AMA meeting: Special section

Meeting Notes: Access to care

Issue: Surgeons worry that nonphysicians could encroach upon doctors of medicine and osteopathy when it comes to performing complex surgical procedures.

Proposed action: Adopt the definition of "surgery" developed by the American College of Surgeons. [Adopted]

Issue: Medicare Advantage plans are paid higher rates than fee-for-service plans, and private fee-for-service plans "deem" physicians as participants after filing one claim.
Proposed action: Seek to eliminate subsidies to Medicare Advantage and prohibit physician deeming without a contract. [Adopted]

Issue: Some physicians worry that the gulf between Medicare payments for primary care doctors and specialists is widening.
Proposed action: Recommend the voting representation on the AMA Relative Value Scale Update Committee, which suggests how much Medicare should value each service, be changed to include more primary care expertise. [Referred for study]

Issue: Physicians are concerned the National Quality Forum could supplant the Physician Consortium on Performance Improvement in developing quality measures.
Proposed action: Oppose any effort to expand the NQF in such a way and report on the forum's activities at the Interim Meeting. [Adopted]

Issue: The federal government could consider further limiting the prices paid for drugs, medical procedures and other services.
Proposed action: Oppose price controls in the health care industry and continue promoting market-based strategies to make health care affordable. [Adopted]

Issue: Immigrants and foreign visitors often lack health insurance.
Proposed action: Support legislation requiring the government pay physicians for federally mandated care, regardless of patient immigration status. [Adopted]

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Meeting Notes: Medical education

Issue: Some physicians remain skeptical of the need for the U.S. Medical Licensing Examination clinical skills test.
Proposed action: Study potential mechanisms for independent oversight of physician licensing exams, with a report due at the 2008 Annual Meeting. [Adopted]

Issue: Resident physicians may hesitate to report work-hour violations for fear of retaliation against them or their programs.
Proposed action: Urge the Accreditation Council for Graduate Medical Education and the American Osteopathic Assn. to alter the resident duty-hour violation reporting system to better protect whistle-blowers. [Referred for study]

Issue: Federal money for graduate medical education is capped, and regulatory changes threaten further restrictions to GME funding.
Proposed action: Collaborate with other stakeholders and advocate for a stable GME funding stream and push for more GME positions. [Adopted]

Issue: Concern that nonphysicians may call themselves board certified.
Proposed action: Communicate concerns to the National Board of Public Health Examiners and other stakeholders about NBPHE plans to create "board certification" for those who complete a master's in public health. Physicians believe the certification would be misleading. [Adopted]

Issue: Some worry that Office of Inspector General guidelines and revised Accreditation Council for Continuing Medical Education guidelines are impacting commercial CME money negatively.
Proposed action: A recent study said no, but continued monitoring on the impact of CME guidelines, standards and regulations on the delivery of CME at the state level is needed. Continued monitoring of trends in CME financing and availability also is needed. [Adopted, with a report due back at the 2009 Annual Meeting]

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Meeting Notes: Medical ethics

Issue: Medical device industry representatives often advise physicians about company equipment, many times during surgery, but the AMA had no ethical policy governing this activity.
Proposed action: A new ethical opinion calling on physicians to prevent industry representatives from breaching patient confidentiality, to assure that their hospitals have mechanisms to verify reps' credentials, and to tell patients if a representative is present during a procedure and explain that person's role. [Adopted]

Issue: Are physicians still obliged to uphold medical ethics when they are serving in nonclinical roles?
Proposed action: An ethical opinion saying that physicians are still bound by their medical ethical obligations to the extent that their nonclinical roles -- practicing health law or working as a health care journalist, for example -- rely on medical experience, perspective or training. [Adopted]

Issue: What should physicians do to avoid conflicts of interest relating to their ownership stake in a health facility?
Proposed action: Update existing ethical opinion to clarify that physician ownership must not be contingent on a specified volume of referrals and that doctors should disclose their financial interests when advising their patients. [Referred for study]

Issue: Some patients have reported trouble filling prescriptions, especially for the emergency contraceptive pill marketed as Plan B, because pharmacists refused to fill the orders on the grounds of conscience.
Proposed action: That the AMA prepare a report on reported delays and recommend ways to make sure patients' legally valid prescriptions are filled in a timely fashion. [Adopted]

Issue: The implantation of rice-grain-sized radio frequency identification tags in humans as a way to store medical information is likely to expand, but poses safety and ethical concerns.
Proposed action: Inform patients about the uncertainties associated with RFID tags, ensure that any information stored on the devices is secure and support further safety and efficacy research. [Adopted]

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Meeting Notes: Medical practice

Issue: Insurers have implemented policies to fine physicians when patients chose to use out-of-network services.
Proposed action: "Vehemently oppose" any penalties insurance companies use against doctors when patients independently use out-of-network services. [Adopted]

Issue: The time psychiatric patients spend in emergency departments is steadily increasing, exacerbating ED crowding issues.
Proposed action: Work with other stakeholders to study the issue and develop recommendations regarding the national scope of the psychiatric bed shortage problem and its impact on the nation's emergency and general medicine resources, including ED overcrowding. [Adopted]

Issue: As more physicians move toward adoption of health information technology, they find the buying decision challenging because so many options are available.
Proposed action: Use the AMA Web site and Association publications to educate physicians about issues to consider when purchasing health information technology systems, including ensuring that there is adequate technical support. [Adopted]

Issue: Health care spending continues to rise more quickly than wages and inflation.
Proposed action: A host of strategies, including reducing preventable disease, improving efficiencies in health care delivery, reducing nonclinical costs that do not add to the value of patient care and improving health-related decision-making processes. [Adopted]

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