AMA eVoice Weekly Newsletter

One person can make a difference

It was a humbling experience for me to represent the AMA on June 22 in the White House Rose Garden as President Barack Obama signed into law the "Family Smoking Prevention and Tobacco Control Act." This new law amends the Federal Food, Drug and Cosmetic Act to grant the Food and Drug Administration (FDA) the authority to protect the public health in its recognition of nicotine being a harmful drug.

To help protect our nation's youth, the new law bans all outdoor tobacco advertising within 1,000 feet of schools and playgrounds and on tobacco-brand sponsorships of sports and entertainment events. It also bans candy and fruit flavors in tobacco products that help to entice the 1,000 youths who take up tobacco use each day in America.

The law does not allow the FDA to totally ban nicotine outright but permits lowering the amount of the addiction-causing nicotine in tobacco products and blocks misleading labels such as "low tar" and "light." More detailed disclosure of ingredients, as well as larger, more specific health warnings, will be required on packaging. And FDA activity will be funded by a user fee on cigarette manufacturers, allocated by market share.

The AMA's mission—to promote the art and science of medicine and the betterment of public health—coincides with this new law. At times, to achieve a mission or a goal, one has to work with others. This bill is a good example of that. The AMA has worked with numerous organizations represented in its House of Delegates and across the nation to protect the public health by strong regulation of tobacco.

And as I sat in the Rose Garden under a cloudy sky, I thought about how sad it was that the one individual who turned AMA policy into being strongly against tobacco use—former AMA President Ronald M. Davis, MD—was not sitting there beside me. I met Dr. Davis when we were both medical students, and he had been a colleague over the years. I admired his dogged pursuit of what was right for patients and annually ensuring that AMA policy was changed and implemented to regulate tobacco to protect our youths and public health.

As these thoughts passed through my head, suddenly the clouds parted and a bright ray of sunshine filled the garden. That's when I knew Dr. Davis, an inspiring AMA leader and advocate for so many years who died too young, was looking down on this event.

Dr. Davis showed through his actions in the AMA that one individual can make a difference. One individual, through the AMA's House of Delegates process, can change AMA policy. One individual can make a change to benefit patient care. One individual can change the world.

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

1) AMA efforts help secure new laws regulating rental networks, mergers
The AMA’s campaign to regulate rental network contracting scored another victory last month when Tennessee Gov. Phil Bredeson signed the “Preferred Provider Transparency Act,” a law that reflects many provisions of the AMA/National Conference of Insurance Legislators model rental network act.

Highlights of Tennessee’s new law include definitions of contracting parties; required registration with the state’s insurance department; original contract privity and termination requirements for contracting entity and downstream entities; limitations on third-party access; mandated transparency, notice and contact information of contracting parties; and clear penalties and enforcement provisions. Connecticut, Georgia, Utah and Vermont notched similar rental network victories during this legislative session, and bills were introduced—with some still pending—in Hawaii, Oregon, Rhode Island and Texas.

Meanwhile, the AMA’s campaign to protect competition in the health insurance market secured a victory in Nevada this spring. Gov. Jim Gibbons signed legislation in May that strengthens state law by limiting the circumstances of when a health insurer merger or acquisition can occur, mandating that the applicant has the burden of proving there are no violations of competitive standards, and allowing the state insurance commissioner to consider new evidence when granting a merger, including the effect on the interests of the insurance-buying public.

The AMA’s Advocacy Resource Center (ARC) has model bills and campaign toolkits on both of these campaigns. Send an e-mail for more information.

2) Review your WellPoint/Anthem contract before July 15
The physician protections of the WellPoint/Anthem multidistrict litigation (MDL) class action settlement agreement are set to end July 15. After that date, WellPoint/Anthem no longer will have to comply with the settlement terms.

Physicians who are contracted with WellPoint/Anthem are encouraged to review their contract and contact their WellPoint/Anthem provider representative to determine how the settlement termination will affect their business relationship with the health insurer.

Download a check list of key settlement terms.

Download the complete settlement agreement.

Visit the AMA Web site to access information about MDL settlements as well as other settlements with health insurers.

In addition, AMA members can download the AMA’s Model Managed Care Contract.

3) Earn CME credit for using AMA Foundation’s health literacy toolkit, patient safety monograph
Two of the AMA Foundation’s educational resources—the health literacy toolkit and the patient safety monograph—have recently been re-approved to provide continuing medical education (CME) credit for physicians through May 2012. Both resources are designed as self-study CME activities, and physicians can earn a maximum of 2.5 AMA PRA Category 1 Credits™ for each activity.

New instructions for claiming credit will be included with each purchase of these resources from the AMA Bookstore. If you already own hard copies, you can print out the new instructions.

View CME information for the health literacy toolkit.

View CME information for the patient safety monograph.

Visit the AMA Foundation Web site to download electronic versions of both resources at no charge.

4) Learning the advantages of electronic claims submission: Just one benefit of being an AMA member
Do you wish you could reduce the time and resources your practice devotes to manual administrative functions? Would you like to expedite a health plan payer’s claims processing turnaround? Then it’s time to get an introduction to electronic claim systems.

Dive into the AMA members-only article “The benefits of electronic claims submission—improve practice efficiencies,” one of the many resources offered by AMA’s Practice Management Center. The AMA, in collaboration with the Connecticut State Medical Society, developed this educational resource to help physicians and their practice staff understand the electronic claim submission process. It features the benefits of submitting claims electronically to health plan payers, discusses the reduction of claim submission costs and errors, and offers tips on getting started.

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

5) In JAMA: Newer, minimally invasive surgical procedure for treatment of sciatica does not result in better outcomes
A comparison of surgical treatments for sciatica finds that the minimally invasive procedure known as tubular diskectomy does not provide a significant difference in improvement of functional disability compared to the more common surgery, conventional microdiskectomy, according to a study in the July 8 issue of the Journal of the American Medical Association (JAMA).

1) News report says Mullen advises ‘measured’ approach to gay policy
According to a story published July 5 by the Associated Press, the nation’s top military officer, Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, said he has advised President Barack Obama to move “in a measured way” in changing the “don’t ask, don’t tell” policy that bans gays from serving openly in the military. During his presidential campaign, Obama pledged to end the ban.

2) Compare major health system reform proposals
An interactive side-by-side comparison of the leading comprehensive reform proposals is available on the Henry J. Kaiser Family Foundation Web site, which allows a user to compare the proposals across a number of key characteristics and plan components. To capture the most important proposals, Kaiser has included those that have been formally introduced as legislation as well as those that have been offered as principles or in white paper form.

3) 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 patients 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, provide the LGBT Medical Education Research Group with contact information for the appropriate dean.

Brought to you by the AMA Section on Medical Schools

1) AMA-SMS meeting presentation slides available online
Slides from educational sessions held during the AMA-SMS meeting in Chicago last month can be viewed on the section’s Web site. The slides include information from sessions covering medical student mentoring, resident duty hours, interprofessional collaboration in health care, innovative strategies for transforming the education of physicians, medical education and disaster preparedness, implementation of the United States Medical Licensing Examination’s comprehensive review recommendations and telemedicine in clinical education.

Presentation summaries will be available in August.

2) AMA looks for ways to trim rising student debt
Steps taken last month by the AMA House of Delegates (HOD) would help address the pressures of rising medical student debt. During its annual policy-making meeting in Chicago, the AMA-HOD directed the AMA to work with medical schools and other stakeholders to increase funding through state and federal scholarship and loan programs and to oppose state efforts to reduce school funding. The AMA also will promote other innovative ways to help students reduce debt, such as by shortening the length of training for combined residency or dual-degree programs, easing loan repayment obligations and ensuring equitable tuition increases.

View a story by American Medical News about these new policies.

3) Plan to attend upcoming conference for CME professionals
The 20th annual Conference on Continuing Medical Education (CME) Provider/Industry Collaboration, “Learning from the past; planning for the future,” will be held Oct. 14–16 in Baltimore. Featured experts will speak on topics including future options for commercial support funding and the report from the Institute of Medicine’s Conflict of Interest in Medical Research, Education and Practice Committee.

Visit the AMA Web site for online registration information and other details about the conference.

4) In the Wall Street Journal: Vermont and Massachusetts ban industry gifts, free meals to physicians
In its July 1 issue, the Wall Street Journal reported on recently enacted laws in Vermont and Massachusetts that ban pharmaceutical companies and makers of medical devices from giving gifts such as meals, resort trips or even coffee mugs to physicians. Legislatures in other states are debating whether to impose similar bans, according to the Journal, and some medical companies are concerned such laws will impede the flow of information to physicians.

Gifts are also banned at Stanford University School of Medicine, The Ohio State University College of Medicine and the University of Pennsylvania School of Medicine, the Journal reports.

1) Column highlights AMA’s commitment to health system reform
In his first column as AMA-MSS chair, Hans Arora, a student at Northwestern University Feinberg School of Medicine, outlines the AMA’s commitment and involvement in efforts to reform the nation’s health system and explains why your involvement in the AMA is so vital to the future of medicine.

2) Learn about the new Income Based Repayment plan
Earlier this month the Income Based Repayment (IBR) plan replaced a popular form of economic hardship deferment known as the “20/220 pathway.” However, the AMA continues to fight for the reinstatement of the 20/220 pathway as well as for other loan repayment options that best serve the individual needs of all medical students and residents.

View an AMA-MSS issue brief and learn more about the IBR.

Learn more about the AMA’s advocacy efforts on this important issue.

3) July issue of Virtual Mentor examines medicine in the era of globalization
Globalization means that ideas, people, resources—and germs—now move unfettered from country to country with great speed. On balance, this is good news for the health of populations around the world. But globalization also raises ethical questions about the conduct of clinical research in developing countries, use of clinics abroad to train U.S. medical students, lack of essential medicines for many who need them, and migration of doctors from low-income countries to those with higher standards of living.

The July issue of Virtual Mentor, the AMA’s online ethics journal, examines these questions through articles and commentaries written by several physicians with international medical experience.

4) Medical students join AMA councils, other groups
The AMA-MSS congratulates those medical students who recently were appointed as members of AMA councils or as representatives or liaisons to other groups. View the names of these student leaders and the groups they represent.

5) Contact the new AMA-MSS leaders
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 governing council officers’ contact information.

Visit the AMA-MSS Web site to fill out a Governing Council Action Form.

6) FREIDA Online: just one benefit of being an AMA member
Residency is just around the corner. Where are you going to go? Which institution has the right program for you?

As an AMA member, you have an outstanding resource at your fingertips—FREIDA Online. FREIDA is a database with more than 8,200 graduate medical education programs accredited by the Accreditation Council for Graduate Medical Education, as well as more than 200 combined specialty programs. AMA members-only functions for FRIEDA include being able to save the contents of your folder to view at a later date and the ability to print program mailing address labels directly to your computer’s printer at no cost.

If you’re an AMA member, don’t lose valuable resources such as access to AMA member functions of FREIDA Online. Renew your membership. If you’re not a member, join the AMA and begin receiving them.

Brought to you by the AMA Minority Affairs Consortium

1) 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.

2) Office of Minority Health launches cultural competency curriculum for emergency responders
The Department of Health and Human Services’ Office of Minority Health is offering a new cultural competency e-learning program, “Cultural competency curriculum for disaster preparedness and crisis response.”

3) Federal grants available to improve minority health
Deadlines are approaching to apply for a pair of grants from the Department of Health and Human Services’ Office of Minority Health that would help fund programs that improve minority health.

Through one grant, about $5.3 million is available for programs designed to improve the health and well-being of racial and ethnic minorities in the Mississippi Delta region. Applications are due July 13.

Through another grant, $1.6 million is available for programs that aim to improve early diagnosis, treatment and management of lupus for populations that are disproportionately affected. The project is expected to result in a consortium to expand and promote the utilization of more comprehensive lupus curricula in medical and nursing schools and among health care professional associations. Applications are due July 17.

4) Study examines state-level racial and ethnic disparities
A new study by the Henry J. Kaiser Family Foundation examined disparities between women of color and white women in the United States and looked at disparities based on 25 indicators, including health insurance coverage, health screenings and factors that influence health and access to care, such as education and income.

View a webcast briefing about the study.

View the video “Women at risk: A view from the safety net,” which was featured during the briefing.

Obtain interactive state-level data on the 25 indicators that influence health outcomes for women.

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) Application deadline extended for AMA-RFS standing committees
The AMA-RFS has extended the application deadline for its standing committees to July 17. AMA-RFS standing committees provide opportunities for residents to get involved and help make a difference.

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.

2) New public health resources available online
As part of its Health Care Education Initiative, the AMA-RFS has posted updated presentations to help educate physicians-in-training and others on important health care topics such as patient safety, Medicaid and the Children’s Health Insurance Program.

Visit the AMA-RFS Web site to access these and other public health resources.

In addition, the section recently added a resource to help you plan a health fair or health screening event.

3) July issue of Virtual Mentor examines medicine in the era of globalization
Globalization means that ideas, people, resources—and germs—now move unfettered from country to country with great speed. On balance, this is good news for the health of populations around the world. But globalization also raises ethical questions about the conduct of clinical research in developing countries, use of clinics abroad to train U.S. medical students, lack of essential medicines for many who need them, and migration of doctors from low-income countries to those with higher standards of living.

The July issue of Virtual Mentor, the AMA’s online ethics journal, examines these questions through articles and commentaries written by several physicians with international medical experience.

4) In the New York Times: Required training in geriatrics suggested for medical residents
In an opinion piece published July 1 by the New York Times, Rosanne M. Leipzig, MD, notes that “there is no requirement for any clinical training in geriatrics, even though patients 65 and older account for 32 percent of the average doctor’s workload in surgical care and 43 percent in medical specialty care, and they make up 48 percent of all inpatient hospital days.”

Dr. Leipzig goes on to write that Medicare contributes more than $8 billion a year to support residency training, yet it does not require that part of that training focus on the unique health care needs of older adults.

Citing the 2008 Institute of Medicine (IOM) report “Retooling for an Aging America,” which concludes that all licensed health care professionals should be required to demonstrate competence in the care of older adults, Dr. Leipzig also suggests that medical resident training programs that receive Medicare money should be required to demonstrate that their trainees are competent in geriatric care.

5) Guidance on protecting yourself and your profession: just one benefit of being an AMA member
Purchasing professional liability insurance is one of the most important and expensive decisions physicians may make in their medical practice. The current environment of increased litigation makes this decision more important than ever. Before purchasing a policy, it’s important to learn as much as possible about the types of coverage, carriers and other options that are available.

Physicians can find this information as well as answers to questions about medical professional liability insurance issues in the AMA resource “Succeeding from medical school to practice.” This three-part guide offers AMA members the tools needed to succeed at every stage of their career.

AMA members can access the guide. Nonmembers can view the guide’s table of contents as well as sample pages.

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.

1) Medicare offering “welcome” exam for Part B users
A one-time preventive physical exam is available to patients within the first 12 months they are eligible for Medicare Part B. The exam, which is covered by Medicare, will include a thorough review of your health, education and counseling about the preventive services you need, including screenings and shots, and referrals for other care.

Visit the Medicare Web site to learn more about this and other preventive services covered under Medicare.

2) Participate in the next Author in the Room program
The Journal of the American Medical Association (JAMA) and the Institute for Healthcare Improvement invite you to participate in this month’s Author in the Room teleconference, which will take place from 1 to 2 p.m. CST July 15. The call will feature Charles Morin, author of “Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia,” an article that appeared in the May 20 issue of JAMA.

Sign up for the teleconference.

Visit the JAMA Web site to subscribe to the Author in the Room podcast and listen to past teleconferences.

If you are not able to participate in the teleconference, send an e-mail with your questions.

Brought to you by the AMA Women Physicians Congress

1) Deadline extended for AMA-WPC Mentor Recognition Program nominations
The deadline to submit nominations for the AMA-WPC Mentor Recognition Program has been extended to July 30. This annual program is a unique opportunity to recognize those who have made a difference in your professional life.

2) 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.

3) Studies find health risks associated with women’s migraines
Two new studies have revealed possible links between migraines and increased risks for heart attacks and strokes as well as brain abnormalities among middle-aged and older women.

One study, published in the journal Neurology, suggests that middle-aged and older women who suffer from migraines with auras—symptoms of which are seeing flashing lights and other sensations—appear to have a higher risk of strokes and heart attacks than their migraine-free peers.

Another study, published in the Journal of the American Medical Association (JAMA), found that such women are more likely than others their age to have brain infarcts, which are areas of dead tissue caused by an insufficient supply of blood.

View an abstract of the study published in Neurology.

View a June 25 CNNhealth.com article about these studies.

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) AMA looks for ways to trim rising student debt
Steps taken last month by the AMA House of Delegates (HOD) would help address the pressures of rising medical student debt. During its annual policy-making meeting in Chicago, the AMA-HOD directed the AMA to work with medical schools and other stakeholders to increase funding through state and federal scholarship and loan programs and to oppose state efforts to reduce school funding. The AMA also will promote other innovative ways to help students reduce debt, such as by shortening the length of training for combined residency or dual-degree programs, easing loan repayment obligations and ensuring equitable tuition increases.

View a story by American Medical News about these new policies.

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 30. Mentors will be recognized in a special commemorative book to be distributed in November during the Interim Meeting of the AMA House of Delegates.

4) Learn about risk assessment and adjustment models
New resources from the AMA can help physicians understand risk assessment and adjustment models. “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. “Terminology used in physician profiling” helps physicians assess information they receive about physician profiling.

View other AMA resources the focus on physician profiling.