AMA eVoice Weekly Newsletter

Stress and adapt

It was a humbling honor for me to stand in front of family, colleagues and friends June 16 and be administered the oath of office as the 164th president of the AMA. As I reflected in my presidential address, the theme of evolution was most fitting this 200th year after the birth of Charles Darwin.

Evolution can be of an individual, an organization, a profession or a society. In any case, the common theme is that when stress occurs, change happens. Survival of the fittest is not always to the largest or strongest, but to those who adapt the best. This is where the AMA and our nation stand with regard to health care.

The current status of health care is a sector reflecting 16 percent of the nation's gross domestic product, and rising costs have forced the question of whether or not the value of what America spends on health care justifies the continued growth. The realization of wasted spending of overuse, misuse and underuse is pervasive. The need for the health care sector to evolve into a health care system is now being called for by those who pay for health care to help control unnecessary costs. The AMA has been at the table to help guide the discussion so that patients are always kept in the center.

As a nation, we have rallied when a goal is set. Victory in World War II and putting a man on the moon are two examples. The goal we must have is access to health care coverage for all. It is not only a goal, but it reflects the AMA's Code of Medical Ethics' ninth principle: A physician shall support access to medical care for all people.

The AMA has developed well-crafted policies over years of debate and refinement in its House of Delegates that serve as the framework for achievement of that goal. The first recognition is that our current status in America where the Emergency Medical Treatment and Active Labor Act, or EMTALA, provides access to medical care for all through the emergency room results in patients living sicker and dying younger. That is not acceptable any longer. Affordable health insurance with a private market to innovate and drive change has to be part of the evolution.

We know that health insurance alone does not guarantee that all will get the medical care our patients need. Ethnic and racial disparities continue despite having health insurance. For this reason, I will be working with my fellow graduate of the University of Texas at El Paso, Willarda Edwards, MD, from Baltimore, as she becomes president of the National Medical Association in July to deliver the message that the need to diversify our work force and education are the keys to health.

Key policies to drive the evolution include the right of Americans to always have the ability to privately contract with their physician for their medical care. Getting rid of the administrative costs that burden everyone must be part of the change. And giving patients an incentive to make the right choices for health will help decrease the disease burden that is coming as a result of chronic diseases such as obesity, diabetes mellitus, cancer, orthopedics and heart disease. The demographics of the baby boomers hitting Medicare age in three short years will stress America, and our evolution will occur.

As the forces of evolution take place, the AMA will continue to be a forceful advocate for our patients and our profession. We as physicians hold a special place in society, and it is for our patients that we exist. I am excited that the change we have desired to make American health care better is upon us, and guided by AMA policies, that evolution can be achieved so all have access to affordable health care coverage and can see the physician they choose in the health system they want.

Your membership is your affirmation that you believe in the AMA's Code of Medical Ethics. After all, it is our ethics that provide the soul of our profession.

1) President Obama receives warm welcome from AMA
The AMA warmly welcomed President Barack Obama to its 158th annual meeting earlier this week in Chicago. Like the president, the AMA is committed to health system reform this year that provides all Americans with affordable, high-quality health coverage.

Highlighting physicians' commitment to their patients, Obama said to a standing ovation that "you did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers. And that's what our health care system should let you be."

Obama, the first U.S. president to address the AMA House of Delegates since Ronald Reagan in 1983, asked the AMA for its help in reforming the nation's health care system.

"I will listen to you and work with you to pursue reform that works for you," Obama said. "Together we can make health care work better for patients and doctors alike."

"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," AMA Immediate Past President Nancy H. Nielsen, MD, PhD, said.

Watch Obama's speech, listen to the audio or view a full transcript.

View the full AMA news release on President Obama's visit with the AMA House of Delegates.

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

2) View highlights from the Annual Meeting
J. James Rohack, MD, a Bryan, Texas, cardiologist, was inaugurated as the 164th president of the AMA on June 16. View a news release about Dr. Rohack's inauguration.

AMA Immediate Past President Nancy H. Nielsen, MD, PhD, closed out her term as AMA president with an inspirational speech during the meeting's opening session. View the text of Dr. Nielsen's speech.

Read highlights from June 14.

Read highlights from June 15.

Read highlights from June 16.

Read highlights from June 17.

Read highlights of the AMA's section and special group meetings.

3) AMA adopts new policies at Annual Meeting
At its Annual Meeting this week, the AMA House of Delegates (HOD) set new policy to support health system reform alternatives that are consistent with the AMA's principles of pluralism, freedom of choice, freedom of practice and universal access for patients.

The AMA also passed policy that provides recommendations on emerging alternative physician payment methods. And the AMA voted to adopt new guiding principles for physicians in the event a patient's electronic medical record is breached and recommendations on how health care organizations, such as medical schools and hospitals, can serve as role models and educators on the importance of adopting a healthier and more sustainable food system.

Several new public health policies also were adopted by the AMA-HOD. Topics included flu protection during airline travel, electronic cigarettes in smoking cessation programs, Vitamin D and the use of tasers by law enforcement agencies.

New AMA policy also calls for adding areas of study to medical education, including health care economics and disaster preparedness. And the AMA approved policy to help address the increasing medical student debt burden.

View news releases on the various policies that were adopted this week. Read highlights from the reference committees.

4) New leaders elected by AMA
At its Annual Meeting, the AMA House of Delegates (HOD) elected Winter Park, Fla., internist Cecil B. Wilson, MD, as president-elect of the AMA. Denver psychiatrist Jeremy A. Lazarus, MD, was re-elected to a third term as speaker of the AMA-HOD and Andrew W. Gurman, MD, an orthopaedic surgeon from Altoona, Pa., a third term as vice speaker.

David O. Barbe, MD, a family physician in Mountain Grove, Mo., was newly elected to the AMA Board of Trustees (BOT), and both Ardis D. Hoven, MD, an infectious disease specialist in Lexington, Ky., and Robert M. Wah, MD, an ob-gyn and reproductive endocrinologist in McLean, Va., were re-elected to the AMA-BOT.

In addition, Raj Ambay, MD, a plastic surgery resident at the University of Wisconsin, Madison, was elected to the resident/fellow position on the board. And Justin B. Mahida, a medical student at The Ohio State University in Columbus, Ohio, was elected to the board's medical student position.

5) ONC outlines criteria for "meaningful use"
The Office of the National Coordinator for Health Information Technology (ONC) released its preliminary definition of "meaningful use" June 16.

Beginning in 2011, Medicare physicians who implement and report meaningful use of electronic health records will be eligible for an initial incentive payment of up to $18,000, and early adopters could receive a five-year bonus of up to $44,000.

The definition for achieving meaningful use of health data includes three parts: data capture and sharing by 2011, advanced clinical processes by 2013, and improved outcomes by 2015.

The criteria for 2011 objectives and measures, include capturing data in coded format; managing populations, such as generating a list of patients by specific conditions and sending patient reminders; improving care coordination, such as exchanging clinical info among providers and performing medication reconciliation; among others.

Visit the ONC Web site to view the full definition, or to learn how you can submit comments to the ONC on the preliminary definition, which are due by June 26.

David Hunt, MD, chief medical officer for the ONC spoke during an Annual Meeting educational session "Overview: American Recovery and Reinvestment Act (ARRA) Health Information Technology Provisions" earlier this week. During the session, Dr. Hunt talked about health IT incentive provisions within the ARRA and what physicians should do to prepare for them.

View the June 16 meeting highlights which covers this session.

Listen to archived audio from the presentation.

Learn more about both the webinar and HIT incentive provisions within ARRA.

6) AMA cheers Senate passage of historic tobacco regulation bill
The U.S. Senate passed its version of H.R. 1256, the "Family Smoking Prevention and Tobacco Control Act," on June 11 by a veot of 79-17. The bill would provide authority to the U.S. Food and Drug Administration (FDA) to regulate the manufacture, sale and distribution and marketing of tobacco products with the primary goal of reducing youth and teen smoking.

"The AMA cheers Senate passage of legislation that will for the first time allow the FDA to strongly regulate cigarette and other tobacco products," said AMA Immediate Past President Nancy H. Nielsen, MD, PhD. "Approximately 1,000 kids become new, regular smokers every day. These new marketing restrictions can help keep our kids away from cigarettes so they can become healthy adults."

The U.S. House of Representatives passed a nearly identical version of H.R. 1256 on April 2. The House is expected to consider the Senate-passed version of the bill in the near future.

View Dr. Nielsen's full statement on the Senate's passage of this bill.

7) The CPT^® Network: just one benefit of being an AMA member
AMA members can get their questions about coding answered through the CPT^® Network, a new system that allows members and subscribers to quickly research a database of commonly asked questions and clinical examples. If the answer to a specific question is not in the database, authorized users can submit an electronic inquiry directly to the AMA's staff of CPT^® coding experts.

As an AMA member, you automatically have access to this valuable resource. And you have six free coding inquiries in your pocket, which could be a big help when you really need it.

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

8) In JAMA: Study compares less invasive CT scan-based screeing method to colonoscopy for patients at increased risk of colorectal cancer
Computed tomographic (CT) colonography may offer patients at increased risk of colorectal cancer an alternative to colonoscopy that is less-invasive, is better-tolerated and has good diagnostic accuracy, according to a study in the June 17 issue of the Journal of the American Medical Association (JAMA).

View an editorial about this subject.

1) Highlights from the AMA-GLBT meeting
An educational program hosted by the AMA-GLBT, titled "Families: The missing link in prevention and promoting well-being for GLBT children, youth and young adults," was well-attended by participants of the Annual Meeting of the AMA House of Delegates and members of Chicago-area GLBT medical student groups.

The program featured Caitlin Ryan, a clinical social worker whose research includes the National Lesbian Health Care Survey, the first major study to identify lesbian health and mental health needs and concerns; the development of an initiative to study the impact of Gay Straight Alliances on school climate and youth development; care of GLBT youth in faith-based agencies; and the Family Acceptance Project,™ which she developed to improve care and health outcomes for GLBT youth.

The advisory committee elected Jennifer Chaffin, MD, a psychiatrist from Missouri, as chair, and Gal Mayer, MD, an internist from New York, as vice chair. And it thanked its outgoing members—including Rebecca Allison, MD, Don Chaplin, MD, and Graham McMahon, MD—for their tireless dedication.

1) Highlights from the Group Practice meeting
The AMA's Advisory Committee on Group Practice Physicians, chaired by Michael Kitchell, MD, convened Friday and discussed such topics as the U.S. Senate Finance Committee's proposals on health system reform, the trend in hospital acquisition of physician practices and the need for establishing quality measures for teams and systems versus individual physicians. On Saturday, the committee co-sponsored "Keeping Senior Physicians in Practice: Issues of competency recertification and the value of experience," an education program that featured John A. Fromson, MD, assistant clinical professor of psychiatry at Harvard Medical School and a nationally recognized expert on physician health.

1) Highlights from the AMA-IMG Section meeting
The AMA-IMG Section discussed several issues of importance—including graduate medical education, work force issues, leadership and diversity—during its meeting and events.

James Hallock, MD, president and chief executive officer of the Educational Commission for Foreign Medical Graduates (ECFMG), updated attendees on the Foundation for Advancement of International Medical Education and Research's leadership institute and ECFMG applicant data.

The AMA-IMG candidates' forum exposed AMA Board of Trustees and Council on Medical Education candidates to AMA-IMG members and their top issues of importance, such as licensure parity and an unbiased residency program selection process.

The fourth annual Desserts From Around the World benefitted the AMA Foundation's IMG Honor Fund. Sponsored by 20 state, specialty and ethnic societies, this tasty affair with international flair attracted more than 400 attendees and was chaired by Mouhanad Hammami, MD, of the National Arab American Medial Association. Donations for the IMG Honor Fund are still being accepted online or by calling J. Mori Johnson at (312) 464-5678.

The AMA-IMG Section's newly elected 2009-10 governing council officers are Hugo Alvarez, MD, immediate past chair; Jayesh Shah, MD, chair; Raouf Seifeldin, MD, vice chair; Rajendra Seth, MD, delegate; Padmini Ranasinghe, MD, alternate delegate; Sarala Rao, MD, at-large member; and Nyapati Rao, MD, at-large member.

Brought to you by the AMA Section on Medical Schools

1) Highlights from the AMA-SMS meeting
Now in its 33rd year, the AMA-SMS hosted an educational session on interprofessional collaboration in health care and co-sponsored a session with the AMA Council on Medical Education on resident duty hours. The AMA-SMS also co-sponsored an educational session with the AMA Medical Student Section on mentoring medical students.

The section also held elections for its governing council. Betty Drees, MD, dean at the University of Missouri-Kansas City School of Medicine, was elected chair; Kenneth Simons, MD, of the Medical College of Wisconsin, was elected chair-elect; and M. Dewayne Andrews, MD, executive dean and vice president for health affairs at the University of Oklahoma College of Medicine, was elected immediate past chair.

At-large members include Arthur Ross, MD, dean and vice president for medical affairs at Chicago Medical School of Rosalind Franklin University of Medicine and Science; Maria Savoia, MD, vice dean of medical education at the University of California, San Diego School of Medicine; and Robert Sokol, MD, distinguished professor of obstetrics and gynecology at Wayne State University School of Medicine.

Louis Ling, MD, associate dean for graduate medical education at the University of Minnesota Medical School, was elected the section liaison to the AMA Council on Medical Education. Michael Reichgott, MD, associate dean for clinical affairs and graduate medical education at Albert Einstein College of Medicine, was elected delegate; and Donald Eckhoff, MD, professor of orthopedic surgery at the University of Colorado School of Medicine, was elected alternate delegate.

1) Highlights from the AMA-MSS Annual Assembly Meeting
More than 600 medical students attended the AMA-MSS Annual Assembly Meeting. The assembly considered 26 items of business, and more than 25 educational programs were held on a range of topics including health system reform, residency, student run-clinics, MD/MBA degrees and mentoring student chapters.

Keynote speaker Geoff Tabin, MD, professor of ophthalmology and visual sciences at the University of Utah and the John A. Moran Eye Center in Salt Lake City and co-director of the Himalayan Cataract Project, spoke Saturday about climbing Mount Everest and eradicating world blindness.

The AMA-MSS held its sixth annual Medical Specialty Showcase, during which more than 40 specialties represented in the AMA House of Delegates provided an introduction to their specialty and offered materials to assist medical students in their career decision-making.

This meeting marked the last national service project event using the theme "Covering the uninsured and protecting access to care." More than 40 medical students traveled to Navy Pier to inform and educate visitors and to distribute information about the importance of access to care, health system reform and the availability of safety net health coverage and services in the Chicago area and the rest of the nation. The team of students successfully engaged in conversations about health care access and reform with more than 300 people. In addition, the AMA-MSS announced its national service project for 2009-11: the AMA's Healthier Life Steps™ Program.

Jefferson Medical College in Philadelphia won the AMA-MSS Chapter of the Year award.

The assembly elected members for its 2009-10 governing council: Kristina Maletz, of Columbia University College of Physicians and Surgeons, vice chair; Kevin Blaine, of the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, delegate; Keili Meyer, of Wright State University Boonshoft School of Medicine, alternate delegate; Hayley Fischer, of Brody School of Medicine–East Carolina University, at-large officer; Jennifer Paisley, of the University of Iowa Carver College of Medicine, speaker; and Matthew Okazaki, of John A. Burns School of Medicine at the University of Hawaii, vice speaker. Hans Arora, Northwestern University, will commence his term as chair and Justin Mahida, Ohio State University, as trustee.

Brought to you by the AMA Minority Affairs Consortium

1) Highlights from the AMA-MAC meeting
The AMA-MAC business meeting Friday included a number of discussions about resolutions and reports before the AMA House of Delegates. The AMA-MAC submitted several items on topics ranging from increased collaboration with the National Medical Association (NMA) following the AMA's apology to African-American physicians to other topics such as working with the Federation of Medicine on the creation and implementation of policies focused on the elimination of racial and ethnic health care disparities.

The AMA-MAC also introduced the winners of its 2009 AMA Foundation Minority Scholars Award program, supported by the Pfizer Medical Humanities Initiative, at its caucus and reception. Congratulations to Rashad Belin, Natalie Casagrande, Kofi Essel, Suzanne Garber, Carl Lambert, Marlene Martin, Lisa Ochoa-Frongia, Elizabeth Phillips, Kasandra Scales, Catalina Soto, Manuel Tapia and Lucille Torres.

Attendees also enjoyed an informative presentation by Hector Castro, MD, the medical director of the Latino Health Institute in New York. Dr. Castro shared the successes he and his team have experienced at the institute and best practices to consider when treating Hispanic patients. In addition, attendees had an opportunity to review and discuss resolutions and reports before the House of Delegates focused on issues of concern to minority physicians, medical students and patients.

The AMA-MAC Governing Council elected new officers for 2009-10; the new chair is Shanda Lohse, MD and the new vice chair is Sandra Gadson, MD.

1) Highlights from the AMA-OMSS Annual Assembly Meeting
The AMA-OMSS held its 53rd assembly meeting and 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.

The section hosted eight AMA PRA Category 1 Credit™ educational programs during the meeting that covered several topics surrounding physician employment and employment contracts. These programs include "Organizational leadership: The Joint Commission 2009 leadership standards," presented by Paul Schyve, MD, senior vice president of the Joint Commission; "Parliamentary procedure 101," presented by Jeremy A. Lazarus, MD, speaker of the AMA House of Delegates (HOD), and Andrew W. Gurman, MD, vice speaker of the AMA-HOD; "Generational change and future healthcare leadership," co-sponsored by the AMA-OMSS and the AMA Young Physicians Section, which featured Richard Corlin, MD, past president of the AMA; and "Health system reform: A candid discussion," which featured a panel discussion including Rich Deem, the AMA's senior vice president of advocacy, Rep. Tom Price, MD, R-Ga., and J. James Rohack, MD, AMA president-elect.

For the first time, the AMA-OMSS distributed results of an AMA survey that was conducted in collaboration with the Society of Hospital Medicine on the growing hospitalist trend. The section also recognized Stephen House, MD, past chair, for his tenure on the AMA-OMSS Governing Council.

1) Highlights from the AMA-RFS Annual Assembly Meeting
The AMA-RFS held its 33rd Annual Assembly Meeting to discuss and shape policy on a variety of issues. Of the 18 items of business considered, seven were immediately forwarded to the AMA House of Delegates. These 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.

The assembly also elected several new members of the AMA-RFS Governing Council: Rana Yehia, MD, vice chair; Alisa Lee Sherick, MD, speaker; Claudia Reardon, MD, vice speaker; Seth Flagg, MD, delegate; Heather Smith, MD, alternate delegate; and Stephen Darrow, MD, membership and outreach officer. The AMA-RFS thanked its speaker, Jesse Ehrenfeld, MD; vice speaker Diana Shiba, MD; and chair Manish Sethi, MD, for leading a successful meeting.

1) Highlights from the AMA-SPG meeting
The AMA-SPG sponsored its second meeting of state liaisons on Friday—led by the group's chair, William Jacott, MD—that included a special presentation by Joanne Schwartzberg, the AMA's director of aging and community service. On Saturday, the group co-sponsored an educational program entitled "Keeping Senior Physicians in Practice: Issues of Competency, Recertification and the Value of Experience," spotlighting the value that senior physicians bring to a practice and common age-related issues to be aware of. More than 300 physicians attended the event, which also was co-sponsored by the AMA Advisory Committee on Group Practice Physicians and the AMA Organized Medical Staff Section.

The AMA-SPG Governing Council recognized Dr. Jacott and John Nettles, MD, who are leaving the council, and welcomed its two newest members, Bohn Allen, MD, from Texas, and Richert Quinn Jr., MD, from Colorado. The governing council also discussed reports and resolutions to the AMA House of Delegates and ways to expand its outreach to senior physicians age 65 years and older through involvement and communications.

Brought to you by the AMA Women Physicians Congress

1) Highlights from the AMA-WPC meeting
More than 150 guests helped the AMA-WPC celebrate 30 years of its Women in Medicine program during its caucus and reception Saturday. The caucus featured a presentation from the AMA Foundation about the new Fund for the Advancement of Women in Medicine; presentations by the 2008 Joan F. Giambalvo Scholarship winners, Sue Yom, MD, and Maurice Clifton, MD; and a review of AMA House of Delegates items of interest to the AMA-WPC.

The AMA-WPC Governing Council will host its annual breakfast for state and specialty society AMA-WPC liaisons. This event, highly regarded by past attendees, featured updates from around the country about what state and specialty medical societies are doing to address issues of importance to women physicians, medical students and patients.

The AMA-WPC Governing Council elected new officers for the 2009-10 term. The new chair is Jennifer Wiler, MD, and the new vice chair is Nancy Church, MD.

1) Highlights from the AMA-YPS Annual Assembly Meeting
At the 2009 AMA-YPS Annual Assembly Meeting, young physicians from across the country met with colleagues to discuss priority issues and help shape AMA policy.

After adopting a series of reports and resolutions, the AMA-YPS Assembly forwarded three resolutions for consideration at the Annual Meeting of the AMA House of Delegates. One resolution asks the AMA to ensure that all resident and fellow physicians-in-training, and all physicians who accept Medicare, Medicaid or Tricare, fall within the definition of public service jobs for the purposes of the Public Service Loan Forgiveness Program. Another resolution asks the AMA to study the impact the new Higher Education Opportunity Act will have on the length of time it will take young physicians to pay off their medical student loans and the effect of early loan repayment on specialty selection. A third resolution asks the AMA to draft legislation allowing 100 percent tax deductibility of student loan interest.

Assembly participants also participated in a town hall meeting focused on the definition of the young physician trustee position on the AMA Board of Trustees. And Richard Corlin, MD, who served as AMA president from 2001–02, presented an educational session on generational change and future health care.

The section also held elections for its governing council. Ravi Goel, MD, was elected chair-elect; Patricia Turner, MD, was elected speaker; Steven Chen, MD, was elected alternate delegate; and Shilpen Patel, MD, was elected member-at-large.