Ronald M. Davis, MD
The Litigation Center of the AMA and State Medical Societies: fighting for physicians nationwide
California's medical students received some good news last month when the state's Supreme Court declined to review an appeal filed by the University of California in a closely watched legal battle involving student tuition hikes.
The court's decision in Kashmiri v. UC Regents came Jan. 23, about two months after a lower court ruled this past November that the university had broken implied contracts with its students after raising professional degree program fees. In light of the decision, the university must issue an estimated $40 million in refunds and interest to those affected, most of which will go to those enrolled in the school's professional graduate degree programs before 2003. The case began that year when students from the university's professional schools filed a lawsuit for breach of contract based on the university repeatedly raising its tuition and fees despite having promised not to do so.
The outcome might not have been possible without the efforts of the Litigation Center of the AMA and State Medical Societies, which joined the California Medical Association in filing an amicus curiae, or "friend-of-the-court," brief last May in support of the students. The brief pointed out that increases in tuition worsen medical students' already steep debt burden and can exacerbate physician shortages in medically underserved areas and some medical specialties, which can disproportionately affect minority populations. Read more>>
Please send comments, questions, and replies to amaprez@ama-assn.org.
eVoice®
AMA eVoice is your regular update on the most important health care issues and recent AMA activities.
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Your news interests
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Faculty practice physician issues
1) Report: UI Hospitals proposes 10-year expansion plan
2) Who stays in-state after training?
Gay, lesbian, bisexual, transgender physician issues
1) Nomination deadline approaching for AMA Advisory Committee on GLBT Issues
2) GLMA annual conference call for abstracts
Group practice physician issues
1) In the Associated Press: Docs oppose Aetna plan on colonoscopies
2) AAPPO hears AMA physicians’ concerns with secondary discount market
3) AMA practice tip: Losing revenue through inappropriate health insurer adjustments
International medical graduate issues
1) Join your colleagues for a “house call” on Congress about Medicare payment
2) AMA-IMG Section Governing Council nominations due in less than one month
Medical school news
1) In AMA Voice: Change under way in medical education
2) 2008 AMA Foundation Excellence in Medicine Award winners to be recognized
3) United States Medical Licensing Examination comprehensive review update
Medical student issues
1) AMA offers health policy opportunities for medical students
2) Mark your calendar for Lobby Day, March 31
3) Register for the 2008 National Advocacy Conference
4) Save the dates for upcoming AMA-MSS regional meetings
5) Check out the latest “Medical student insider”
6) Application deadline approaching for student position on AMA Foundation board
Minority health issues and professional concerns of minority physicians
1) Due Feb. 15: AMA-MAC Governing Council nominations
2) Come to the NHMA conference in April
Organized medical staff issues
1) View new webcasts on the revised Standard MS.1.20, economic credentialing and the future of health care
2) Now available: “Physician’s guide to medical staff organization bylaws”
3) Printable version of “Principles for strengthening the physician-hospital relationship” available online
4) AMNews editorial highlights AMA principles for strengthening the physician-hospital relationship
Resident and fellow issues
1) Study: Depression in residents, not burnout, poses patient safety risk
2) In the Associated Press: Docs oppose Aetna plan on colonoscopies
3) Upcoming AMA-RFS application deadlines in February
Senior physicians issues
1) Medicare offers one-time abdominal aortic aneurysm screening
2) Early retirees choose locum tenens work
3) Nominations due Feb. 29 for AMA-SPG Governing Council seat
Women physician and women's health issues
1) Last call for AMA-WPC leaders’ nominations due Feb. 15
2) Attend the AMWA’s 2008 Annual Meeting
Young physician issues
1) Young physician advocates: Mark your calendars for the National Advocacy Conference
2) Prepare to be “profiled” by insurance companies
3) February issue of Virtual Mentor now available
General AMA news:
1) AMA applauds investigation of health insurance industry
2) Critical NPI date approaching for Medicare billing
3) Students, residents get boost from AMA-supported provisions in new higher education reauthorization bill
4) Register for the AMA National Advocacy Conference, April 1–2
5) Virtual Mentor looks at care for the incarcerated patient
6) In JAMA: Gaps exist for adopting conflicts of interest policies among medical schools
Your news interests
Sign up to receive customized AMA eVoice messages.
Faculty practice physician issues
1) Report: UI Hospitals proposes 10-year expansion plan
University of Iowa (UI) Hospitals unveiled a 10-year expansion plan that includes a new children’s hospital and major renovations at the main hospital in Iowa City, according to a report in the Chicago Tribune. The plan would cost $700 to $850 million and funding will come from hospital revenues and private donations. The plan would include building a tower for critical care patients and making all patient rooms private. UI Hospitals now has 680 beds—400 of which are semiprivate—and plans to add 125 to 130 more. Over the past two years UI Hospitals has seen a 12 percent increase in total patients, and officials expect the numbers to grow by 3 to 4 percent annually through 2017. Care at UI Hospitals and clinics is delivered in collaboration with University of Iowa physicians, the state’s largest multi-specialty medical and surgical group practice composed of faculty physicians of the UI Roy J. and Lucille A. Carver College of Medicine.
2) Who stays in-state after training?
More states are looking for ways to increase their physician numbers, with many hoping that new or expanded medical schools will help increase the in-state physician pipeline. Doctors who complete medical school and residencies in the same state are most likely to stay and practice in that state. New statistics reflect that 67.3 percent of physicians who completed medical school and residency in the same state, stayed in-state according to the 2007 State Physician Workforce Data Book, Center for Workforce Studies, Association of American Medical Colleges.
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Gay, lesbian, bisexual, transgender physician issues
1) Nomination deadline approaching for AMA Advisory Committee on GLBT Issues
The AMA is soliciting nominations for three open positions on the AMA Advisory Committee on Gay, Lesbian, Bisexual and Transgender (GLBT) Issues with terms beginning in June. All nominations are due Feb. 22.
The seven-member advisory committee is composed of three at-large members and four members who represent the AMA Medical Student Section (AMA-MSS), AMA Resident and Fellow Section, AMA Young Physician Section, and Gay and Lesbian Medical Association (GLMA) respectively. Appointments will be made for the at-large, AMA-MSS, and GLMA representatives.
If you are interested in being considered as a nominee, please visit the Web site for additional information and a nomination form. You or your respective organization should then send your completed form to the AMA by Feb. 22. For further information, contact Michael Kutnick by sending an e-mail or calling (312) 464–4335.
2) GLMA annual conference call for abstracts
The Gay and Lesbian Medical Association (GLMA) invites you and your colleagues to present at its 26th annual conference, which will take place Oct. 22–25 at the Renaissance Seattle Hotel in Seattle.
GLMA’s annual conference is the world’s largest gathering of lesbian, gay, bisexual and transgender (LGBT) health care professionals. The conference is remarkable for its size, scopee, and diversity of programming, with presentations and workshops on the human immunodeficiency virus (HIV)/AIDS, lesbian health, gay men’s health, transgender health, substance abuse, aging, intersex health, families and relationships, and legal issues.
There is no better place for researchers, clinicians, public health professionals, and policymakers working in the area of LGBT health to get the word out about their work and to engage other leaders in the field.
Proposals must be submitted online and are due March 31.
Applicants will be asked to submit information about their proposed presentation along with a curriculum vitae or resume.
Visit the Web site for more information.
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Group practice physician issues
1) In the Associated Press: Docs oppose Aetna plan on colonoscopies
Gastroenterologists, along with other physicians, opposed a planned policy by Aetna Inc. to not pay for a type of anesthesia, propofol, used during colonoscopies, according to a report in the Associated Press. Aetna plans to limit payment for the drug, which requires administration by an anesthesiologist, beginning April 1. Many physicians fear that such a policy could steer patients away from the lifesaving procedure because the cost of the most commonly used anesthetic for the procedure, propofol, would not be covered. Aetna claims that moderate sedation, which does not require an anesthesiologist, is sufficient enough for the procedure. Humana and WellPoint also limit the use of propofol, unless medical necessity is proven. UnitedHealthcare on the other hand, covers the drug on the grounds that it increases screenings.
2) AAPPO hears AMA physicians’ concerns with secondary discount market
In January, AMA staff presented physicians’ concerns on the present condition of non-transparency in the secondary discount market to the American Association of Preferred Provider Organizations (AAPPO) and the National Association of Specialty Health Organizations joint board meeting. AMA staff shared the clear message that physicians need up-front transparency and fair contracting and communicated that preferred provider organization networks should not allow entities that do not have a contractual relationship with them to apply or transfer a physician’s contractual discount. The AMA is working closely with AAPPO to develop joint educational materials for physicians and provider networks to encourage clear and understandable contracts.
AMA members can access additional information on the secondary discount market.
3) AMA practice tip: Losing revenue through inappropriate health insurer adjustments
The AMA developed the educational resource, “Is your practice losing revenue through inappropriate health insurer adjustments?” to alert physician practices of the need to carefully review health insurer explanations of benefits in order to pinpoint and address underpayments based on inappropriate adjustments by the health insurer.
AMA members can download this educational tool at no charge.
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International medical graduate issues
1) Join your colleagues for a “house call” on Congress about Medicare payment
Physicians from around the country will rally April 2 on Capitol Hill to hold lawmakers accountable for their promises regarding payments in the Medicare program. The white coat rally will be part of the AMA National Advocacy Conference April 1–2 at the Grand Hyatt Washington.
At the conference, hear from insiders about the political climate of Capitol Hill and get the latest developments in the battle to reform the Medicare physician payment system. After the rally, participants will meet with members of Congress and their staffs. Make this the year you look your representative and senators in the eye and press them to finally replace Medicare’s flawed payment formula.
Learn more and register.
2) AMA-IMG Section Governing Council nominations due in less than one month
The AMA-IMG Section Governing Council is seeking candidates to fill one AMA-IMG resident/fellow position and two physician positions for its 2008 election. Nomination applications are due March 7, and candidates will be elected in mid-April by AMA-IMG Section members. All candidates must submit an application, curriculum vitae and high-resolution electronic photo. Endorsements and letters of support from medical associations are optional.
Those interested in the resident/fellow position must apply to the AMA Resident and Fellow Section first. Send an e-mail for instructions on how to apply for the resident/fellow position.
Download (Word, 68KB) a nomination form.
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Medical school news
(Brought to you by the AMA Section on Medical Schools)
1) In AMA Voice: Change under way in medical education
The lead article in the January 2008 issue of AMA Voice for academic physicians highlights the AMA’s Initiative to Transform Medical Education (ITME) and AMA member Carl Sirio, MD, chair of the ITME leadership group and past chair of the AMA Council on Medical Education.
View (PDF, 1.63MB) and download the January issue of AMA Voice.
View (PDF, 311KB) and download the latest ITME report.
2) 2008 AMA Foundation Excellence in Medicine Award winners to be recognized
In association with the Pfizer Medical Humanities Initiative, the AMA Foundation Excellence in Medicine Awards honor the heroes of the medical profession—those who exemplify the highest values of altruism, compassion and dedication to patient care.
The AMA Foundation Leadership Awards— as part of the AMA Foundation Excellence in Medicine Awards—are presented to medical students, residents/fellows, early career physicians and established physicians in recognition of their strong non-clinical leadership skills in advocacy, community service, public health or education. Through organized medicine and community activities, individuals from each stage of the physician lifecycle can—and do—make a difference in the quality of health care. The recognition dinner and ceremony for 2008 recipients will be held in Washington, D.C., on March 31.
View (PDF, 21KB) a list of the 2008 Leadership Award recipients.
Learn more about the AMA Foundation Excellence in Medicine Awards.
3) United States Medical Licensing Examination comprehensive review update
The Committee to Evaluate the United States Medical Licensing Examination (USMLE) Program (CEUP) has completed its review with a target date of mid-March to finalize recommendations. The CEUP report and information on the feasibility and implications of the recommendations will be extensively reviewed. Proposed changes to the USMLE will need to be approved by the Federation of State Medical Boards and the National Board of Medical Examiners no earlier than spring 2009. If changes are approved, it will take at least two additional years to work out the details for implementation.
View the update.
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Medical student issues
1) AMA offers health policy opportunities for medical students
The AMA-MSS offers assistance to students seeking to increase their involvement and education in national health policy and national legislative activities of organized medicine.
The Government Relations Internship Program (GRIP) is an opportunity for medical student members of the AMA to enhance their medical education through work in health care policy. Students must arrange their own six- to eight-week internships—between June and August—in advance. The deadline to apply for the GRIP is Feb. 15.
Learn more about the GRIP.
2) Mark your calendar for Lobby Day, March 31
The AMA’s 2008 Medical Student/Resident and Fellow Lobby Day will be held March 31, at the Madison Hotel in Washington, D.C. Lobby Day activities include educational sessions on effective advocacy and lobbying techniques, briefings on legislative issues currently before Congress, and a full afternoon on Capitol Hill meeting with legislators and their staff.
The AMA will provide—on a first-come, first-served basis—a limited number of complimentary hotel rooms for AMA members for the night of March 30; however, anyone may attend the events on March 31 at no charge.
Visit the Web site for more information and to register. The registration deadline is Feb. 15.
3) Register for the 2008 National Advocacy Conference
Are you coming to Washington, D.C., for the AMA Medical Student/Resident and Fellow Lobby Day? If you are, consider staying for the 2008 AMA National Advocacy Conference (NAC). Hundreds of physicians, medical students and their spouses will gather in the nation’s capital April 1 for NAC, where they will learn about the political climate surrounding the country’s pressing health care issues and prepare to lobby the 110th Congress.
The cost of NAC registration for student members is $50 and includes the Nathan Davis Awards for Outstanding Government Service dinner.
Learn more and register.
4) Save the dates for upcoming AMA-MSS regional meetings
AMA-MSS Regions 2, 5 and 7 have meetings coming up, and you’re invited.
The AMA-MSS Region 2 Meeting, entitled “Perspectives on genetic discrimination,” will be held Feb. 29–March 1 at the University of Iowa Carver College of Medicine in Iowa City, Iowa.
The AMA-MSS Region 5 Meeting, entitled “What can purple do for you?” will be held Feb. 29–March 1 at the West Virginia University School of Medicine in Morgantown, W.Va.
The AMA-MSS Region 7 Meeting, entitled “Becoming a better physician advocate,” will be held March 1 at Stony Brook University Health Sciences Center in Long Island, N.Y.
Visit the Web site for more information on all region meetings.
5) Check out the latest “Medical student insider”
“Medical Student student insider” (MSI) is a monthly column written by the AMA’s Government Relations Advocacy Fellow (GRAF), who is responsible for working with the AMA’s federal advocacy team to advance the association’s legislative agenda and policies on behalf of physicians, patients and medical students.
Visit the Web site for the latest news on issues that affect physicians, medical students and patients.
6) Application deadline approaching for student position on AMA Foundation board
Applications are being accepted now through Feb. 19 for the student member position on the AMA Foundation Board.
Richard Rodriguez, a student at Florida State University College of Medicine is the current student member on the AMA Foundation Board. The AMA Foundation’s mission is to advance health care through support of programs in medical education, research and service. Through partnerships with numerous donors, the AMA Alliance, AMA affiliations and other organizations, the AMA Foundation works to improve the health of our nation’s communities and strengthen the patient-physician relationship through its better health initiatives.
Learn more about the AMA Foundation’s current activities. Apply (Word, 47KB).
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Minority health issues and professional concerns of minority physicians
(brought to you by the AMA Minority Affairs Consortium)
1) Due Feb. 15: AMA-MAC Governing Council nominations
There is still time to submit your nomination for key leadership positions on the AMA-MAC Governing Council; members will be elected or appointed this spring. Two elected positions and three appointed positions are open for nomination:
- One elected delegate—This governing council member is the voice of the AMA-MAC in the AMA House of Delegates and will be elected by the AMA-MAC membership to serve a three-year term to begin in June.
- One elected at-large member—This at-large member will be elected by the AMA-MAC membership to serve a two-year term to begin in June.
- Three appointed representatives—Representatives from the National Medical Association (NMA), AMA Resident and Fellow Section (AMA-RFS), and AMA Medical Student Section (AMA-MSS) will be appointed by these respective groups.
The nomination deadline is Feb. 15. (Please note that AMA sections may have earlier deadlines.) Electronic photos and statements of interest are required. Apply for the AMA-MAC Governing Council at-large and delegate positions.
Visit the AMA-MSS or AMA-RFS Web sites respectively, to submit nominations for the AMA-MSS or AMA-RFS representative positions on the AMA-MAC Governing Council. All nominations must be submitted through the respective section’s Web site.
Contact the NMA regarding its appointed representative on the AMA-MAC Governing Council.
2) Come to the NHMA conference in April
Mark your calendar to attend the National Hispanic Medical Association’s (NHMA) 12th annual conference, “Healthcare reform and health disparities: A priority for Hispanic communities,” April 17–20 in Washington, D.C. AMA-MAC Governing Council Chair Diana Ramos, MD, will serve as a moderator. Also, the AMA-MAC will have an exhibit booth at the conference, so stop by and see the display and resources.
Learn more and register.
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Organized medical staff issues
1) View new webcasts on the revised Standard MS.1.20, economic credentialing and the future of health care
The AMA-OMSS launched three webcasts that address priority issues for medical staffs. The first webcast addresses how medical staffs can successfully implement the revised Joint Commission Medical Staff Bylaws Standard MS.1.20—and provides an overview of the recently adopted revisions. Compliance with this standard by July 2009 is critical to preserving medical staff self-governance. The second economic credentialing webcast assists medical staffs in implementing strategies to address the potential execution of economic credentialing, understanding legal issues involving economic credentialing policies and accessing physician/hospital rights and remedies and developing other methods for addressing physician/hospital disputes. The third webcast discusses the fundamental driving forces affecting value in health care; defines value; explores the trends in its component parts: cost, access, quality and security of benefits; and describes future scenarios for health care and the implications for all health care stakeholders, including hospitals, physicians and local communities.
AMA members can view the webcasts at no charge.
2) Now available: “Physician’s guide to medical staff organization bylaws”
Because medical staff bylaws are considered a contract and 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 the revised Joint Commission Standard MS.1.20.
AMA members can view (PDF, 995KB) the guide at no charge. Non-AMA members will be able to purchase the guide in the coming weeks.
3) Printable version of “Principles for strengthening the physician-hospital relationship” available online
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 now available online.
View (PDF, 90KB) and download this resource. These principles are designed to improve the working relationship between physicians and hospitals, and ultimately foster better patient care and increase patient safety.
Send an e-mail to order a poster of the principles to post in your medical staff lounge.
4) AMNews editorial highlights AMA principles for strengthening the physician-hospital relationship
An editorial in the Feb. 18 edition of American Medical News (AMNews) addresses how AMA principles for strengthening the physician-hospital relationship can help prevent further deterioration between hospital governing bodies and their physician staffs.
View the editorial.
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Resident and fellow issues
1) Study: Depression in residents, not burnout, poses patient safety risk
A study in the British Medical Journal of 123 residents in three U.S. pediatric programs found that one in five of the participating residents were depressed and about three out of four had burnout. Despite the frequency of burnout and depression, few studies have quantified their relation with patient safety. The study also found that depression was associated with a significantly increased rate of medical errors. According to researchers, error rates among residents suffering from burnout were no different than among those who were not burned out. That finding “indicates that mental health may be a more important contributor to patient safety than previously suspected.”
View the British Medical Journal study.
2) In the Associated Press: Docs oppose Aetna plan on colonoscopies
According to an Associated Press article, gastroenterologists, along with other physicians, are opposing a planned policy by Aetna Inc. to not pay for a type of anesthesia, propofol, used during colonoscopies. Aetna plans to limit payment for the drug, which requires administration by an anesthesiologist, beginning April 1. Many physicians fear that such a policy could steer patients away from the lifesaving procedure because the cost of the most commonly used anesthetic for the procedure, propofol, would not be covered. Aetna claims that moderate sedation, which does not require an anesthesiologist, is sufficient enough for the procedure. Humana and WellPoint also limit the use of propofol, unless medical necessity is proven. UnitedHealthcare on the other hand, covers the drug on the grounds that it increases screenings.
View the Associated Press article.
3) Upcoming AMA-RFS application deadlines in February
Visit the Web site for more information on the following leadership councils and their applications:
- AMA Council on Long Range Planning and Development applications due Feb. 18.
- AMA Council on Legislation applications due Feb. 18.
- International Medical Graduate Governing Council applications due Feb. 26.
Visit the Web site for more information on the following awards and their applications:
- Paul Ambrose Award applications due Feb. 29.
- Jordan Fieldman, MD, Award applications due Feb. 29.
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Senior Physicians issues
1) Medicare offers one-time abdominal aortic aneurysm screening
In an effort to help Medicare beneficiaries learn more about preventive services covered under Medicare, the AMA-SPG will feature a covered service regularly in AMA eVoice.
Aneurysms can form in any section of the aorta, but are most commonly found in the belly area. Screening tests can help decipher a condition before any symptoms appear since symptoms can come or go or remain constant. Medicare covers this one-time screening if you receive a referral as a result of your “Welcome to Medicare” physical exam. You must also receive the physical exam and screening within the first six months that you have Medicare Part B coverage.
Learn more about this and other preventive services covered under Medicare.
2) Early retirees choose locum tenens work
For physicians who are not ready to retire but want to scale down their work hours, locum tenens work provides an excellent alternative to full-time practice. Physicians can enjoy more reasonable hours, while combining work and travel time in a new location.
View other voluntary opportunities online and access National Association of Locum Tenens Organizations.
3) Nominations due Feb. 29 for AMA-SPG Governing Council seat
AMA-SPG is seeking nominations for its Governing Council, composed of seven physicians over the age of 55, either retired or still practicing medicine. The AMA-SPG Governing Council is charged with advising the AMA Board of Trustees and staff on issues that bear directly on senior physicians.
View all nomination materials, including the current AMA-SPG Governing Council roster. Nominations are due Feb. 29. Contact Carrie Waller at (312) 464-4546 with additional questions.
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Women physician and women's health issues
(brought to you by the AMA Women Physicians Congress)
1) Last call for AMA-WPC leaders nominations due Feb. 15
The AMA-WPC would like you to submit nominations for key leadership positions on the AMA-WPC Governing Council; members will be elected or appointed this spring. Five elected positions, including three section representative positions, are open for nomination:
- Two elected at-large members—Two governing council members will be elected by the AMA-WPC membership to serve a two-year term to begin in June.
- Three elected AMA section representatives—Representatives from the AMA Medical Student Section (AMA-MSS), AMA Resident and Fellow Section (AMA-RFS) and AMA Young Physician Section (AMA-YPS) will be elected by the AMA-WPC membership at large. Nominations should be submitted through the respective sections only.
Nominations are due Feb. 15. (Please note that AMA sections may have earlier deadlines.) Electronic photos and statements of interest are required.
Apply for the AMA-WPC Governing Council at-large positions.
Visit the AMA-MSS, AMA-RFS or AMA-YPS Web sites respectively, to submit nominations for the AMA-MSS, AMA-RFS or AMA-YPS representative positions on the AMA-WPC Governing Council. All nominations must be submitted through the respective section’s Web site.
2) Attend the AMWA’s 2008 Annual Meeting
The American Medical Women’s Association (AMWA) Annual Meeting will take place March 7–9 in Anaheim, Calif. AMWA is sharing a meeting venue with the Women’s Health Forum to provide attendees with high quality continuing medical education and an extensive educational and exhibition program.
Learn more and register.
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Young physician issues
1) Young physician advocates: Mark your calendars for the National Advocacy Conference
Young physicians interested in policy and advocacy should plan to attend the National Advocacy Conference April 1–2 at the Grand Hyatt in Washington, D.C. Keynote speaker Tony Snow will kick off the conference with an insider’s view of the political climate. Plenary sessions will focus on Medicare payment reform, expanding health insurance coverage to the uninsured and the role health care will play in the November general election.
On April 2, physicians will rally on Capitol Hill for a “house call” on Congress as part of the National Advocacy Conference. Join your colleagues to hold lawmakers accountable for their promises regarding payments in the Medicare program, and following the rally, meet with your members of Congress and their staffs.
Learn more and register.
2) Prepare to be “profiled” by insurance companies
More and more health insurers are creating profiles of physicians for the purpose of publishing “doctor-ratings” aimed at patients and establishing tiered and narrow health plan networks. The AMA has been active on many fronts to expose these profiling programs for what they are: schemes to steer patients toward doctors deemed “less costly” than their peers, based on flawed methodology. In the meantime, the AMA offers an array of resources to help members to understand, prepare for, and, when necessary, challenge the way they are profiled. Among the most recent additions to these resources are “Physician profiling: How to prepare your practice” and “How to challenge your ‘profile' or placement in a tiered or narrow network.”
Learn more about AMA resources on physician profiling.
Download (PDF, 550KB) “Physician profiling: How to prepare your practice.”
Download (PDF, 434KB) “How to challenge your ‘profile’ or placement in a tiered or narrow network.”
3) February issue of Virtual Mentor now available
February’s Virtual Mentor examines care for the incarcerated. Men and women in U.S. prisons have a constitutionally protected right to medical care. Though some claim this is unjust, it doesn’t take too much thought to realize that a civilized society could hardly allow infectious disease, acute injury, or severe mental illness to go untreated among those it holds in custody. The unfairness, of course, is that America’s non-incarcerated residents are not guaranteed care. Assuring access, however, says nothing about the quality of care prison patients receive, and that is the subject of this month’s Virtual Mentor.
Read the February issue of Virtual Mentor online.
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General AMA news
1) AMA applauds investigation of health insurance industry
The AMA joined New York Attorney General Andrew Cuomo at a Feb. 13 press conference to announce his industry-wide investigation of UnitedHealth Group and a probe of 16 national health insurers regarding an alleged scheme to defraud consumers.
"The investigation launched today by New York Attorney General Andrew Cuomo calls into question the validity of a system that health insurers have used for years to reimburse physicians and their enrolled members," said AMA President-elect Nancy H. Nielsen, MD, PhD. "UnitedHealthGroup and other health insurers have shortchanged tens of millions of patients who agreed to pay higher premiums for access to their choice of physicians from outside a health insurers' network."
At the center of the scheme is Ingenix Inc., the nation's largest provider of health care billing information, which serves as a conduit for rigged data to the largest insurers in the country. As shown throughout this six-month investigation, Ingenix operates a defected and manipulated database that most major health insurers use to set reimbursement rates for out-of-network medical expenses. By distorting the "reasonable and customary" rate, insurers are able to keep their reimbursements artificially low and force patients to absorb a higher share of the costs.
"These patients have a right to expect fair and accurate payment for services promised by health insurers," said Dr. Nielsen. "The AMA greatly appreciates the Attorney General's interest and leadership in protecting consumers, and we offer our full cooperation in any effort to hold UnitedHealth accountable to New York state laws."
Read the full Feb. 13 statement from Dr. Nielsen.
View Attorney General Cuomo's announcement of the investigation.
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2) Critical NPI date approaching for Medicare billing
Beginning March 1, all Medicare claims must contain a National Provider Identifier (NPI) and legacy number, or just an NPI number, for billing, pay-to and rendering physicians. Legacy numbers can still be used to identify referring and ordering physicians through the end of the NPI contingency period, which is May 23.
Physicians who bill Medicare and are being paid for claims submitted with both an NPI and a legacy number are strongly urged to test their ability to get paid using just their NPI. To test this, they should submit one or two claims as soon as possible. This step is critical to ensuring that their claims will be processed without interruption beginning March 1.
If Medicare cannot match a physician's NPI to his or her legacy number in its system, the claim with an NPI only will be rejected. If the claim is processed and the physician is paid, the physician can continue to increase the volume of claims sent with only the NPI. Physicians whose claims are rejected should call their Medicare carrier or the enrollment staff with their Medicare Administrative Contractor for Part A and Part B for advice right away.
Note: If Medicare cannot match a physician's NPI to his or her legacy number, the physician might be required to re-enroll, a process that can take several months. Physicians are urged to act now to avoid claims processing problems on March 1.
After May 23, no legacy numbers will be permitted on any electronic claims, including those to Medicare and commercial payers, pursuant to the Health Insurance Portability and Accountability Act. In addition, no legacy numbers will be permitted on Medicare paper claims after this date.
Visit the Web site for more information about the NPI standard.
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3) Students, residents get boost from AMA-supported provisions in new higher education reauthorization bill
As part of a higher education reauthorization bill passed by the U.S. House of Representatives late last week, the AMA successfully secured a number of provisions to aid medical students and residents faced with high debt burdens and to ensure there are enough young physicians to serve the aging population. This bill, known as the College Opportunity and Affordability Act of 2007, H.R. 4137, would amend and reauthorize the Higher Education Act (HEA) of 1965 for another five years.
The AMA secured a number of provisions in the wide-ranging bill, including a federal loan forgiveness program for physicians who serve in areas of need. The bill includes disclosure requirements for private lenders that will improve transparency, requirements for certain federal lenders to ensure applicants are provided notice about terms of consolidation, and a Government Accountability Office study that will analyze the impact of debt on medical school graduates.
The Senate passed its version of the bill in July 2007. The House and Senate will resolve differences between the bills before sending it to the president. The HEA is set to expire on March 31.
The AMA also continues to work with the Department of Education (DOE) and Congress to permanently reinstate and expand medical education loan deferment eligibility during residency. The program, known as the "20/220 pathway," was eliminated in October 2007 under separate legislation, but after vocal activism by the AMA and its student and resident members, the DOE temporarily reinstated it until fall 2008. Negotiations are ongoing for permanent reinstatement of the "20/220 pathway."
View the full Feb. 13 news release.
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4) Register for the AMA National Advocacy Conference, April 1–2
Hundreds of physicians and medical students will gather April 1–2 in Washington, D.C., for the AMA National Advocacy Conference. This year's conference will include a white coat rally on Capitol Hill to send Congress a message about changing its approach to Medicare payments.
Conference participants will gain an insider's view of the political climate in Washington, D.C., hear from members of Congress on expanding coverage for America's 47 million uninsured, and learn from experts on how health care will influence the upcoming elections.
Former White House press secretary Tony Snow will deliver the keynote address, and veteran television journalist Forrest Sawyer will serve as master of ceremonies at the Dr. Nathan Davis Awards for Outstanding Government Service gala celebration. On March 31, attend the AMA Foundation Excellence in Medicine Awards dinner. Physicians' spouses and families are invited to attend the AMA Alliance Capitol Conference—Winter Session.
Learn more and register.
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5) Virtual Mentor looks at care for the incarcerated patient
In today's prison population, the human immunodeficiency virus, hepatitis C, mental illness and drug abuse—diseases in which require great medical attention and care—are all too common. But "the fact that prison inmates are one of the few sectors of American society assured medical care doesn't necessarily mean that they are receiving anywhere near the same quality of care that the general public does," according to the February issue of Virtual Mentor, the AMA's online ethics journal.
This subject leads this month's discussion in Virtual Mentor, and guides the exploration of other topics, including the gap between guaranteed health care and quality of care, the legal, ethical and social reasons why prisoners deserve health care, and the internal and external challenges prison physicians face in attempting to deliver that care.
View this month's issue as well as past issues of Virtual Mentor, and take an online ethics poll on caring for the incarcerated patient. Stay tuned for upcoming issues on medicine and personhood, medical care for U.S. immigrants, and system constraints on optimal care.
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6) In JAMA: Gaps exist for adopting conflicts of interest policies among medical schools
A minority of U.S. medical schools surveyed have adopted policies on conflicts of interest regarding financial interests held by the institutions, while at least two-thirds have policies applying to financial interests of institutional officials, according to a study in the Feb. 13 issue of the Journal of the American Medical Association (JAMA). In an accompanying editorial, an author comments on the findings of this study.
Preview the study.
Preview an editorial on this topic.
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