Reference Committee Highlights

Meeting Highlights

 

Reference Committee on Amendments to the Constitution and Bylaws

The AMA adopted Council on Ethical and Judicial Affairs (CEJA) Report 2, which sets identified ways in which physicians and other stakeholders in health care could work together to ensure sufficient access to appropriate health care for all people. The report affirmed that health care is a fundamental human good that affects the opportunity to pursue life goals, reduces pain and suffering, helps prevent premature loss of life and provides people with information needed to plan for their lives.

The AMA adopted CEJA Report 3, which sets ethical guidelines for physicians on how to handle a breach of patients’ electronic health records. The report was based on physicians' dedication to prevent harm to patients, to respect patient privacy and autonomy, and to uphold trust in the patient-physician relationship.

The AMA adopted CEJA Report 4, which addresses the conflict of interest that arises when a physician is responsible for supervising a nonphysician clinician who is also the physician's employer. The report recognizes that physicians in such arrangements must give precedence to their ethical obligation to act in the patient’s best interest by always exercising independent professional judgment, even if that puts the physician at odds with the employer or supervisor.

Reference Committee A

The AMA adopted policy supporting health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice and universal access for patients.

The AMA resolved to oppose the practice of gender rating in individual insurance markets and to advocate for states to ban the use of gender rating in setting rates, premiums, co-pays, surcharges or coverage for patients. The AMA also resolved to advocate for states to prohibit the existence of a prior cesarean section as a basis for underwriting or rating insurance, including denying, canceling, limiting or excluding coverage, charging a higher premium or denying claims, and to advocate for maternity coverage as a part of any covered benefit by individual insurance carriers.

The AMA voted to adopt recommendations from the Council on Medical Service Report 8, which include supporting the patient-centered medical model as a way to provide care to patients without restricting access to specialty care and advocating that all health plans and the Centers for Medicare & Medicaid Services use a single standard to determine whether a physician practice qualifies to be a patient-centered medical home.

In addition, the AMA adopted a set of principles that should be upheld in the development of any Medicare physician payment reform efforts, including ensuring that reform efforts promote improved patient access to care; are designed with input by the physician community; ensure payment rates that cover the full cost of sustainable medical practice; include participation options for all physicians; and ensure an appropriate level of physician decision-making authority over any shared-savings distributions.

Reference Committee B

The AMA approved a Board of Trustees report that reaffirms two pieces of existing policy. The first recommends that the AMA enhance physicians’ collective bargaining abilities within existing antitrust laws and continue meeting with the Justice Department and Federal Trade Commission (FTC) to enhance their understanding of the unique nature of medical practice and to seek interpretations of antitrust laws that reflect that nature. The second suggests that the AMA reopen dialogue with the Justice Department and FTC concerning more flexible approaches to physician network joint ventures.

The AMA voted to support law and public policy that would provide an open source electronic health record that meaningfully represents the interests of physicians and patients, and that embodies an open standards platform that is both interoperable at large and supports diverse substitutable software applications based on open or proprietary code. The AMA will work with the Department of Health and Human Services and other agencies to implement this policy.

The AMA voted to caution health care policy-makers that money from the health information technology (IT) provisions outlined in the American Recovery and Reinvestment Act will cause a sudden rise in the demand for health IT products and services, which may result in inflated prices for physicians. The AMA also will advise health care policy-makers, as well as physicians, that the ongoing maintenance of health IT can be costly and that this ongoing expense will fall to physicians long after that money is exhausted.

The AMA adopted new policy to communicate to the federal government that the electronic medical record (EMR) incentive program should made consistent with AMA principles by removing penalties for noncompliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems. The AMA also will support the concept of electronic prescribing, as well as the offering of financial and other incentives for its adoption. However, the AMA will strongly discourage a funding structure that financially penalizes physicians that have not adopted such technology.

After hearing strong and impassioned testimony, the AMA voted to include in its top advocacy priorities: 1) the enactment of federal legislation that ensures and protects the fundamental right of patients to privately contract with physicians, without penalties for doing so and regardless of payer, within the framework of free market principles, with the goal of accomplishing this by 2010, and 2) the restoration of fairness to the current health care marketplace through changes in statutes and regulations so that physicians are able to negotiate—individually and as defined groups—fair contracts with private sector and public sector health plans.

Reference Committee C

The AMA House of Delegates (HOD) acted to collaborate with the Association of American Medical Colleges to advocate that Congress rescind funding caps on graduate medical education (GME) imposed by the Balanced Budget Act of 1997 and expand funding for GME positions in specialties and geographic regions with medical work force shortages.

The AMA-HOD recommended the development and implementation of educational experiences in public health, preventive medicine, disaster preparedness and health care economics across the continuum of medical education starting in medical school and extending to continuing medical education.

Delegates recommended that the AMA pursue diversity on all test and oversight committees of the United States Medical Licensing Examination to better reflect the diverse perspectives of multiple test-takers, including international medical graduates.

Delegates also recommended that the AMA advocate to pursue increased funding for medical student scholarships and loan forgiveness programs, oppose efforts to reduce medical school funding and reinstate loan repayment deferment programs during residency training.

Reference Committee D

The AMA House of Delegates resolved to urge the Department of Health and Human Services Emergency Care Coordination Center, in collaboration with the Centers for Disease Control and Prevention and other stakeholders, to assess shortfalls in funding, staffing, vaccine, drug and data management capacity, and prepare for an influenza pandemic or other serious public health emergency. The AMA will also urge the president and Congress to provide funding and other resources to help bolster the infrastructure and capacity of state and local health departments to prepare for, respond to and protect the population from an influenza pandemic or other serious public health emergency.

The AMA adopted policy to support the redirection of federal resources toward the development and dissemination of more comprehensive health and sex education programs that are shown to be efficacious by rigorous scientific methodology, including those that include scientifically accurate education on abstinence, in addition to contraception and condom use, transmission of STDs and HIV, and teen pregnancy.

The House also adopted Council on Science and Public Health Report 4, which supports continued research on vitamin D and its metabolites, particularly long-term studies that address the benefits, adverse outcomes and potential confounders across all life-stage groups.

Reference Committee E

The AMA adopted recommendations from the Council on Science and Public Health in support of widely disseminating the report “The Use of Hormones for ‘Anti-aging’: A Review of Efficacy and Safety” to inform physicians, policymakers and the public about the current scientific evidence on the use of hormones as antiaging agents. The recommendations support that the AMA take the position that proponents of any hormone or other substance as an anti-aging agent have the responsibility to prove that any claims of positive benefit/risk be supported by well-designed, randomized, placebo-controlled clinical trials.

The AMA adopted policy to publicly call for enhancement of the protocols, authority, oversight and funding, as well as encourage public health leadership, at the federal agencies charged with regulation of the food industry and maintenance of a safer food supply, and to monitor the success of such efforts. Furthermore, the policy asks the AMA to support transparency and tracking of foods from the point of origin to the point of sale, as well as timely coordination in activities of multiple federal agencies involved in the regulation of the food industry and maintenance of a safer food supply. The policy also requires a report back on the progress made on assuring a safer food supply for the American public at the 2010 Annual Meeting of the AMA House of Delegates.

Reference Committee F

The AMA voted to approve various recommendations from a report by the Speakers’ Special Advisory Committee on the House of Delegates (HOD). Among those recommendations, the AMA will:

• Appoint a task force to look into the structure and function of a meeting that could replace the Interim Meeting of the AMA House of Delegates (HOD) as it’s currently structured; the role and function of AMA-HOD members at the replacement meeting; the timing and location of the replacement meeting; the timing of the Annual Meeting of the AMA-HOD; how and when the AMA would transition to the replacement meeting; how to maximize the value and minimize the cost of the replacement meeting; and how to address the concerns of the various AMA councils, sections and special groups regarding how the timing and nature of the replacement meeting would affect their work. The task force will report back to the AMA-HOD during the 2009 Interim Meeting.
• Establish a new type of business item, an “information statement,” to bring issues to the awareness of the AMA-HOD or the public, draw attention to existing policy for purposes of emphasis, or simply make a statement. Such items of business will be included in the AMA-HOD handbook and include appropriate attribution but will not go through the reference committee process, be voted on in the AMA-HOD or be incorporated into AMA-HOD proceedings.
• Encourage sponsors of resolutions to post draft resolutions on the AMA Web site before official submission to allow members of the AMA-HOD, other AMA parties, AMA members and other invited parties to provide input.
• Use its corporate Web site to provide ways for members of the AMA-HOD, AMA members and other invited parties to provide comments on the activities and work of the AMA’s councils.
• Use the opening session of the AMA-HOD more for substantive discussion and less for ceremonial purposes. The AMA also will move most award presentations to more appropriate venues than the opening session.
• Pilot-test virtual reference committees in the AMA-HOD. The AMA also will encourage the AMA’s sections to use virtual reference committees.

Reference Committee G

The AMA adopted recommendations from Council on Medical Service Report 4 that call for reaffirming current policy that supports requiring hospitals, physicians and other health care providers to make information about fees and prices on frequently provided services and procedures readily available to consumers. Reaffirmation of current policy was also proposed which opposes changes in the Medicare and Medicaid hospital reimbursement systems that result in cost shifting to private patients, noting the adverse effects on the private sector of such cost shifts in efforts to save dollars for federal programs. A report recommendation also calls for encouraging hospitals to adopt, implement, monitor and publicize policies on patient discounts, charity care, and fair billing and collection practices, and to make access to those programs readily available to eligible patients.

The AMA adopted principles from Board of Trustees Report 18 that call for the release and accurate use of physician data, including patient privacy safeguards, data accuracy and security safeguards, transparency requirements, review and appeal requirements, physician profiling requirements, quality measurement requirements and patient satisfaction measurement requirements. Additional recommendations of the report call for policy on the release of claims and payment data from governmental programs and using such policy as a basis for draft model legislation; creating additional tools to assist physicians in dealing with the release of physician data; continuing to monitor the status of, and take appropriate action on, any legislative or regulatory opportunities regarding the appropriate release and use of physician data and its use in physician profiling programs; and monitoring Web sites and programs that collect and use data on patient satisfaction and taking appropriate action when safeguards are not in place to ensure the validity of the results.

Furthermore, these recommendations call for continuing and intensifying efforts to educate employers, health care coalitions and the public about the potential risks and liabilities of pay-for-performance and public reporting programs that are not consistent with AMA policies, principles and guidelines.

The AMA voted to not adopt policy that called for review and consolidation of its existing policy regarding the National Practitioner Data Bank (NPDB) and reporting back to its members with an assessment of the current practices of the NPDB. This assessment would have specifically identified who is eligible to be listed on the NPDB and to whom the information on the NPDB is available.