However, is the government willing to contribute to the upgrading of the EMRs that those doctors with foresight have been using?

While the law does not mention government contributions to specifically help doctors upgrade existing EMR systems, early adopters whose first payment year is 2011 or 2012 are eligible for an initial incentive payment up to $18,000.In 2014, the payment limit would equal $12,000.Adopters whose first payment year is 2015 would receive nothing.

Several readers wrote in with concerns about privacy. I think this response encapsulates the thoughts of many.

I am certain you have heard the following, “Once you put anything on the Internet, it is there forever.” The same is going to become true of each individual's medical record—it will be there forever—and it will be available to people who know how to mine that information without the patient ever knowing ... who has viewed [it] and what consequences they have suffered as a result.

There's no question that privacy is a serious concern. However, the stimulus law maintains and expands the privacy and security protections that are provided under the Health Insurance Portability and Accountability Act (HIPAA). This is especially important as patient health information is electronically transferred through Health IT systems.

The law amends HIPAA to protect patient health information by applying the HIPAA rules directly to business associates and other non-HIPAA covered entities, allowing patients to pay out of pocket for a health care service and request non-disclosure of the rendered service, and authorizing increased civil monetary penalties for HIPAA violations. The law also defines which actions constitute a breach (including some inadvertent disclosures), requires an accounting of disclosures to a patient upon request, imposes restrictions on certain sales and marketing of protected health information and grants authority to state attorneys general to enforce HIPAA.

For more details, I invite you to view the explanation of the privacy provisions in the stimulus law (PDF) that the AMA has posted online.

Please be aware that a substantial, and growing, number of physicians in America (including this one) are convinced that single payer is the ONLY model that will work for our country and for our profession.

Like this reader, a number of people asked why the AMA does not support a single-payer system. Please keep in mind that the AMA and single-payer advocates emphasize the same goal of universal coverage. Where we differ is on how to implement it. Single-payer systems are plagued with an undersupply of medical personnel, inadequate payment levels, long waiting periods and a lack of patient choice, so the AMA does not believe that full government control is a workable model for our nation.

I encourage you to read more about the AMA's health care reform proposal, which seeks to enhance patient choice and encourage patients to be conscious of health insurance costs while also maintaining innovation in the private sector.

The problem is not with Health IT or CER initiatives. Many people simply do not trust this administration. Health reform should be a Republican initiative just as Nixon was the only one who could go to China and Clinton was the best president to sign (reluctantly) welfare reform.

I respectfully disagree. Health system reform doesn't affect just one political party, so why should it be assigned to only one? The efficiency of our nation's health care system is critical to each and every one of us, and only together can we begin to reform the system so that it serves the best interests of physicians and their patients.

As my colleagues and I wrote in last week's letter, the current state of our health care system simply is not sustainable, so standing pat is not an option. It's time we begin to solve this problem—now.

I urge you to take a look at an action kit that outlines the AMA's perspective on many of the key issues that are part of the health system reform debate. We'll update and add new information as this issue evolves and as more specific legislative proposals are issued by Congress and the Obama administration. Please check this resource often for the most recent material. And I encourage you to sign up for the AMA Physicians' Grassroots Network, through which you can receive regular legislative alerts.

Thank you to the many readers who sent in their comments. Sharing opinions and ideas is one way we can work together to change health care for the better.

E-mail comments, questions and replies to Dr. Nielsen

1) AMA offers health system reform briefing papers, details on stimulus law
In an effort to keep physicians informed and to help prepare them for active participation in current and future discussions on health system reform, the AMA has prepared an action kit outlining its perspectives on many of the key issues involved. The AMA has also compiled a summary of the new economic stimulus law, known as the American Recovery and Reinvestment Act of 2009.

View the summary about the economic stimulus law.

3) AMA resource covers medical home recognition
A new resource from the AMA features a pair of incentive programs that are based on the medical home model, a concept that has attracted the attention of large employers, physician groups, insurers, states and the federal government, all of which are collaborating to explore a new way of delivering health care.

Last year the AMA adopted the "Joint Principles of the Patient-Centered Medical Home," joining the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and the American Osteopathic Association in endorsing the principles. The principles include guidelines for the coordination of care to improve the patient-physician relationship, quality and safety, access to care and the payment model for coordinated services.

Along with public and private payers launching medical home pilots, Bridges to Excellence (BTE) recently partnered with the National Committee for Quality Assurance (NCQA) to offer an incentive program for physicians that is based on the medical home model. The AMA resource "Achieving medical home recognition" features the BTE and NCQA models, notes AMA policy regarding the medical home concept, and details other BTE and NCQA programs that are integral to physician practices being recognized as medical homes.

4) New Graduate Medical Education Directory coming soon
The 2009–2010 version of the Graduate Medical Education Directory, also referred to as the "Green Book," will be available in April. The directory is the only complete printed list of all residency/fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and will include:

• Contact information for more than 8,794 ACGME-accredited and combined specialty programs and 2,055 graduate medical education (GME) teaching institutions
• Descriptions and data for specialties and subspecialties
• American Board Medical Specialty certification requirements
• Medical licensure information
• A glossary of commonly used GME terms
• Lists of programs that are newly accredited and withdrawn

Also, this edition includes four disciplines that now have accredited programs for the first time:

• Hospice and palliative medicine
• Medical biochemical genetics (medical genetics)
• Pediatric transplant hepatology (pediatrics)
• Endovascular surgical neuroradiology (neurology)

AMA members can purchase the book at a discount rate. Visit the AMA Bookstore for more information.

5) AMA offers guidance in developing code of conduct
The new Joint Commission leadership standard covering code of conduct, LD.03.01.01, took effect Jan. 1, 2009. The standard's Elements of Performance requires, among other things, that hospitals have a code of conduct that defines acceptable, inappropriate and disruptive behavior, and that leaders create and implement a process for managing disruptive and inappropriate behaviors.

In response to these actions, the AMA adopted policy that calls for medical staffs to develop and implement their own code of conduct in the medical staff bylaws. Under the policy, hospitals should also have a code of conduct applicable to members of the board, management and all employees.

To assist medical staffs with implementation of a code of conduct in accordance with AMA policy and consistent with the Joint Commission leadership standard, the AMA Office of the General Counsel, in conjunction with the AMA-OMSS, drafted a model code of conduct for insertion in medical staff bylaws.

Visit the AMA-OMSS Web site to access the AMA's model code of conduct.

In addition, AMA members can access ""Physicians' Guide to Medical Staff Organization Bylaws," an excellent resource for medical staffs and their bylaws committees.

Contact Jim DeNuccio, director of the AMA-OMSS and Physicians in Practice, by e-mail or call (312) 464-5597 with questions.

6) In JAMA: Scientific evidence for ACC-AHA clinical practice guidelines
For more than 20 years, the American College of Cardiology (ACC) and the American Heart Association (AHA) have released clinical practice guidelines to provide recommendations on care of patients with cardiovascular disease. The ACC/AHA guidelines currently use a grading schema based on level of evidence and class of recommendation.

According to a study in the Feb. 25 issue of Journal of the American Medical Association, clinical practice guidelines are systematically developed statements to assist practitioners with decisions about appropriate health care for specific patients' circumstances. Guidelines are often assumed to be the epitome of evidence-based medicine. Yet, guideline recommendations imply not only an evaluation of the evidence but also a value judgment based on personal or organizational preferences regarding the various risks and benefits of a medical intervention for a population.

Preview an editorial on this topic.

1) Software that determines precise copay rates becoming popular among physicians
According to a report in the Los Angeles Times, a growing number of physician practices are using software that can immediately access patient insurance information and determine the precise copayment rates. The software also enables physicians to predict whether a deductible has been met and the amount an insurer will pay once a claim is submitted.

Developed by health insurance companies, these programs can enable the physician's front office staff to ask for patient payments at the time of service. An estimated 13 percent of physician revenue comes from patients, not insurers, and that figure is likely to rise as more consumers shoulder the burden of higher copays and deductibles.

1) Number of businesses protecting transgender employees increasing
A recent report released by the Human Rights Campaign Foundation revealed that 60 of the largest Fortune 100 businesses and nearly half of the nation's largest law firms, best colleges and universities now prohibit discrimination based on gender identity. The report shows the rapid expansion of protections for gay, lesbian, bisexual and transgender workers in the private sector over the past decade, with 35 percent or roughly 175 of Fortune 500 businesses having gender identity protections. This is in comparison to nine years ago, when just three Fortune 500 businesses had such protections.

1) Study: Physicians often override electronic medication safety alerts
A recent study published in the Archives of Internal Medicine suggests that current medication safety alerts may be inadequate to protect patient safety. This is a result of clinicians who often override most electronic medication safety alerts and instead rely on their own judgment when prescribing drugs for patients.

Investigators looked at the electronic prescriptions generated by 2,872 doctors at community-based outpatient practices and the medication alerts associated with those prescriptions. The physicians submitted 3.5 million electronic prescriptions from January through September 2006, and about one in 15, or 6.6 percent, of those prescription orders produced an alert for a drug interaction or drug allergy. The investigators found that doctors overrode more than 90 percent of the drug interaction alerts and 77 percent of the drug allergy alerts.

1) Take part in an IMG patient-physician communication study
In an effort to expand the scientific understanding of patient-physician communication, a doctoral student at The Ohio State University would like to compare the experiences of international and U.S. medical graduates.

Those willing to participate are asked to complete a 15-minute questionnaire that explores communication patterns among doctors and their patients. Responses to the questions will be anonymous; by completing the survey, participants consent to take part in the research study voluntarily.

Although the AMA does not endorse or participate in the survey, it is promoted as an opportunity for its IMG Section members. Please complete the survey by March 15.

Complete the survey.

E-mail Parul Jain or professor Raup-Krieger with questions.

2) Participate in new AMA-IMG Section virtual congress
As part of the AMA-IMG Section's new virtual congress format, resolutions submitted by April 3 for consideration during the section's annual congress will be placed on the AMA-IMG Section Web site for review and online testimony submissions. This new format should increase the participation of AMA-IMG Section members and will allow the section's resolutions to be included in the AMA House of Delegates handbook.

The AMA-IMG Section Governing Council and resolutions committee will review all submitted testimony and finalize resolutions by April 27. AMA-IMG Section members will vote between April 30 and May 7 to approve or not approve each resolution in its final form.

E-mail resolutions for consideration. Resolutions are due no later than April 3.

Visit the AMA-IMG to view the resolution writing guidelines. Call Carolyn Carter-Ellis at (312) 464-5397 with questions.

3) Review the latest AMA-IMG work force report
A newly updated discussion paper that addresses physician shortages and misdistribution as well as statistics on IMGs is now available. The paper, International Medical Graduates in the U.S. Physician Workforce, offers information on international medical schools and recommendations for better use of the IMG work force. It is intended to spark open dialogue among IMGs and between IMGs and non-IMGs.

Download a copy of this discussion paper (PDF).

Contact Carolyn Carter-Ellis at (312) 464-5397 or send an e-mail with any questions.

Brought to you by the AMA Section on Medical Schools

1) Save the date: 2009 AMA-SMS Annual Meeting in Chicago
The next AMA-SMS meeting will be held June 12–14 at the Hyatt Regency Chicago. This meeting will provide medical education colleagues an opportunity to network, help develop AMA policy and discuss issues affecting medical education.

Visit the AMA-SMS Web site at the end of February or e-mail Jackie Drake for more information.

2) Submit nominations for AMA councils and committees
The AMA is accepting nominations to fill this year's council and committee vacancies. Deadlines for nominations vary depending on the specific council. These include elected councils on constitution and bylaws, medical education, medical service, and the council on science and public health; appointed councils on legislation and long-range planning and development; and the nominated council on ethical and judicial affairs.

Visit the Web site for instructions about the nomination and election process.

3) Join colleagues for interactive communications training
Learn how to blend the craft of communication with the art of medicine this spring during the 29th annual Medical Communications Conference, which will be presented by the AMA from April 1–3 at the Hyatt Regency Tamaya Resort and Spa in Santa Ana Pueblo, N.M. The conference will offer more than 40 different workshops, case-study sessions, panels, roundtables and one-on-one critiques.

CNN's Sanjay Gupta, MD, a past participant of the conference, will accept a health communications achievement award and discuss his career as a practicing neurosurgeon and one of the best-known medical reporters in the world. And Allan Hamilton, MD, script consultant for Grey's Anatomy and Private Practice, will share how he uses stories from his vast experiences as an intern, resident and surgeon.

AMA members receive a special discount on registration. Send an e-mail to register.

4) AMA Annual Meeting webcasts added to archives
The AMA-OMSS is offering four 90-minute educational webcasts: "Transitioning to an improved hospital discharge," "Keys to the successful implementation of the revised Joint Commission Medical Staff Bylaws Standard MS.1.20," "Creating a new future for a new day with a revamped organized medical staff structure" and "Physician hospitals of America: Reclaiming quality patient care through physician leadership."

Three of these programs provide AMA PRA Category 1 Credit™. Visit the AMA-OMSS Web site to access these programs and learn more about each one.

Accreditation statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation statement
The American Medical Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

1) Get ready for Cover the Uninsured Week
The AMA-MSS will join a number of influential organizations as a national supporter of the Robert Wood Johnson Foundation's seventh annual Cover the Uninsured Week, March 22–28.

This involvement is part of the AMA-MSS's National Service Project and its ongoing dedication to covering the uninsured and protecting access to care. Last year more than 40 AMA-MSS chapters participated in Cover the Uninsured Week events, and local chapters are encouraged to participate this year.

Chapter involvement grants (CIGs) are available to AMA-MSS chapters to offset the costs of Cover the Uninsured Week events and to help pay for other student projects and recruitment events. Chapters are eligible for up to $1,000 per academic year, with a maximum of $500 per event.

Apply for a CIG at least 30 days before your event.

Read about last year's events and to learn how to get involved this year.

2) Medical students benefit from AMA efforts to fight insurer scheme
The AMA is alerting medical students and residents that they may be entitled to settlement money if they were covered by Aetna Student Health while at college between 1998 and 2008. Aetna Student Health, formally known as Chickering Student Health, is a health plan administered by Aetna and sponsored by colleges and universities.

Aetna recently announced an agreement with the New York attorney general's office requiring the insurer to pay $5 million plus interest and penalties to 73,000 students from more than 200 colleges across the U.S. who were shortchanged on reimbursements for out-of-network care.

The inadequate reimbursements stem from outdated information that Aetna Student Health used from the databases of Ingenix, a UnitedHealth Group unit. During the past nine years, the AMA has worked diligently with regulators and the courts to expose how the Ingenix database has corrupted the system used by health insurers for out-of-network reimbursements.

Medical students and residents covered by Aetna plans during college from 1998–2008 are encouraged to contact Aetna at (866) 805-7643 to see if they are eligible under the settlement.

3) AMA Foundation names leadership award recipients
The AMA Foundation will honor 15 medical students, 10 residents/fellows and five early career physicians from across the country at the annual Excellence in Medicine Awards March 9 in Washington, D.C.

Presented in association with Pfizer Inc, the leadership awards recognize outstanding, nonclinical leadership skills in advocacy, community service, public health and education. The awards provide leadership development training to further strengthen their efforts toward advancing health care in America.

The AMA-MSS congratulates the following AMA student members:

• Stephanie L. Andrus, State University of New York at Buffalo School of Medicine and Biomedical Sciences
• Manisha Bahl, University of California, San Francisco School of Medicine
• Richard Alan Brucker, Tulane University School of Medicine
• Enrico Castillo, University of Pittsburgh School of Medicine
• Erica Dommasch, UMDNJ–Robert Wood Johnson Medical School
• Jamie Soo-Moi Eng, Rosalind Franklin University of Medicine and Science/The Chicago Medical School
• Hayley Fischer, Brody School of Medicine–East Carolina University
• Jason Franasiak, University of Virginia School of Medicine
• Felicity L. Kelly, University of Texas Health Science Center at Houston
• Abimbola "Abi" Obafemi, UMDNJ–New Jersey Medical School
• Gina Porter, University of Missouri–Kansas City School of Medicine
• George Salloum, Wright State University Boonshoft School of Medicine
• Loren Riskin, Duke University School of Medicine

Visit the Web site for a complete list of award recipients and more information about the award.

4) Participate in exciting media rotation with Discovery Health
Medical students are encouraged to apply for the AMA/Discovery Health internship, a four-week program during which one AMA medical student member will help develop a medical education program that will air on the Discovery Health Channel.

Available only to AMA medical student and resident and fellow members, this exciting opportunity provides hands-on experience in translating scientific data into an entertaining and informational program. The selected student will work primarily at Discovery Communications headquarters in Silver Spring, Md., and travel to relevant on-site and studio shoots for the program. A stipend of $3,000 will be provided to cover living expenses. Dates and length of the rotation are flexible. Applications are due April 17.

Visit the Web site for more information and to apply.

5) Mark your calendars for upcoming AMA-MSS region meetings
AMA-MSS regions 2, 5, 6 and 7 have upcoming meetings, and you're invited to attend.

• The AMA-MSS Region 2 meeting, "Forensics in medicine," will be held April 3–4 at the Kansas City University of Medicine in Kansas City, Mo.
• The AMA-MSS Region 5 meeting, "Together toward tomorrow," will be held Feb. 27 at Wright State University in Dayton, Ohio.
• The AMA-MSS Region 6 meeting, "Understanding how actions of lawmakers and policymakers will impact our lives as physicians," will be held March 7–8 at George Washington University School of Medicine in Washington, D.C.
• The AMA-MSS Region 7 meeting, "Surviving and thriving during medical school and residency," will be held Feb. 7 at the Massachusetts Medical Society in Waltham, Mass.

Visit the Web site for more information about these meetings, for a list of states in each region and to learn more about organizing a region meeting.

6) AMA-MSS chapter of the week: University of Maryland
Next month, third-year medical students from the AMA-MSS chapter at the University of Maryland will offer advice on studying for the boards and what study materials are most useful. The presentation "How to Survive Step 1" is geared to second-year students, but first-year students are also invited to attend.

Contact Laura Caputo for more information on this project.

Visit the AMA Bookstore for more information on helpful books for the Step 1, 2, and 3 exams and COMLEX Review books.

7) Apply now for AMA-MSS Convention Committees
Are you interested in becoming more involved in the AMA-MSS? If so, AMA student members are encouraged to apply for one of the various convention committees that expedite the conduct of business at each AMA-MSS Assembly meeting.

Positions are available on the community service project committee, logistics and resources committee, reference committee, hospitality committee and many other committees.

Applications are due April 2. The AMA-MSS Assembly meeting will be held June 11–13 in Chicago.

Visit the Web site for the committees.

Brought to you by the AMA Minority Affairs Consortium

1) Take part in a patient-physician communication study
In an effort to expand the scientific understanding of patient-physician communication, a doctoral student at The Ohio State University would like to compare the experiences of international and U.S. medical graduates.

Those willing to participate are asked to complete a 15-minute questionnaire that explores communication patterns among doctors and their patients. Responses to the questions will be anonymous; by completing the survey, participants consent to take part in the research study voluntarily.

Although the AMA does not endorse or participate in the survey, it is promoted as an opportunity for its IMG Section members. Please complete the survey by March 15.

Visit the Web site to complete the survey.

E-mail Parul Jain or professor Raup-Krieger with questions.

2) Harvard Business School offers strategies to improve equity in health care
Clinicians, educators and administrators seeking tools to offer more effective and equitable care can attend a program focused on economic, ethnic, racial, gender and linguistic disparities in health care delivery. The course, Getting to Equal: Strategies to Improve Care for all Patients, sponsored by the Harvard Business School, will be held April 2-5 in Boston. The program will also concentrate on issues of sexual minorities and people with disabilities.

Visit the Web site for more information and to register for the event, or contact Augustus White, MD, at (617) 998-8802 with questions.

1) AMA-OMSS wants your feedback on new proposals
Proposed Care Transition Measures, developed by the AMA-convened Physician Consortium for Performance Improvement (PCPI), is launching a public comment period for the draft of the Care Transitions measurement set. The PCPI is committed to enhancing quality of care and patient safety by taking the lead in the development, testing and maintenance of evidence-based clinical performance measures and measurement resources for physicians.

The Care Transitions measures will be submitted to the National Quality Forum (NQF) in response to the forthcoming NQF call for care-coordination measures. Please provide your comments directly on the PCPI Web site by tomorrow, Feb. 27.

Visit the Web site to review the measures and to submit public comments.

2) AMA-OMSS resolution encourages health-related educational and training programs
A new resolution passed by the AMA-OMSS urges hospital medical staffs to include community health topics such as core issues, principles, planning, assessment and other essential policies in their education and training programs. Resolution 10, Community Health Issues in Hospital Medical Staff Education, also encourages hospital medical staffs to establish mutually beneficial educational relationships with community health organizations and local medical societies.

Organized hospital medical staffs conduct ongoing educational programs for their physicians, house staff, students and non-physician personnel that usually deal with strictly clinical subjects.

The resolution recognizes that communities are often impacted by numerous catastrophic events requiring significant organized involvement of hospitals and their medical staffs.

3) Save the date: 2009 AMA-OMSS Annual Meeting in Chicago
The AMA-OMSS assembly meeting will be held June 11–13 at the Hyatt Regency Chicago. Look for more information to come shortly in regard to this meeting.

Visit the AMA-OMSS Web site to view the full 2008 AMA-OMSS Interim Assembly Meeting summary and PowerPoint presentation for the AMA 2008 Interim meeting, as well as its disposition of actions.

4) Download free copy of AMA-OMSS presentation for medical staffs, hospital boards
The AMA-OMSS developed two PowerPoint presentations—one for medical staffs and another for hospital boards—to provide information on the section and its mission, duties and past actions.

AMA members can visit the AMA-OMSS Web site to view and download these presentations free of charge.

5) AMA Annual Meeting webcasts added to archives
The AMA-OMSS is offering four 90-minute educational webcasts: "Transitioning to an improved hospital discharge," "Keys to the successful implementation of the revised Joint Commission Medical Staff Bylaws Standard MS.1.20," "Creating a new future for a new day with a revamped organized medical staff structure" and "Physician hospitals of America: Reclaiming quality patient care through physician leadership."

Three of these programs provide AMA PRA Category 1 Credit™. Visit the AMA-OMSS Web site to access these programs and learn more about each one.

Accreditation statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation statement
The American Medical Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

6) Align your bylaws with Joint Commission standards
Because medical staff bylaws are considered a contract and are legally binding in most states, it is extremely important that they are well-designed and well-written. The fourth edition of the "Physician's guide to medical staff organization bylaws" contains practical guidance on bylaws development, model bylaw language, information on emerging issues and recent trends in medical staff re-engineering. The guide will be especially helpful to medical staffs as they update their bylaws to align with Joint Commission standards.

AMA members can download the guide (PDF) at no charge.

7) Resource helps strengthen physician-hospital relationship
A printable version of the "Principles for strengthening the physician-hospital relationship," developed by the AMA-OMSS and adopted by the AMA House of Delegates, is available online (PDF). These principles are designed to improve the working relationship between physicians and hospitals and ultimately foster better patient care and improve patient safety.

Send an e-mail to order a poster of the principles for your medical staff lounge.

1) Apply for legislative awareness internship in Washington, D.C.
The AMA-RFS, in conjunction with the AMA's Washington, D.C., office, is sponsoring a two-week legislative internship program this spring. The program provides residents and fellows the opportunity to participate in the political process of organized medicine at the national level. Applications are due tomorrow, Feb. 27.

Visit the AMA-RFS Web site for more information and an application.

2) AMA-RFS acknowledges members for leadership
Have you demonstrated leadership among resident physicians or in the area of advocacy? The AMA-RFS is accepting applications for two awards: the Paul Ambrose Award for Leadership Among Resident Physicians and the Jordan Fieldman, MD, Award. Airfare and hotel accommodations will be provided for recipients to be recognized at the AMA-RFS Annual Assembly Meeting in June.

Visit the AMA-RFS Web site for more information and an application. Applications are due tomorrow, Feb. 27.

3) AMA Foundation recognizes resident and fellow leaders
The AMA Foundation will honor 15 medical students, 10 residents/fellows and five early career physicians from across the country at the annual Excellence in Medicine Awards on March 9 in Washington, D.C.

Presented in association with Pfizer Inc, the leadership awards recognize outstanding, nonclinical leadership skills in advocacy, community service, public health and education. The awards provide leadership development training to further strengthen their efforts toward advancing health care in America.

The AMA-RFS congratulates the following resident and fellow winners:

• Jaspal Ahluwalia, MD
• Alexander Ding, MD
• Sabesan Karuppiah, MD
• Christoph I. Lee, MD
• Beth Lawson Loney, MD
• Andrew C. Miller, MD
• Rosalyn Nguyen, MD
• Anathea C. Powell, MD
• Christian C. Shults, MD
• Karen M. Winkfield, MD

Read the bios (PDF) of these and all Leadership Award winners.

1) Senior physician liaison meeting planned for AMA Annual Meeting
The AMA-SPG Governing Council is seeking representation from each state on senior-oriented programs that can be presented for discussion at both the Annual and Interim meetings of the AMA House of Delegates (HOD).

These meetings are attended by an increasing number of senior physicians from the AMA-HOD, a third of which are members of the AMA-SPG, so representation can enhance the effectiveness of the group and promote sharing of concerns with other delegates.

William Jacott, MD, AMA-SPG Governing Council chair, is looking forward to meeting with the liaison group, as the first meeting was lively and informative. He encourages states that did not send a representative to do so.

"Your feedback is needed as we all approach the many opportunities and issues involving senior physicians," said Dr. Jacott.

The next meeting is scheduled for June 12 at the Hyatt Regency Chicago.

E-mail Alice Reed to provide suggestions or to confirm your state liaison at the meeting.

2) Travel abroad with your fellow senior physicians this summer
The AMA-SPG is offering trips through AHI International, a leader in educational travel and cultural excursions. Senior physicians can travel abroad to South Africa, China, Egypt and other international destinations. All shore excursions and three meals a day are included.

Visit the AMA-SPG Web site for an online brochure.

Contact Georgianne Cooper at (312) 464-5622 or send an e-mail for more information.

Brought to you by the AMA Women Physicians Congress

1) Participate in National Women and Girls HIV/AIDS Awareness Day
According to the U.S. Department of Health and Human Services (HHS), in 2005, women represented 26 percent of new AIDS diagnoses, up from 11 percent in 1990. To generate awareness of those statistics, National Women and Girls HIV/AIDS Awareness Day will be celebrated March 10, with the theme "HIV is Right Here at Home."

The HHS reports that most women are infected with HIV through heterosexual contact and injection drug use. Women of color are disproportionately affected by HIV/AIDS, with AIDS being the leading cause of death for black women ages 25 to 34.

Visit the Web site for more information and to download resources such as posters, save-the-date cards, graphics and other materials.

2) In JAMA: The feminization of medicine and population health
Less than half of U.S. medical school graduates are women, but females account for the majority of residents in primary care programs, according to a study in the Feb. 25 issue of the Journal of the American Medical Association (JAMA).

The study, The Feminization of Medicine and Population Health, poses the question of how practice styles or specialty choices of this growing number of women physicians affect health care outcomes overall. In a commentary published in the same issue, the authors suggest that this may result in improved population health.

1) Save the date: AMA-YPS Annual Assembly Meeting in Chicago
Young physicians, mark your calendars. The 2009 AMA-YPS Annual Assembly Meeting will be held June 11–13 at the Hyatt Regency Chicago. Contact the AMA-YPS by May 1 to submit resolutions and volunteer for reference, AMA House of Delegates handbook review and credentials committees.

E-mail Jane Ascroft for more information.

2) AMA offers resource for evaluating business models
Are you seeking ways to simplify your practice and reduce administrative overhead? The AMA's Practice Management Center has created the educational resource Cash practice alternatives: Considerations for physicians to assist in evaluating whether limiting your practice's financial dependence upon health insurer contracts might be a viable option. This resource covers the various cash practice alternatives and helps assess which business model best suits a practice's particular situation.

Visit the Web site to access Cash practice alternatives: Considerations for physicians as well as other educational resources.

3) AMA Annual Meeting webcasts added to archives
The AMA-OMSS is offering four 90-minute educational webcasts: "Transitioning to an improved hospital discharge," "Keys to the successful implementation of the revised Joint Commission Medical Staff Bylaws Standard MS.1.20," "Creating a new future for a new day with a revamped organized medical staff structure" and "Physician hospitals of America: Reclaiming quality patient care through physician leadership."

Three of these programs provide AMA PRA Category 1 Credit™. Visit the AMA-OMSS Web site to access these programs and learn more about each one.

Accreditation statement
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation statement
The American Medical Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

4) Join colleagues for interactive communications training
Learn how to blend the craft of communication with the art of medicine this spring during the 29th annual Medical Communications Conference, which will be presented by the AMA from April 1–3 at the Hyatt Regency Tamaya Resort and Spa in Santa Ana Pueblo, N.M. The conference will offer more than 40 different workshops, case-study sessions, panels, roundtables and one-on-one critiques.

CNN's Sanjay Gupta, MD, a past participant of the conference, will accept a health communications achievement award and discuss his career as a practicing neurosurgeon and one of the best-known medical reporters in the world. And Allan Hamilton, MD, script consultant for Grey's Anatomy and Private Practice, will share how he uses stories from his vast experiences as an intern, resident and surgeon.

AMA members receive a special discount on registration. Send an e-mail to register.