AMA eVoice Weekly Newsletter

Building bridges—be the change

As you read this column, the celebration of our nation's 223^rd birthday will soon be celebrated. Our democracy has undergone dramatic changes over the years with advances to ensure that life, liberty and the pursuit of happiness are not just words on paper but truly inalienable rights. The question that is posed is this: What exactly do inalienable rights mean when it comes to health care?

There continue to be some in America that believe health care is a right, and as such, should only be available to those who can afford to pay for medical care directly or through premiums. There are others who believe that medical care is a right, and as such, should be provided by the government for all citizens with payment through taxes.

As a result, we have a gulf between many individuals with firm beliefs that they have the correct vision. As AMA Immediate Past President Nancy H. Nielsen, MD, PhD, so wonderfully put it last year in her inauguration speech, we as the AMA have to build bridges to cross the chasms.

This year at the Annual Meeting of the AMA House of Delegates, President Obama noted the fear of change and the cynicism of past efforts to reform the American health care system has left many scars. His commitment to build a health care system that allows physicians to care for our patients rather than being administrators and accountants and to preserve choice allows those words of life, liberty and the pursuit of happiness to come closer to fruition.

I noted in my presidential address that we as physicians must be the change we wish to have in health system reform. Our existence as a profession is in service to others. And the AMA's Code of Medical Ethics guides us on that road to achieve life, liberty and the pursuit of happiness for all Americans.

It is clear these next few months will have much rhetoric and misinformation. I was sitting 5 feet away from President Obama as he addressed the AMA House of Delegates, which gave him multiple standing ovations during his speech. In regard to medical liability, he recognized that health system reform cannot happen if doctors are constantly looking over their shoulders in fear of lawsuits. That was an important recognition by the president, who comes from a political party that does not favor discussion of any sort on the cost of defensive medicine.

When the president mentioned he was not advocating for caps, a smattering of boos were heard before he finished the sentence that he was supportive of exploring a range of ideas to put patient safety first, let doctors focus on practicing medicine and encourage broader use of practice guidelines. Some papers the next day ran headlines that the president was booed, not that the AMA shared the goals of pluralism, freedom of choice, freedom of practice and universal access for patients with him, or that the president recognized defensive medicine costs and the need to have ways to control unnecessary costs.

These next few months, as health system reform discussions accelerate, there will be many opportunities for misinformation to be spread. I ask you to avail yourself to get your information from trusted sources. Our AMA advocacy team produces the Health System Reform Bulletin that can be sent to you by e-mail. If you wish to receive this weekly update, contact the AMA.

Let us always remember our goal: affordable, quality health care coverage for all Americans. When you celebrate our nation's birthday tomorrow, July 4, remember that you can be the change in allowing those bridges to be built.

1) AMA victory: Drugs out of Medicare physician payment formula
Costs of physician-administered drugs will no longer be part of Medicare's sustainable growth rate (SGR) formula, the Centers for Medicare & Medicaid Services (CMS) announced July 1—a major victory for America's seniors and their physicians.

The announcement came as part of CMS's release of its 2010 Medicare physician payment schedule proposed rule. The drug costs will be removed retroactive to the 1996–97 base year of the SGR formula, which will greatly lessen cuts in Medicare physician payments that have been forecast for future years. Although there is still a 21.5 percent cut in Medicare physician payments scheduled for 2010, this action will substantially reduce the legislative cost of congressional proposals to reform physician payments and makes a permanent solution to the Medicare physician payment problem much more feasible.

"Instead of yet another Band-Aid fix, today's action paves the way for Congress to ensure stable payment rates that reflect increasing medical practice costs and preserve seniors' access to care," AMA President J. James Rohack, MD, said.

The AMA continues to review the 1,128-page proposed rule and will develop a more detailed summary of the proposed changes.

Read more from Dr. Rohack.

2) AMA president discusses health system reform on CNN
In a nearly 10-minute interview on CNN on July 1, AMA President J. James Rohack, MD, detailed the AMA's position on health system reform with Elizabeth Cohen, the network's senior medical correspondent, and anchor Tony Harris.

3) Federation comments on "meaningful use" of electronic health records
The AMA and 81 specialty and state medical societies submitted comments to the Office of the National Coordinator (ONC) June 26 about the definition of what it means to be a "meaningful user" of an electronic health record for the purposes of qualifying for incentives under the American Recovery and Reinvestment Act (ARRA).

The ONC's Health Information Technology (HIT) Policy Committee was unable to reach consensus on defining the term at its June meeting and is expected to further discuss the issue July 16 after receiving public input. The AMA remains very concerned that the proposed definition is not achievable within the time frames outlined in the law and will continue to work to ensure that a workable definition of meaningful user is adopted.

Also, the Centers for Medicare & Medicaid Services (CMS) recently launched a Web page on the HIT incentive program authorized under ARRA.

4) AMA unveils enhanced ePrescribing Learning Center
Earlier this year the AMA launched a new online learning center to provide physicians with the information and tools they need to make informed decisions about electronic prescribing (ePrescribing). Earlier this week, the AMA unveiled enhanced tools for ePrescribing and opened the site and all its resources to all physicians.

Some of the new tools include a system finder that selects three systems for a user based on their responses to a brief questionnaire; side-by-side comparisons of up to three ePrescribing vendors at one time; the ability to read vendor feedback and ratings from other users and provide your own vendor feedback; and automated contact-a-vendor capability for when a decision is reached.

"With the current Medicare ePrescribing incentive and the promise of increased patient safety and practice efficiency, physician interest in adopting new technologies is increasing," said AMA Board of Trustees member Joseph M. Heyman, MD. "We are glad to be able to offer physicians guidance on ePrescribing."

View an AMA news release about the enhanced learning center.

5) Keep copies of health insurer contracts and fee schedules
Taking command of payer contracts and thoroughly understanding their implications is essential to the success of a physician practice. Protect your practice from inappropriate payer discounts by understanding the implications of contract provisions, and keep copies of all your signed health insurer contracts and contracted fee schedules.

If you don't have copies of these important documents, contact the health insurer for a copy. The WellPoint/Anthem, Health Net, Humana and Blue Cross Blue Shield settlements require these health insurers to provide physicians with copies upon written request. Request yours before the settlements expire. The WellPoint/Anthem settlement terminates July 15, 2009; the Humana settlement ends Oct. 19, 2009; and the Health Net settlement expires July 1, 2010. If a health insurer does not honor your request, consider filing a compliance dispute.

View the complete provisions of each settlement.

Learn more about filing a compliance dispute.

6) A discount on Financial Management of the Medical Practice: just one benefit of being an AMA member
Do you feel like an expert on keeping the financial side of your medical office running smoothly? If you think that you'll have any hand in that, it might be best to build up your knowledge base.

Use your AMA member discount to receive a discount on Financial Management of the Medical Practice, a valuable resource that simplifies financial analysis and outlines steps to assure revenue maximization and expense management. Available through the AMA Bookstore, it covers budgeting, ratios and benchmarking and provides financial report samples, charts, checklists and a glossary of financial terminology.

Purchase Financial Management of the Medical Practice—as well as any of the hundreds of other books and products available through the AMA Bookstore—with your member discount.

If you're an AMA member, don't lose valuable resources such as this. Renew your membership. If you're not a member, join the AMA and begin receiving them.

7) In JAMA: the obligation to participate in biomedical research
Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it, according to an article in the July 1 issue of the Journal of the American Medical Association (JAMA).

While some commentators have offered reasons against the current prevailing view that participation in biomedical research is above and beyond the call of duty, authors of this article propose a novel public goods argument for an obligation to participate in biomedical research unless people have a good reason not to. According to the authors, doing so would help society at large by helping people live longer and healthier.

View the JAMA report video about this article.

1) Lawmaker introduces LGBT health equality bill
Legislation introduced last week by Rep. Tammy Baldwin, D-Wis., would be the first comprehensive approach to improving all areas of the health care system in which lesbian, gay, bisexual and transgender (LGBT) Americans face inequality and discrimination.

Baldwin introduced the "Ending Health Disparities for LGBT Americans Act" June 23. In addition to investing in data collection and research, the bill would establish nondiscrimination policies for all federal health programs, provide funding for cultural competence training for health care providers, extend Medicare benefits to same-sex domestic partners, create a new office of LGBT Health within the Department of Health and Human Services and provide funding for community health centers that serve the LGBT community.

 

2) ACLU says hospital discriminated against gay couple
After a lesbian was barred from visiting her partner and giving advice about her treatment at a Fresno, Calif., hospital, the American Civil Liberties Union and the National Center for Lesbian Rights sent a letter to the hospital urging that it adopt policy changes respecting same-sex relationships.

3) In the New York Times: New guidelines would protect transgender federal workers from discrimination
According to a story published June 23 by the New York Times, White House lawyers are quietly drafting first-of-their kind guidelines barring workplace discrimination against transgender federal employees. The guidelines, which would be included in an updated federal handbook for managers and supervisors to be distributed and posted online later this year, would list transgender people as among several groups protected by antidiscrimination laws, the Times reports.

1) Optima test prep sued; choose USMLE test preparation companies carefully
Optima University—a provider of United States Medical Licensing Examination (USMLE) review courses—is being sued by the National Board of Medical Examiners and the Federation of State Medical Boards over allegations that Optima is unlawfully using questions that they own and have copyrighted. The AMA-IMG Section advises all international medical graduates to use caution when choosing a test preparation company while studying for the USMLE tests.

Learn more about the lawsuit.

2) Dessert reception a great success
The AMA-IMG Section thanks its generous sponsor partners for a successful fourth annual Desserts from Around the World Reception, held June 13 at the Hyatt Regency Chicago. This tasty affair with international flair attracted more than 350 attendees and more than 22 sponsoring partners.

View the entire list of sponsoring partners.

If you're interested in sponsoring next year's reception, send an e-mail or call (312) 464-5397.

3) View results of AMA-IMG resolutions
Learn about how AMA-IMG Section resolutions faired in the AMA House of Delegates (HOD) last month by visiting the AMA-IMG Web site and reading the unofficial summary of actions in the AMA-HOD. Contact the AMA-IMG Section's Carolyn Carter-Ellis by e-mail or call (312) 464-5397 if you have questions.

Brought to you by the AMA Section on Medical Schools

1) AMA-SMS meeting set for Nov. 6
The next AMA-SMS meeting will be held from 2 to 5 p.m. Nov. 6 at the Marriott Copley Place in Boston in conjunction with the Association of American Medical Colleges (AAMC) Annual Meeting.

The meeting will be held at the same time as the Interim Meeting of the AMA House of Delegates in Houston. The AMA-SMS Governing Council decided to hold the section meeting in Boston rather than in Houston because of the large number of AMA-SMS members who regularly attend the AAMC meeting.

Visit the AMA-SMS Web site beginning in August to view meeting details.

2) Survey to assess care for LGBT patients
This spring, deans of medical education at all Doctor of Medicine and Doctor of Osteopathic Medicine schools in the United States and Canada received surveys inquiring about practices and principles of lesbian, gay, bisexual and transgender (LGBT) health-related education at their institutions. The survey is the first phase of the LGBT-Medical Education Assessment (LGBT-MEA) by the LGBT Medical Education Research Group, a partnership of faculty and student researchers at Stanford University School of Medicine and Harvard Medical School.

The LGBT-MEA aims to assess the breadth, depth and efficacy of medical education with respect to caring for LGBT people and to develop practical tools that medical schools can use to evaluate and improve their curricula.

To facilitate completion of this survey by deans at your school, visit the Stanford School of Medicine Web site to provide the LGBT Medical Education Research Group with contact information for the appropriate dean.

Learn more information about the LGBT-MEA project.

3) Recognize your mentors
The AMA Women Physicians Congress (WPC) is seeking nominees for its Physician Mentor Recognition Program, which provides an opportunity to acknowledge those physicians who contribute in small, often unsung ways to the professional life of individuals in medicine. Nominations are due by July 31.

Send an e-mail with questions.

4) In American Medical News: Stimulus money expected to help cut medical student debt
An article in the June 23 issue of American Medical News reports that nearly $200 million from the federal economic stimulus package is expected to provide up to 3,300 repayment awards to clinicians who agree to serve two years with the National Health Service Corps. The hope is that the funding will increase the ranks of primary care doctors and assist communities in need.

1) AMA strongly supports reinstatement of "20/220 pathway"
In a June 23 letter to Sen. Richard Burr, R-N.C., the AMA expressed strong support for Burr's amendment to the U.S. Senate Health, Education, Labor and Pensions Committee's health system reform bill, the "Affordable Health Choices Act." The amendment would restore the debt-to-income pathway known as the "20/220 pathway," an economic hardship loan deferment program that many medical residents have relied upon during their initial years of residency. The program was scheduled to be discontinued July 1.

"Helping our medical students finance their education and assisting our medical students, resident physicians and young physicians to better manage their high student loan debt burden is one of the AMA's top legislative priorities," Michael Maves, MD, MBA, the AMA's executive vice president and chief executive officer, wrote in the letter to Burr.

While the "Affordable Health Choices Act" is unlikely to become law in its current form, the AMA will continue to advocate that any final health system reform legislation include significant debt relief provisions, including the 20/220 pathway.

2) Obama to AMA: I need your help
In an earnest appeal to the nation's physicians last month, President Barack Obama pledged to work with the AMA to reform the nation's health care system in a way that works best for doctors and patients. The president's comments came during an address at the Annual Meeting of the AMA House of Delegates (HOD), which took place in Chicago.

Obama, the first U.S. president to address the AMA-HOD since Ronald Reagan in 1983, commended the AMA for joining with other health care stakeholders to help reduce the rate of growth in health care spending by 1.5 percent over the next decade. And he detailed ways—such as covering the uninsured, making insurance more affordable, increasing the value physicians receive from health care spending and enhancing prevention and wellness for all patients—to make that happen.

"[We need] to control the spiraling cost of health care," Obama said during a special session of the AMA-HOD that drew several standing ovations. "And to do that, we're going to need the help of the AMA."

"We have a historic opportunity for reform this year, and the AMA is actively working for health reform that covers the uninsured, makes insurance more affordable, increases the value our nation receives from its health care spending and enhances prevention and wellness for patients," said AMA Immediate Past President Nancy H. Nielsen, MD, PhD.

View President Obama's speech, listen to the audio or read a full transcript.

Learn more about the AMA's position on health system reform.

3) Contact the AMA-MSS's new leadership
The first meeting of the 2009–10 AMA-MSS Governing Council will be held July 24–26, when the governing council will set its goals for the year. All medical students are invited to provide input on these goals.

Visit the AMA-MSS Web site for contact information for the governing council's officers.

Fill out a Governing Council Action Form.

4) New Government Relations Advocacy Fellow begins term
T.R. Eckler, a medical student at the University of Rochester School of Medicine, is the AMA-MSS 2009–10 Government Relations Advocacy Fellow (GRAF). Working out of the AMA's Washington, D.C., office, Eckler will assist with research, support the AMA Council on Legislation and work on various legislative advocacy projects that can help physicians help patients. Among many other duties, Eckler will write the Medical Student Insider, a column written by the GRAF to keep the section abreast of legislative and advocacy developments of interest to medical students.

Contact Eckler by e-mail or call (202) 789-7424 with any questions or concerns regarding legislative or advocacy issues.

5) Enter Virtual Mentor's student essay contest
All medical students are invited to take part in the John Conley Foundation for Ethics and Philosophy in Medicine ethics essay competition. The competition is presented by Virtual Mentor, the AMA's online ethics journal.

This year's competition examines the topic of physicians' conscientious objection to discussing or providing treatment options to patients that are legal but objectionable to a physician's religious beliefs.

Visit the Virtual Mentor Web site to view the scenario, essay guidelines and instructions for how to enter the contest. The author of the best essay will be awarded $5,000, and the winning essay will be published in Virtual Mentor.

Submissions must be sent as e-mail attachments by July 31.

6) Feedback wanted about AMA-MSS meeting programs
The AMA-MSS is looking for medical students' feedback about the various educational programs and activities held during the section's annual assembly meeting last month in Chicago. Feedback gathered through the AMA-MSS's post-meeting evaluation will help the section with programming for the next meeting, to be held Nov. 5–7 in Houston preceding the Interim Meeting of the AMA House of Delegates.

 

 

7) JAMA: Just one benefit of being an AMA member
Are you hungry for more knowledge? Would you like to take a break from textbooks and read new articles from physicians in the field? Your AMA benefits are bringing that resource to your front door.

Look in your mailbox for the Journal of the American Medical Association (JAMA), the most comprehensive resource for original research, reviews, commentaries, editorials, essays, medical news and correspondence. An international peer-reviewed general medical journal published 48 times annually, JAMA is the most widely circulated medical journal in the world. Since 1883, physicians and health care professionals around the world have turned to JAMA for groundbreaking research and insightful commentary from leaders across the broad spectrum of health care.

You can choose to receive the weekly print version, or just access it online. Don't forget this valuable membership resource that the AMA provides.

View the JAMA Web site.

If you're an AMA member, don't lose valuable resources such as JAMA. Renew your membership. If you're not a member, join the AMA today and begin receiving them.

1) Summary documents from AMA-OMSS meeting now online
During the 53rd AMA-OMSS Assembly meeting, held June 11–14 in Chicago, the section considered 35 items of business, including those on the need for principles for developing sustainable and successful hospitalist programs and standardization of health information technology user interfaces.

Visit the AMA-OMSS Web site to access the meeting summary, the disposition of actions and other items from the meeting.

2) AMA-OMSS reveals results of survey of primary care physicians and hospitalists
The AMA-OMSS and the Society of Hospitalist Medicine recently completed a nationwide survey of primary care physicians and hospitalists to examine each groups' opinions of the growing hospitalist trend.

The survey, which follows a similar one from 2007, is designed to assess the effects of the hospitalist model on primary care physicians' practices and to determine primary care physicians' and hospitalists' perceptions of this model on the care of their shared patients.

Some key findings:

• More than 90 percent of hospitalists believe that hospitalist presence has improved the quality of hospital care, while less than half of primary care physicians feel the same way. However, since 2007, there is a significant trend toward an increase in primary care physicians believing that the hospitalist model does improve the quality of care in several domains. In fact, 46 percent of primary care physicians agree or strongly agree that hospitalists have improved the overall quality of hospital care, which is up from 40 percent just two years ago.
• Communication between hospitalists and primary care physicians throughout the hospital stay were recognized by both groups as being an area that needed improvement. Only 50 percent of hospitalists reported that they were effective at communicating with the primary care physicians during the hospital stay, and 70 percent felt they were effective with the communication at discharge. Not surprisingly, when asked those same questions, the rates of primary care physicians who felt hospitalists were effective was about half the rates as hospitalists (25 percent and 35 percent, respectively).
• Both primary care physicians and hospitalists want organizations such as the AMA-OMSS to provide resources to improve communication between hospitalists and primary care physicians as well as related resources and educational materials for both groups to more effectively care for patients.

3) View AMA-OMSS webcasts for CME credit
The AMA-OMSS offers several 90-minute educational webcasts, some for purchase and others free of charge. All programs for purchase provide AMA PRA Category 1 Credit™.

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

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) AMA strongly supports reinstatement of "20/220 pathway"
In a June 23 letter to Sen. Richard Burr, R-N.C., the AMA expressed strong support for Burr's amendment to the U.S. Senate Health, Education, Labor and Pensions Committee's health system reform bill, the "Affordable Health Choices Act." The amendment would restore the debt-to-income pathway known as the "20/220 pathway," an economic hardship loan deferment program that many medical residents have relied upon during their initial years of residency. The program was scheduled to be discontinued July 1.

"Helping our medical students finance their education and assisting our medical students, resident physicians and young physicians to better manage their high student loan debt burden is one of the AMA's top legislative priorities," Michael Maves, MD, MBA, the AMA's executive vice president and chief executive officer, wrote in the letter to Burr.

Visit the AMA-RFS Web site to view the letter.

2) AMA testifies at Senate health reform roundtable
AMA Board of Trustees (BOT) member Samantha Rosman, MD, testified June 11 at an issue-focused roundtable discussion on health system reform hosted by the U.S. Senate Health, Education, Labor and Pensions Committee.

Dr. Rosman, whose term on the AMA-BOT has since concluded, discussed the AMA's proposals for reforming the health insurance market to make health insurance affordable for all Americans. With respect to proposals to establish a new public health plan, she stated the AMA's belief that a reformed private health insurance market with a health insurance exchange like the Federal Health Employee Benefits Program should make such an option unnecessary. She also expressed the AMA's opposition to any government-run program that links payment rates to Medicare or that compels physicians to participate.

View more information about the event and statements from all the presenters.

3) In the Rochester Post-Bulletin: Mayo model praised, but can it last?
A story published June 25 by the Rochester Post-Bulletin notes the wide praise the Mayo Clinic has recently received for the high quality of care it provides at a relatively low cost. With the clinic losing $840 million on $1.7 billion in Medicare treatment last year, the story also questions how long it can survive in a system in which fee for service is rewarded instead of quality and value.

4) Apply for a seat on an AMA-RFS standing committee
The AMA-RFS is accepting applications for positions on its standing committees. Committee seats are appointed by the section's governing council for a one-year term. Apply for a position on the

• Committee on long-range planning
• Committee on medical education
• Membership committee
• Legislative advocacy committee
• Poster symposium committee
• Public health committee

Visit the AMA-RFS Web site to learn more about these committees and to apply for a seat on one of them.

5) Final AMA-RFS meeting summary of actions available online
The AMA-RFS considered 18 items of business at its annual assembly meeting in Chicago last month, forwarding eight items immediately to the AMA House of Delegates. Some items covered resident duty hours, transfer of care, direct-to-consumer advertising, loan repayment, health insurance coverage of pre-existing conditions and the impact of specialty board-mandated residency completion dates on parental leave during residency training.

Visit the AMA-RFS Web site to read about the actions taken by the AMA-RFS Assembly and AMA House of Delegates.

1) Census Bureau: Number of people 65 and older worldwide to triple by 2050
Figures released last week by the U.S. Census Bureau reveal that the world's 65-and-older population will triple by mid-century to one in six people. Such growth will, according to story published June 24 by the Associated Press (AP), leave "the U.S. and other nations struggling to support the elderly."

View the Census Bureau's international database.

1) Review actions from AMA-YPS meeting
The AMA-YPS Web page contains final actions on reports and resolutions considered by the section's assembly at its annual meeting in Chicago last month. Three resolutions addressing student loan debt were adopted by the section and forwarded immediately to the AMA House of Delegates (HOD). Two of these resolutions were subsequently adopted by the AMA-HOD, and the third was referred to the AMA Board of Trustees for further study.

2) Reference committee report, AMA-HOD handbook review grids available online
The annotated report of the AMA-YPS Reference Committee and the AMA House of Delegates (HOD) handbook review grids, which outline the section's position on all items of business considered during the Annual Meeting of the AMA-HOD, are available on the AMA-YPS Web pages.

View the annotated report.

Send an e-mail if you have questions.

3) Recognize your mentors
Young physician members of the AMA Women Physicians Congress (WPC) are encouraged to nominate a mentor for the AMA-WPC's annual Physician Recognition Program, a unique way to acknowledge those individuals who have made a difference in your professional life.

Nominations are due by July 31. Mentors will be recognized in a special commemorative book to be distributed in November during the Interim Meeting of the AMA House of Delegates.