AMA eVoice Weekly Newsletter

Homework for August

This is a historic time for physicians in America as Congress has its recess and congressional members go back to their homes to hear from constituents about health system reform. Your homework is to be engaged and let them know what you want.

What happens if Congress does nothing? The uninsured will still rely on charity and emergency departments for access to health care. They will live sicker and die younger. The AMA has been pushing for providing health insurance with advanceable subsidies to help people purchase coverage. And those who obtain health insurance but have pre-existing medical conditions will continue to be denied coverage for medical costs. The AMA supports elimination of pre-existing exclusions from health insurance.

If Congress does nothing, the burden of administrative waste will remain part of the unnecessary costs in health care. The AMA supports eliminating these costs through simplification. Antitrust relief to allow independent medical practices to interact to improve quality has to be allowed. In addition, the unnecessary costs of defensive medicine have to be addressed without removing caps on noneconomic damages that provide stability of medical liability premiums and access to high-risk medical specialties from states that have proven reforms.

If Congress does nothing, the flawed Medicare sustainable growth rate formula will create a 40-percent cut in payments over the next six years starting Jan. 1, 2010. Bottom line: This needs to be fixed and replaced.

And above all, we must preserve the patient-physician relationship so patients can receive care from the physician of their choice without interference by health insurance companies or the government.

Now is the time to be involved if you want to help change the status quo. Visit the AMA Web site for the latest developments on health system reform legislative activities and AMA advocacy efforts.

—J. James Rohack, MD

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

1) Learn the facts about health system reform legislation
With Congress in recess throughout this month, now is the time to find out what’s true and what’s not regarding H.R. 3200, “America’s Affordable Health Choices Act.”

The AMA Web site contains the latest developments on health system reform legislative activities and AMA advocacy efforts, as well as a link to a story by PolitiFact, a fact-check service by the St. Petersberg Times that points out misinformation and dispels falsehoods about the bill that have been circulating in recent weeks.

Visit the AMA Web site for the latest developments on health system reform legislative activities and AMA advocacy efforts.

2) AMA holds forum on health reform
Physicians from New York and Pennsylvania had their questions about health system reform legislation answered by AMA leaders Aug. 6 during a tele-town hall Physicians’ Forum held by the AMA.

AMA Immediate Past President Nancy H. Nielsen, MD, PhD, and Richard Deem, senior vice president of advocacy at the AMA, addressed questions about medical liability reform, health savings accounts and the AMA’s role in health system reform. A survey conducted at the end of the call found that 92 percent of respondents said the hour-long forum was “very useful.”

The AMA plans to do more Physicians’ Forums across the country in the coming weeks.

3) AMA president talks health system reform on ReachMD
AMA President J. James Rohack, MD, spoke this week on ReachMD XM Satellite Radio, Channel 160, in an interview with ReachMD host Michael Greenberg, MD, about a range of issues regarding health system reform, including the AMA's recent support for the House health reform bill, H.R. 3200, “America's Affordable Health Choices Act of 2009.” Dr. Rohack also touched upon representing physicians in the health reform debate and the prospects for medical liability protections being included in the final version of H.R. 3200.

Listen to the interview.

4) MS.1.20 task force reaches consensus on revised standard
The MS.1.20 Implementation Task Force reached consensus in March to revise the Joint Commission’s Medical Staff Standard 1.20 (MS.1.20)—a standard created in 2004.

The 18-member task force was convened in January 2008 by the Joint Commission to analyze the potential impact of implementing such a standard. After more than a dozen discussions, the group concluded that a revised standard was needed to resolve several concerns, such as the cost and burden associated with changing bylaws and the potential for disrupting relationships between medical staffs and governing bodies.

The task force—which includes representatives from the AMA, American College of Physicians, American College of Surgeons, American Dental Association, American Hospital Association, Federation of American Hospitals and National Association of Medical Staff Services, among others—disseminated a working draft standard, MS.01.01.01, to its constituents in an effort to gather feedback.

The results of this feedback will be communicated to the Joint Commission by Oct. 15. If the feedback supports the proposed standard, the Joint Commission will consider giving all interested parties an opportunity to comment on the proposal. But until further notice, the current standard will remain in effect.

Hospitals are expected to be compliant with MS.01.01.01 as stated in the 2009 Hospital Accreditation Manual. E-mail Joe Ann Jackson of the AMA at hospital.accreditation@ama-assn.org with questions.

5) AMA Foundation free clinic grant applications due Aug. 31
The AMA Foundation is accepting applications for its 2010 Healthy Communities/Healthy America program. This program will award 10 free clinics with grants of $10,000 to implement diabetes management and education projects for the uninsured and is supported by an educational grant from Lilly USA, LLC.

Projects must focus on helping uninsured diabetics successfully achieve or maintain recommended A1C levels and improve their self-management skills. Federally qualified health centers and referral networks that coordinate care but do not provide direct care themselves are ineligible to apply.

Letters of inquiry are due Aug. 31.

Visit the AMA Foundation Web site to view eligibility criteria and download an application.

6) Virtual Mentor: clinical responsibility in the age of patient autonomy
According to the August issue of Virtual Mentor, the autonomy principle reminds us that every individual person has values, reasons and standards of his or her own, as well as an interest in self-determination. Medicine must be practiced so that an individual’s self-determination is protected and, therefore, he or she is empowered to make medical decisions according to his or her standards.

In this month’s Virtual Mentor, authors call up and examine ethical values and virtues that supplement respect for patient autonomy in providing adequate protection for patients and research subjects.

7) A discounted subscription rate for the CPT^® Assistant newsletter: just one benefit of being an AMA member
How well do you understand the intricacies of coding? AMA members can access the CPT^® Assistant newsletter, which provides detailed articles, commentaries, updates and other timely facts about coding, at a discounted price. Read specific clinical vignettes that offer insight into confusing codes or view anatomical illustrations, charts and graphs for quick reference.

Read more about the CPT^® Assistant newsletter and subscribe to it.

Send an e-mail to CPTAsstSample@ama-assn.org to order a free sample of the CPT^® Assistant newsletter.

If you’re an AMA member, don’t lose valuable resources such as the discounted CPT^® Assistant newsletter subscription rate. Renew your membership. If you’re not a member, join the AMA today and begin receiving them.

8) In JAMA: Intense, prolonged exposure to World Trade Center attack associated with new health problems several years later
A large number of individuals—such as recovery and rescue workers, nearby residents and office workers—who experienced intense or prolonged exposure to the World Trade Center attack reported new diagnoses of asthma or post-traumatic stress five to six years after the attack, according to a study in the Aug. 5 issue of the Journal of the American Medical Association (JAMA), a theme issue on violence and human rights.

View the study “Asthma and posttraumatic stress symptoms 5 to 6 years following exposure to the World Trade Center terrorist attack.”

1) Survey shows suicide contemplated by nearly a third of Massachusetts’ transgender population
Nearly a third of transgender residents in Massachusetts have considered suicide, according to a survey by the Massachusetts Department of Public Health.

The survey, which compared the health of lesbian, gay, bisexual and transgender people to heterosexual and nontransgender residents, found that about 31 percent of transgender respondents said they have considered attempting suicide in the past year. That compares to just 2 percent for heterosexual residents, 4 percent for gay and lesbian residents, and 7 percent for bisexual residents.

View a story about the survey published in the Boston Herald.

2) House subcommittee approves domestic partner health benefits bill
Legislation that would grant full health care benefits to domestic partners of gay and lesbian federal employees cleared its first hurdle last week when a U.S. House of Representatives subcommittee approved the measure. The House Subcommittee on Federal Workforce Issues approved the “Domestic Partnership Benefits and Obligations Act”—which would extend to same-sex partners several benefits including access to health care coverage, retirement and disability plans, and life and long-term-care insurance—by a 5–3 vote.

View coverage of this by the Washington Post.

3) Association of Gay and Lesbian Psychiatrists offers resident paper award
The Journal of Gay and Lesbian Mental Health (JGLMH)—the official journal of the Association of Gay and Lesbian Psychiatrists (AGLP)—is seeking outstanding resident papers on lesbian, gay, bisexual and transgender mental health for its resident paper award. Submissions can be original research papers, review articles, or case series and detailed case reports. The award includes $500, publication in JGLMH and assistance with travel to the AGLP annual meeting to present your work.

The deadline to submit a paper is April 1.

Send an e-mail to Roy Harker at rharker@aglp.org with entries or questions.

1) Program can provide you with supplementary retirement income
A special program designed under Internal Revenue Code 79 can provide supplementary retirement income to physicians while their practice receives a business tax deduction.

Section 79 of the Internal Revenue Code (IRC 79) permits an eligible corporation to offer up to $50,000 of group term life insurance for full-time employees at no cost to the employee. The total cost of supplying this coverage is generally fully deductible to the corporation. IRC 79 also allows for coverage to be offered using permanent life insurance, giving business owners a way to use excess pre-tax profits to provide tax-advantaged benefits to participating employees.

A new program offered by Infinity Wealth Management, LLC, called Select 79, provides group practices with a structured plan to purchase affordable term life insurance on its employees. In addition, this plan can provide key employees with a cash-value accumulation policy they can use for supplemental retirement income.

AMA Insurance Agency has completed a comprehensive due diligence and screening process of Infinity Wealth Management and has approved the company as a member of its Trusted Source Network^SM.

To learn more about Select 79 from Infinity Wealth Management, contact Mike Hegwood, assistant vice president with AMA Insurance Agency, at mike.hegwood@amainsure.com or (312) 464-5247. Consult with your attorney or tax advisor for complete up-to-date information concerning federal and state tax laws in this area.

1) Next AMA-IMG Section meeting set for Nov. 6–9
The next AMA-IMG Section Congress meeting will take place Nov. 6–9 at the George R. Brown Convention Center in Houston. Visit the AMA-IMG Web site later this summer for more details about the meeting and to download a registration form. All AMA-IMG Section meetings are free to attend, and guests are welcome. If you have any questions, send an e-mail to img@ama-assn.org or call J. Mori Johnson, director of the AMA-IMG Section, at (312) 464-5678.

2) Resolutions for Interim Meeting due Sept. 1
If you would like to submit a resolution to the AMA-IMG Section’s Virtual Congress, please e-mail your resolution to img@ama-assn.org by Sept. 1.

This year’s Interim Meeting of the AMA House of Delegates will focus only on advocacy issues, so all resolutions submitted from the AMA-IMG Section for the meeting must fit the following definition of advocacy: Active use of communication and influence with public and private sector entities responsible for making decisions that directly affect physician practice, payment for physician services, funding and regulation of education and research, and access to and delivery of medical care.

View guidelines for writing a resolution.

If your resolution does not fit the aforementioned advocacy definition, it will be held over until the AMA-IMG Section’s June 2010 meeting.

If you have any questions or would like to submit a draft resolution for comments, e-mail it to img@ama-assn.org or call Carolyn Carter-Ellis of the AMA-IMG Section at (312) 464-5397.

3) AMA-IMG observership program guidelines now available
International medical graduates interested in observership programs can review guidelines for such programs on the AMA-IMG Web site. Developed by an expert working group, the guidelines can serve as a template for physicians and medical associations seeking to establish an observership program to help acculturate international medical graduates to the practice of medicine in the United States.

Visit the AMA-IMG Web site to download the program guidelines and evaluation forms. Call (312) 464-5678 with questions or if you know of an observership program for international medical graduates.

4) 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.

Visit the USMLE Web site to learn more about the lawsuit.

Brought to you by the AMA Section on Medical Schools

1) Update on ITME: addressing gaps in medical education
Phases one and two of the AMA’s Initiative to Transform Medical Education (ITME), which took place from 2005 to 2007, identified gaps in the preparation of physicians and developed recommendations for change across the continuum of medical education. Phase three, which began in 2007 and is ongoing, is developing strategies to address these gaps.

Other ITME-related activities are taking place in the following three areas:

• Medical education learning environment—Two working conferences have taken place to date. The focus of these conferences has been to identify factors in the learning environment that inhibit and promote the acquisition of professional behaviors by medical students and resident physicians. A research proposal has been developed and grant funding is being explored. The goal is to implement the recommendations from the conferences in medical schools and study the results.
• Physician re-entry into the work force—A survey of state medical licensing boards was conducted in conjunction with the American Academy of Pediatrics this summer to determine if re-entry was addressed in state medical licensing laws or regulations. ITME will be making recommendations to state medical boards to make re-entry requirements more consistent across states.
• Medical school admissions—One of the recommendations from phase two was to enhance the importance of the interpersonal domain in medical school admissions. ITME will hold a working conference on medical school admissions in December to review current thinking about the admissions criteria and processes and to create a work plan for further action.

2) New resource offers assistance during training
An easy-to-navigate resource developed by the AMA Resident and Fellow Section can help young physicians prepare for a successful career. “Succeeding from Medical School to Practice” features tips, links and streaming video specifically for medical students, residents and fellows, and young physicians.

View this resource; forward it on to your medical students, resident physicians and colleagues.

3) In American Medical News: Unique program teaches professionalism to medical students
An article in the July 27 issue of American Medical News reports that the Ohio University College of Osteopathic Medicine and the State Medical Board of Ohio have teamed up on an initiative to educate medical students about how to avoid ethical missteps and behaviors that could lead to charges of professional misconduct. One of the highlights of this popular program has students attending a board meeting to get a firsthand look at board activities.

1) Mark your calendar for AMA-MSS Interim Assembly Meeting deadlines
This year’s AMA-MSS Interim Assembly Meeting will be held Nov. 5–7 at the George R. Brown Convention Center in Houston. Join the section for policymaking and educational sessions, a national service project event, the annual Research Poster Symposium and more.

Please keep the following deadlines in mind:

• Convention committee applications are due Sept. 7.
• Research Poster Symposium abstracts are due Sept. 18.
• Final resolutions with checklist are due Sept. 25; a draft resolution must be posted on the AMA-MSS Health Policy and News listserv by Sept. 11.
• Meeting registration and AMA Board of Trustees, chair-elect and regional delegate applications are due Oct. 1.

In addition, the AMA-MSS is planning programs for the meeting and would like your ideas. Use the online form to submit your ideas by Sept. 7.

2) Chapter of the Week: Wayne State University holds AMA white coat breakfast
Medical students of the AMA-MSS chapter at Wayne State University will host a breakfast Aug. 8 prior to the white coat ceremony to outline the benefits of AMA membership for the incoming class and their families. Incoming students will learn about future leadership opportunities and how the AMA can help them now as medical students and later as doctors.

What events does your chapter have planned for the incoming class? Chapter involvement grants are available to AMA-MSS chapters to help put student community service projects and recruitment events into action. Chapters are eligible for up to $1,000 per academic year.

Visit the AMA-MSS Web site to learn more and apply for a grant at least 30 days before your event.

3) AMA Morning Rounds: just one benefit of being an AMA member
Have you been getting your daily dose of government and medicine, public health and pharmaceutical news? If this doesn't ring a bell, then you haven't been reading AMA Morning Rounds.

The authoritative news briefing written exclusively for AMA members, AMA Morning Rounds provides concise summaries of the day's most important developments in health care. Have the latest stories in government and medicine, the medical-legal landscape, health care coverage and access, public health, and pharmaceutical and medical device news waiting for you in your e-mail inbox every weekday morning.

Subscribe to AMA Morning Rounds.

Renew your AMA membership, or join the AMA and gain access to valuable resources such as this.

4) AMPAC sets dates for 2010 political education programs
The AMA Political Action Committee (AMPAC) will hold its annual candidate workshop from Feb. 19–21 and annual campaign school from April 21–25.

Both programs have been held for more than 25 years and provide unmatched political training for physicians, medical students and other friends of medicine who are interested in either seeking public office or in working to elect other friends of medicine. Each program will be held at the Ritz-Carlton Pentagon City in Arlington, Va., just a short ride from Reagan Washington National Airport.

AMPAC covers all costs for AMA members and their spouses only, excluding transportation to the Washington, D.C.-metro area. AMA membership needs to be current for 2010.

Medical student admission is limited, so students must also submit a 500-word essay on why they would like to attend the programs and what they hope to gain. Student applications are due Dec. 18 for the candidate workshop and Jan. 22 for the campaign school.

Recent medical student attendees include:

• Hans Arora, AMA-MSS Governing Council chair
• Kristina Maletz, AMA-MSS Governing Council vice chair
• Maya Babu, former student representative for the AMA Women Physicians Congress
• Chris DeRienzo, MD, former student representative on the AMA Board of Trustees
• Jay Widmer, former student representative on the AMPAC Board of Directors
• Kunal Mitra, student representative on the AMA Foundation board, former AMA-MSS at-large officer and a former Government Advocacy Relations Fellow

Other graduates include Sen. John Barrasso, MD, R-Wyo., and Rep. Tom Price, MD, R-Ga., in addition to dozens of state and local officeholders and candidates from across the country.

Visit the AMPAC Web site for more information, or send an e-mail to kaiserhe@email.uc.edu to contact Heather Kaiser, student representative on the AMPAC Board of Directors.

Brought to you by the AMA Minority Affairs Consortium

1) Report exposes racial and ethnic disparities in children’s health care
A report published July 20 that found “extensive, pervasive, and persistent” racial and ethnic disparities in children’s health care also provided recommendations on how to eliminate them.

The report, “Achieving optimal health and healthcare for all children: How we can eliminate racial and ethnic disparities in children’s health and healthcare,” was commissioned by First Focus, the bipartisan children’s advocacy organization. First Focus pointed to its findings as evidence that health system reform should include a strengthening of Medicaid and the Children’s Health Insurance Program.

View a full news release about the report.

2) Study finds African-Americans have nation’s highest obesity rate
A study from the Centers for Disease Control and Prevention, published in the July 17 Morbidity and Mortality Weekly Report, indicates that non-Hispanic black Americans have the highest rate of obesity in the United States among major racial groups.

View the study “Differences in prevalence of obesity among black, white, and Hispanic adults—United States, 2006–2008.”

1) FTC sets Nov. 1 as new enforcement date for “red flags” rule
The Federal Trade Commission (FTC) has delayed the enforcement date of the “red flags” rule until Nov. 1. Enforcement of the “red flags” rule, which requires certain businesses to develop identity theft prevention and detection programs, originally was set for Nov. 1, 2008. But following advocacy efforts from the AMA and other associations, compliance was extended twice—first to May 1, and then to Aug. 1.

The new compliance date of Nov. 1 is a result of continued advocacy by the AMA and others who continue to object to the applicability of this rule to health care providers and other professionals.

View guidance materials that can help physicians prepare for the new Nov. 1 deadline.

2) AMA-OMSS Assembly meeting set for this fall
The next AMA-OMSS Assembly meeting will take place Nov. 5–7 at the George R. Brown Convention Center in Houston, preceding the Interim Meeting of the AMA House of Delegates.

More information about the meeting will be posted later this month on the AMA-OMSS Web site. In the meantime, details of the section’s June assembly meeting are available for viewing.

3) Learn about risk assessment and adjustment models
New resources from the AMA can help physicians understand risk assessment and adjustment models. One resource, “An introduction to risk assessment and risk adjustment models,” defines the terms “risk assessment” and “risk adjustment” and provides overviews of the prominent risk assessment and risk adjustment models and their various uses, including profiling physicians. Another resource, “Terminology used in physician profiling,” helps physicians assess information they receive about physician profiling.

View other AMA resources that focus on physician profiling.

4) AMA-OMSS webcasts offer 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) Guidance on building a practice: just one benefit of being an AMA member
Do you want to start your own practice? Where do you begin? AMA members can get advice from a special resource: “Succeeding from Medical School to Practice, Part 3.”

In the third and final part of this guide, learn how to write a business plan, raise capital, hire and retain a staff, market your practice and more to ensure success. Developed by your AMA physician colleagues, this easy-to-navigate resource includes a wealth of valuable information plus streaming video to help you confront the nonclinical demands of training and today’s practice environment.

AMA members can visit view “Succeeding from Medical School to Practice, Part 3.”

Don’t miss out on valuable resources such as this. Renew your AMA membership or join the AMA today and begin receiving these benefits.

2) Mark your calendar for next Research Poster Symposium
The sixth annual Research Poster Symposium will be held in November during the AMA-RFS Interim Assembly Meeting in Houston. Abstract submissions must be of original work by current residents and fellows and should fall into one of four categories: basic science, clinical medicine, health policy and medical education, or a clinical vignette. Top abstracts will be selected for presentation at the symposium.

3) Take a FIRST step in learning about student debt
Members of the academic medicine community looking for help in navigating the complexities of student debt can use the Financial Information, Resources, Services, and Tools (FIRST) resource, developed by the Association of American Medical Colleges (AAMC) in collaboration with the medical school financial aid community and the Organization of Student Representatives.

FIRST offers a full range of information for applicants, medical school students, residents, advisors and financial aid officers. The goal of the resource is to help medical school borrowers expand their financial literacy, make smart decisions about student loans and manage their student debt wisely.

1) In JAMA: CSF biomarkers may help predict Alzheimer’s disease in patients with mild cognitive impairment
Several proteins in cerebrospinal fluid (CSF) biomarkers can predict which patients with mild cognitive impairment will develop Alzheimer’s disease, according to a study in the July 22/29 issue of the Journal of the American Medical Association (JAMA).

2) In American Medical News: Doctors find fulfillment working abroad
A story published July 20 by American Medical News features physicians who travel to other countries to practice medicine. And that doesn’t have to mean working in an underdeveloped country.

Physicians who go on this type of journey say money is not the main motivation. Some are attracted by the idea of working and traveling while seeing more of a county than is possible in a brief visit.

Brought to you by the AMA Women Physicians Congress

1) Osteoporosis-linked fractures have risen dramatically
The hospitalization rate of patients admitted for treatment of hip, pelvis and other fractures associated with osteoporosis increased 55 percent between 1995 and 2006, according to the Agency for Healthcare Research and Quality (AHRQ).

2) In the Miami Herald: Uterine fibroid sufferers have less invasive option available
A new treatment technique for patients who suffer from uterine fibroids is available, according to a profile published July 28 by the Miami Herald. Uterine fibroids, which are benign tumors in the muscle of the uterus, are one of the most common problems in women of child-bearing age.

1) AMA-YPS seeks your insight on physician re-entry issues
The AMA-YPS is collaborating with the American Academy of Pediatrics (AAP) Physician Re-entry into the Workforce Project to learn more about information and resources that will assist physicians who leave and then later desire to re-enter clinical practice.

The AMA-YPS is aware that re-entry issues are a consideration for young physicians and would like your input through a short survey. Even if you have not left or re-entered the work force, or do not have immediate plans to do so, your opinion is valued.

Complete the survey by Aug. 21. This is not an AMA survey, there are no personal identifiers, and responses will be collated and reported in the aggregate.

2) 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 June. 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.

3) FTC sets Nov. 1 as new enforcement date for “red flags” rule
The Federal Trade Commission (FTC) has delayed the enforcement date of the “red flags” rule until Nov. 1. Enforcement of the “red flags” rule, which requires certain businesses to develop identity theft prevention and detection programs, originally was set for Nov. 1, 2008. But following advocacy efforts from the AMA and other associations, compliance was extended twice—first to May 1, and then to Aug. 1.

The new compliance date of Nov. 1 is a result of continued advocacy by the AMA and others who continue to object to the applicability of this rule to health care providers and other professionals.

View guidance materials that can help physicians prepare for the new Nov. 1 deadline.