AMA eVoice Weekly Newsletter

Lessons from Apollo

"Houston, the Eagle has landed." When those words were uttered 40 years ago, it brought great national pride to Americans that a goal set seven years prior had been accomplished. It showed how the interplay of government and the private sector to achieve a common mission could be achieved before the advent of fast computers and instant communication via the Internet.

"Houston, we've got a problem" was another phrase uttered by a member of the Apollo 13 mission to the moon that could have resulted in tragedy. But as the lead flight director stated, "Failure is not an option." What lessons from the Apollo missions can we, as physicians, apply to our nation's own engaged debate on health system reform?

First, if one does not have a common goal, the private and the public sectors cannot succeed. As Alice noted to the Cheshire Cat from "Alice's Adventures in Wonderland," "Which road do I take?" to which the Cheshire Cat replied, "Where do you want to go?" Alice said, "I don't know," to which the Cheshire Cat replied, "Then, it doesn't matter. If you don't know where you are going, any road will get you there."

The goal the AMA has set is affordable, portable quality health care coverage for all Americans, preserving patients' choice of plans as well as their choice of physicians. Some of the correspondences that I and other AMA leadership have received from members as well as nonmembers is not to have change-or that the goal the AMA has set is impossible to achieve.

The Apollo 13 mission might have seemed impossible to bring back the astronauts when they had a massive failure of their space module. But those in mission control focused on achieving the goal of bringing back the astronauts alive. And they achieved it.

As the King in Alice in Wonderland said, "Begin at the beginning and go on till you come to the end: then stop." They didn't follow the Mock Turtle's words: "Well, I never heard it before, but it sounds uncommon nonsense."

The AMA has been challenged in providing physicians factual information in a timely fashion. If you are receiving this message, it is because

you are one of the few physicians' e-mail addresses the AMA has. The next time you are asked by a fellow AMA member what is happening, please encourage them to give the AMA their e-mail address so they can receive the routine communication needed to be an informed physician. And if they want to be engaged in the political process, tell them to sign up for the AMA's Physicians' Grassroots Network.

The final lesson from Apollo was as the Greek God who was Iatromantis, physician and seer, and Oulious, health-giving. He was the father of Asclepius, the god of healing. We take our role in the current health system reform debate seriously as we know that if we achieve the goal, those who follow us in this noble medical profession will be able to practice the art and science of medicine and the betterment of public health with the freedoms our nation was founded on.

Failure is not an option.

—J. James Rohack, MD

1) Contact your senators about eliminating the SGR formula
The debate about health system reform includes a major difference between legislation under consideration in the U.S. House of Representatives and what is being discussed in the Senate. And it has to do with eliminating Medicare’s flawed sustainable growth rate (SGR) formula.

The House legislation would eliminate the SGR formula that will produce a Medicare physician payment cut of more than 21 percent in 2010 and cuts totaling about 40 percent in the coming years. The House legislation accomplishes this in a manner that does not require Congress to find offsetting savings through other Medicare cuts, cuts to other programs or raising additional revenues. The political challenge of offsetting the cost of a long-term SGR solution is the very problem that has obstructed organized medicine’s past efforts to eliminate the formula once and for all.

Unfortunately, budgetary rules governing consideration of health system reform are preventing the Senate Finance Committee from discussing a permanent solution to this annual problem. Therefore, it’s necessary for the Senate to take special steps to eliminate the SGR.

All physicians are urged to contact their senators and encourage them to support a motion to "waive the budget act" and vote for a separate proposal to eliminate the SGR without offsetting cuts or revenues. Call, visit or e-mail your senators during their August break and insist that they support elimination of the SGR as part of any health system reform bill.

Visit the Legislative Action Center or call the AMA Physicians’ Grassroots Hotline at (800) 833-6354 to contact your senators.

See the devastating effect the current Medicare payment system is having on patients and on physician practices, as well as the growing cost of congressional inaction.

2) Check out the AMA’s new health system reform Web site
The AMA launched a health system reform Web site this week where visitors can learn the facts and get the details about the AMA’s position on health system reform. Users can read the AMA’s vision for reform, view media interviews of AMA leaders, access a variety of resources that can help explain the reform process and learn more about how to get involved.

View our health system reform Web site.

And visit the AMA’s Facebook page and Twitter site to follow the latest AMA happenings in health system reform via ongoing live updates.

3) HHS issues rule requiring individuals be notified of breaches of their health information
New regulations requiring health care providers, health plans and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals when their health information is breached were issued Aug. 19 by the U.S. Department of Health and Human Services (HHS). These "breach notification" regulations implement provisions of the Health Information Technology for Economic and Clinical Health Act, passed as part of the American Recovery and Reinvestment Act of 2009.

The HHS interim final regulations are effective 30 days after publication in the Federal Register, which was Aug. 19, and include a 60-day public comment period.

View the full HHS news release.

4) AMA holds additional forums on health reform; more states to come
The AMA hosted two more tele-town hall Physicians’ Forums this week as part of the AMA’s ongoing series in which physicians can ask AMA leaders about health system reform legislation.

On Aug. 19, AMA Immediate Past President Nancy H. Nielsen, MD, PhD, and Richard Deem, senior vice president of advocacy at the AMA, participated in a call with physicians in Arizona, Alaska, California, Hawaii, Nevada, Oregon and Washington. On Aug. 20, AMA President J. James Rohack, MD, and Cindy Brown, vice president of government affairs at the AMA, held a call for physicians in Texas and Oklahoma. Physicians from New York and Pennsylvania took part in a call with Dr. Nielsen and Deem on Aug. 6.

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

5) New resource: AMA flier can help you explain health system reform to your patients
If you have questions about health system reform, chances are your patients do, too. To help bring clarity to some of the commonly asked questions they might have, the AMA developed a one-page flier that explains what health system reform would mean for them.

6) Guidance on evaluating incentive plans: just one benefit of being an AMA member
What incentive plans make the most sense for you and your patients? Do you know what you should consider before entering a pay-for-performance program?

The AMA’s online practice management tips can help. AMA members can seek answers and insight and address these questions with the members-only article, "Physician’s guide to evaluating incentive plans." This resource encourages physicians to evaluate incentive plans for their potential to improve health care quality and their ability to operate in an ethical and fair manner. It provides questions and observations that can be useful when looking at common properties of pay for performance and other physician incentive programs.

Access this and other members-only articles on practice management.

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

7) In JAMA: Palliative care intervention for patients with advanced cancer provides quality of life and mood benefits
Patients with advanced cancer who received a palliative care intervention focused on addressing physical and psychosocial issues and care coordination, according to a study in the Aug. 19 issue of the Journal of the American Medical Association (JAMA). That was provided at the same time as cancer treatment reported improved quality of life and mood but did not experience a significant change in the number of days in the hospital or the severity of their symptoms compared to patients who received usual care.

View the study, "Effects of a Palliative Care Intervention on Clinical Outcomes in Patients With Advanced Cancer."

1) Studies reveal new lesbian, gay and bisexual stats on family population
Results of several nationwide studies involving the 194,000 lesbian, gay and bisexual (LGB) couples who have children under the age of 18 were presented July 30 at Fenway Health's annual faculty meeting in Boston, according to Bay Windows, a New England-based newspaper that covers gay, lesbian, bisexual and transgender issues.

Keynote speaker Gary Gates, senior research fellow at University of California, Los Angeles, School of Law's Williams Institute, revealed that, according to the study, LGB parenting is more likely to occur in regions where fewer legal protections are available to LGB families, such as in the South and the heartland, Bay Windows reports.

As an explanation, Gates offered the possible desire of LGB parents to raise their children in family-focused communities and indicated that different-sex couples living in the South and the nation's heartland are more likely to have children than those who live on either the West or East coasts, Bay Windows reports.

2) National Coalition for LGBT Health meeting set for this fall
The fall meeting of the National Coalition for LGBT Health will take place Sept. 30–Oct. 2 at the Westin Washington, D.C., city center. This meeting overlaps with the Gay and Lesbian Medical Association's (GLMA) Annual Conference, so some of the programming will be produced together by the GLMA and the coalition.

The GLMA and the coalition will offer a jointly sponsored LGBT health policy track to members of both organizations, and joint receptions will take place each night. In addition, the coalition will be organizing a Lobby Day, which will be available to participants of both organizations, on Oct. 2 on Capitol Hill.

3) ACLU suit dismissed after changes made at Tennessee schools
Two Tennessee school districts have agreed to stop blocking access to online information about lesbian, gay, bisexual and transgender (LGBT) issues as part of a settlement reached in a lawsuit brought by the American Civil Liberties Union (ACLU).

A federal court dismissed the lawsuit against the Metropolitan Nashville Public Schools and Knox County Schools after the settlement was reached. As part of the agreement, the school departments have agreed to stop using filtering software that blocks or otherwise places a barrier to student or faculty access to the LGBT sites. If they break this agreement, the case will return to the court.

The ACLU filed the case in May in the U.S. District Court for the Middle District of Tennessee against Metropolitan Nashville Public Schools and Knox County Schools on behalf of three high school students in Nashville, one student in Knoxville and a high school librarian in Knoxville who is also the advisor of the school's Gay-Straight Alliance.

Read a news release by the ACLU.

View a Knoxville News Sentinel story about the settlement.

1) 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 it 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.

2) 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.

3) Wanted: Your voice on AMA-IMG Section committees
The AMA-IMG Section needs your support and voice, so please consider joining one of the section's committees. View a list of committees. Then send an e-mail to img@ama-assn.org with your contact information and committee of interest. For more information, call Carolyn Carter-Ellis of the AMA-IMG Section at (312) 464-5397.

Brought to you by the AMA Section on Medical Schools

1) June meeting presentation summaries posted online
Summaries of presentations from the AMA-SMS's June meeting, which took place in conjunction with the Annual Meeting of the AMA House of Delegates, are available on the section's Web site. Access the summaries.

2) Now's the time to think about a Doctors Back to School event
With a new school year already under way in some communities, physicians are encouraged to learn about the AMA's Doctors Back to School program and to plan an event at a local school.

The goal of the program, which sends minority physicians and medical students into the community as a way to introduce children to professional role models, is to increase the number of minority physicians and ultimately work toward eliminating racial and ethnic health disparities. Doctors Back to School aims to show kids of all ages, especially those from underrepresented racial and ethnic groups, that medicine is an attainable career option for everyone.

Access the Doctors Back to School action kit to help you plan an event. The kit contains four main components—student, school, parent and physician. Portions of the student and parent components are available in Spanish.

3) In the AMA's GME e-Letter: Patient care handoffs a hot topic
This month's issue of the AMA's GME e-Letter tackles handoffs of patient care and the importance of teaching effective elements of careful and organized handoffs. The GME e-Letter is the AMA's monthly newsletter that covers information of interest to the graduate medical education (GME) community.

4) New medical schools in the pipeline
Five developing medical schools are listed as "applicant schools" by the Liaison Committee on Medical Education (LCME): Scripps School of Medicine, in La Jolla, Calif.; Central Michigan University School of Medicine, in Mount Pleasant, Mich.; Oakland University William Beaumont School of Medicine, in Rochester, Mich.; Touro University College of Medicine, in Hackensack, N.J.; and Hofstra University School of Medicine, in Hempstead, N.Y.

Visit the LCME Web site for an explanation of how medical schools obtain "applicant school" status as well as other pertinent LCME information.

1) Submit meeting ideas for AMA-MSS Interim Assembly Meeting
Do you have an idea for a forum at this year's AMA-MSS Interim Assembly Meeting? If so, submit your ideas by Sept. 7 to help develop programming for the meeting, which will take place Nov. 5–7 in Houston. While the AMA-MSS will do its best to fit every program into the lineup, space is limited and program request submissions are not guaranteed.

If you have questions, contact AMA-MSS speakers Jennifer Paisley at jennifer.paisley@gmail.com or Matthew Okazaki at okazakim@hawaii.edu, or e-mail the AMA-MSS at mss@ama-assn.org.

Visit the AMA-MSS Web site for more information about the AMA-MSS Interim Assembly Meeting, including registration and upcoming meeting deadlines for convention committees, resolutions and leadership position applications.

2) Save the date: AMA-MSS Research Poster Symposium set for Nov. 6–7
The AMA-MSS is accepting abstract submissions for the seventh annual AMA-MSS Research Poster Symposium, which will take place Nov. 6–7 during this year's AMA-MSS Interim Assembly Meeting in Houston. Abstracts are due by 5 p.m. CST Sept. 18.

The poster symposium is hosted by the AMA-MSS and the AMA Resident and Fellow Section. Abstracts may be submitted in one of the following eight categories: biochemistry/cell biology, cancer biology, cardiology/vascular biology, clinical/epidemiological/health care, immunology/microbiology, neurobiology/neuroscience, radiology/imaging and surgery.

Abstracts will be reviewed by the AMA-MSS Committee on Scientific Issues and selected for presentation during the symposium. Prizes will be awarded to one winner in each category, with an overall winner receiving a trip to the 2010 AMA-MSS Annual Assembly Meeting in Chicago.

3) Take a FIRST step in learning about student debt
Need help navigating the complexities of student debt? 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, can assist you.

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.

4) Medical students' views sought for LGBT education assessment
A survey from the Lesbian, Gay, Bisexual and Transgender (LGBT) Medical Education Research Group is asking U.S. and Canadian medical students what they have learned and what they think they should learn about LGBT health and medical care.

This medical education assessment is a partnership of faculty and student researchers at Stanford University School of Medicine and Harvard Medical School. All students' opinions are being collected anonymously, regardless of sexual orientation, gender identity, gender expression, personal beliefs and subject knowledge.

5) "Succeeding from medical school to practice": just one benefit of being an AMA member
"Succeeding from medical school to practice" is a comprehensive, easy-to-navigate resource that can help students confront the nonclinical demands of training and the practice environment. Developed by resident physicians, this AMA members-only guide features tips, links and streaming video organized into sections for medical students, residents and fellows, and young physicians.

The medical school section provides an overview of the American health care system and covers numerous other topics, including how to choose a residency program and prepare for the match, how medical education is funded, and how to budget and manage personal finances.

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

Brought to you by the AMA Minority Affairs Consortium

1) Online program covers access to care
Learn why expanding access to health care is a main component of health system reform efforts by viewing an Aug. 10 program co-sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation. Visit the Alliance for Health Reform Web site to access a webcast, podcast, speakers' PowerPoints and other downloadable resource materials from this program.

2) View state-by-state race and ethnicity data of medical school graduates
Updated figures that break down by state the number of medical school graduates by race and ethnicity and Hispanic ethnicity for 2008 is available on the Association of American Medical Colleges Web site.

3) Now's the time to think about a Doctors Back to School event
With a new school year already under way in some communities, physicians are encouraged to learn about the AMA's Doctors Back to School program and to plan an event at a local school.

The goal of the program, which sends minority physicians and medical students into the community as a way to introduce children to professional role models, is to increase the number of minority physicians and ultimately work toward eliminating racial and ethnic health disparities. Doctors Back to School aims to show kids of all ages, especially those from underrepresented racial and ethnic groups, that medicine is an attainable career option for everyone.

Access the Doctors Back to School action kit to help you plan an event. The kit contains four main components—student, school, parent and physician. Portions of the student and parent components are available in Spanish.

Once you complete your program, the AMA wants to hear about it. Send an e-mail to mac@ama-assn.org with the details.

1) 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.

2) MS.1.20 task force reaches consensus on revised standard
The MS.1.20 Implementation Task Force reached consensus earlier this year 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.

3) 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) In the Chattanooga Times Free Press: expanding coverage while physician shortage worsens
Health care reform proponents aim to expand health care coverage to provide almost universal coverage to Americans. But physicians say they are worried that if current policies remain, there won't be enough medical providers, either in practice or in the medical school pipeline, available to take care of those new patients, according to an Aug. 17 article in the Chattanooga Times Free Press.

2) Preparation for contract negotiations: just one benefit of being an AMA member
Are you trying to land a job? If so, are you prepared for contract negotiations? More and more resident and fellow physicians are transitioning into first-time jobs as part of established medical groups, hospitals and other health care institutions, for which they are required to sign an employment agreement.

These contracts cover more than just salaries. To know what you should anticipate when signing a contract, AMA members can access the AMA's model annotated physician employment agreement, just one of the many resources available through the AMA's three-part guide "Succeeding from medical school to practice." Also, learn more about negotiations and important contract provisions by watching the accompanying streaming video.

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

1) Travel opportunities available
Seventeen trips to international travel destinations will be available to AMA-SPG members in 2010 through AHI Travel.

Travelers have the opportunity to spend time with fellow AMA senior physicians on land- or cruise-based excursions to such countries as South Africa, Italy and China. The cruises will explore the waterways of Holland and Belgium, the Yangtze River in China and the passage of Peter the Great in Russia. Tours range from eight to 14 days and include optional excursions to add at your leisure. Trips can sell out six months in advance of the departure date, so sign up soon.

Visit the AMA-SPG Web site to learn more about AHI's educational and leisure travel destinations.

2) Learn more about volunteering opportunities
To maintain an active lifestyle in retirement, many seniors are interested in sharing their time and expertise with others by volunteering. Opportunities are available in health care volunteer positions overseas or working in free clinics within the United States, and the AMA-SPG offers resources and links to volunteering organizations to help you learn about what's available.

View the AMA-SPG volunteering Web page.

Send an e-mail to Alice Reed of the AMA-SPG at alice.reed@ama-assn.org if you have suggestions of other content to include on the group's volunteering Web page.

Brought to you by the AMA Women Physicians Congress

1) What are your plans for Women in Medicine Month?
Are you planning something special to commemorate September as Women in Medicine month? Is there something you would like to share with other eVoice readers? Would you like to involve others? If so, e-mail your stories or ideas to wpc@ama-assn.org. The AMA-WPC will share a select number of your stories or opportunities in upcoming editions of eVoice.

2) Online program covers access to care
Learn why expanding access to health care is a main component of health system reform efforts by viewing an Aug. 10 program co-sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation.

Visit the Alliance for Health Reform Web site to access a webcast, podcast, speakers' PowerPoints and other downloadable resource materials from this program.

3) Column promotes adult vaccinations
A column posted on the Society for Women's Health Research Web site explains the need for adults to be diligent in getting themselves vaccinated and highlights a list of adult vaccinations recommended by the Centers for Disease Control and Prevention.

1) Share 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) AMA-YPS Assembly meeting set for this fall
The next AMA-YPS 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-YPS Web site.

3) In the AMA's GME e-Letter: Patient care handoffs a hot topic
This month's issue of the AMA's GME e-Letter tackles handoffs of patient care and the importance of teaching effective elements of careful and organized handoffs. The GME e-Letter is the AMA's monthly newsletter that covers information of interest to the graduate medical education (GME) community.