AMA meeting: Special section

Meeting notes: Legislative actions

Issue: Reauthorization of the State Children's Health Insurance Program.

Proposed Action: Provide SCHIP for children only at or below 200% of the federal poverty level, and transition toward coverage through a system of tax subsidies and vouchers by 2010, changing AMA policy. [ Rejected ]

Issue: The practice of some insurance companies and agents pressuring seniors to switch from traditional Medicare coverage to Medicare Advantage plans.

Proposed Action: Pursue legislation to require Medicare Advantage policies to include a seven-day waiting period, under which seniors could cancel the change, and a patient signature page showing that the patient understands he or she is canceling traditional coverage. [ Adopted ]

Issue: Limits on Medicaid beneficiaries who need long-term care. They are guaranteed only benefits related to nursing home care.

Proposed Action: Support Medicaid program reform that requires services to be provided in the most appropriate settings based on individual needs, and gives equal access to community-based programs. [ Adopted ]

Issue: Eliminating racial and ethnic disparities in health care.

Proposed Action: Develop model legislation and help state and local medical societies advocate for new state commissions to eliminate disparities. [ Adopted ]

Issue: Concern from physicians interested in volunteering at free clinics and elsewhere about medical liability coverage.

Proposed Action: Urge states to adopt laws that provide liability relief for volunteer physicians who serve at free clinics, deliver pro bono care or help in times of disaster. [ Adopted ]

Issue: Providing quality health care for all Americans.

Proposed Action: Promote legislation to ensure access to affordable, high-quality health care coverage. [ Adopted ]

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Meeting notes: Medical practice

Issue: Health plans' use of claims data to rate how efficiently physicians provide care can be inaccurate and mislead patients.

Proposed action: Actively oppose all so-called economic profiling and widely publicize how the practice may harm patients. [ Adopted ]

Issue: Doctors often waste time navigating pharmacy chains' automated phone menus to call in prescriptions.

Proposed action: Work with the executives of multistate pharmacy chains to standardize the option allowing doctors to quickly bypass automated messages and phone in a prescription. [ Adopted ]

Issue: Physicians want to reduce administrative burdens and registration fees for physician identifiers such as a Drug Enforcement Administration number.

Proposed action: Work with agencies to require only one DEA number that would be physician-specific, and study whethermultiple physician identifiers areneeded or could be eliminated. [Adopted ]

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Meeting notes: Medical ethics

Issue: Disagreements about treatment sometimes arise among doctors, parents and child patients. Resolving these disputes ethically and in the pediatric patient's best interest can be an awesome challenge for physicians.

Proposed action: A new ethical opinion that says pediatric patients should participate in medical decision-making in a way that is appropriate to their mental development; institutional policies should address how to resolve disagreements; and physical force and courts should be last resorts. [ Adopted ]

Issue: Doctors with financial ties to commercial umbilical cord blood banks have recommended the facilities to patients even though there is a 1 in 20,000 chance that low-risk children would develop a condition requiring them to use stem cells from their own cord blood.

Proposed action: A new ethical policy calling for doctors to obtain informed consent before cord blood is banked. Also, it calls on physicians to disclose any financial ties and recommend public, rather than private, banking to patients unless there is a family predisposition to a condition for which cord blood stem cells are therapeutically indicated. [ Adopted ]

Issue: Doctors may be missing cases of domestic violence and abuse by only questioning supposedly high-risk patient populations.

Proposed action: Revise AMA ethical guidelines to state that physicians should routinely inquire about violence and abuse, consider the possibility during differential diagnosis, note cultural variations when treating abused patients, and report abuse where legally required by supplying minimal information to respect patients' privacy. [ Adopted ]

Issue: Some physicians have skirted their ethical duty by limiting access to procedures that could benefit patients through the use of trade secrets, confidentiality agreements and other means, but existing AMA policy addresses only the unethical use of patents.

Proposed action: Amend the Code of Medical Ethics to make clear that the use of any legal tool to impede the sharing of medical knowledge is unethical. [ Adopted ]

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Meeting notes: Access to care

Issue: Only 3% of employers in 2006 offered the health-savings accounts and consumer-driven health plans the AMA has supported as an option for patients.

Proposed action: Encourage employers to promote greater health plan choice and ownership, offer workers tools to evaluate health plans, and support a fairer and more uniform health insurance market. [ Adopted ]

Issue: More than a third of workers have health plans that charge percentage-based co-payments, rather than fixed-dollar co-pays, for expensive specialty drugs.

Proposed action: A new policy saying the AMA believes that health plans should encourage the judicious use of resources instead of simply shifting drug costs to patients; that cost-sharing should be based on a number of factors affecting patient adherence and health outcomes; and that new tools should be made available so that doctors and patients can price out drug options before deciding which will be prescribed. [ Adopted ]

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Meeting notes: Other actions

Issue: Patients may get mixed signals about messages to quit smoking when hospitals and other places where they receive care also sell cigarettes.

Proposed action: Oppose tobacco sales at any facility where health services are provided. [ Adopted ]

Issue: A declining number of family physicians and internists and fewer medical students are choosing primary care as a career.

Proposed action: Study barriers to primary care medicine as a career choice and the impact of these barriers on the profession of medicine as a whole and on access to health care. [ Adopted, report expected at 2008 Interim Meeting ]

Released: AMA 2007 and 2008 finances

Reported: Operating profits are projected to be $13.9 million in 2007, $3.2 million better than projections for the year. In 2008, a $9.8 million operating surplus is expected. But the AMA is forecasting a $6.3 million operating loss for next year because it plans to spend $16.1 million of its reserves on media buys for its campaign on access to care for the uninsured.

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