News in brief - July 3, 2006

AMA adopts measure to boost doctors' bargaining power with health plans - AMA takes action on physician visas - Doctors shouldn't be held at fault for bad advice from Medicare carriers - AMA to work with scope partnership to oppose naturopaths' med licensure

AMA adopts measure to boost doctors' bargaining power with health plans

Physicians seeking antitrust relief against the monopsony power of large health insurers will get help from the American Medical Association. At its Annual Meeting in June, the AMA House of Delegates adopted a new policy to study and create model state legislation to enhance doctors' bargaining power on behalf of their practices and patients.

Delegates recalled the 2005 merger of PacifiCare Health Systems and UnitedHealth Group. Doctors expressed widespread concern that they have little to no leverage when negotiating reimbursement contracts with dominant health plans.

Meanwhile, the Federal Trade Commission has maintained its position against physician collective bargaining, saying it could adversely affect competition.

"We need to regulate these unfair business practices and the uneven relationship between physicians and health plans," said M. Eugene Sherman, MD, a cardiovascular disease specialist and alternate delegate from Colorado.

The AMA will present its recommendations to the House of Delegates at the 2007 Annual Meeting.

AMA takes action on physician visas

At its Annual Meeting in June, the American Medical Association took actions designed to make it easier and faster for foreign doctors to get visas for work in the United States and to be able to stay here once they do.

The AMA voted to request that Congress reauthorize the J-1 visa program and that the State Dept. expedite the granting of visas to international medical graduates who pass U.S. medical licensing exams. The Association also decided to lobby Congress to exempt from immigration caps any physicians with H-1b visas who have fulfilled the requirements for J-1 visa waivers.

In the interests of visa recipients who are facing abusive or unworkable conditions on the job, the AMA will ask the State Dept. to waive on a case-by-case basis the continuous-service requirement so the foreign doctor can seek other employment without being penalized.

Doctors shouldn't be held at fault for bad advice from Medicare carriers

Physicians who receive erroneous information from Medicare carriers should not be penalized for acting on it regardless of how the request was transmitted, the American Medical Association agreed at its Annual Meeting.

The AMA will call on the Centers for Medicare & Medicaid Services to drop the requirement that physicians' inquiries be in writing to avoid penalties that might arise from billing the program incorrectly or making an error based on bad carrier advice. The resolution also pushes CMS to require that carriers immediately confirm in writing guidance given over the phone.

The AMA also calls on CMS to change the claims appeal process to allow more redetermination requests to be handled by phone. Now, a physician may use the phone to go through the first level of appeal only if the doctor has made a minor error or omission. If the Medicare carrier has made a mistake, physicians must submit the appeal in writing.

AMA to work with scope partnership to oppose naturopaths' med licensure

The American Medical Association voted at its Annual Meeting to work with the Scope of Practice Partnership to oppose medical licensure of naturopaths and to report its work at the Interim Meeting later this year.

Physicians pushing for such a prohibition said patient safety could be threatened if naturopaths get medical licenses without meeting the standards that allopathic or osteopathic physicians must meet. Medical licensure requirements vary by state.

In a related resolution, the AMA voted to ensure that graduates of "nurse doctoral programs" are not misrepresenting their medical licensure status or educational background to patients. Physicians had complained that some of these nurses were referring to themselves as doctors in the treatment room, potentially confusing and endangering patients under their care.