AMA meeting: Special section

Medical practice

Issue: With more practices operating on a cash basis, physicians worry that some patients may not know the fees, or how they areexpected to pay them.
Proposed action: The AMA is to adopt principles for a cash-based practice that include an appropriate fee schedule that is understandable and easily accessible to patients. Cash-based practices should encourage patients to have health insurance coverage for catastrophic illnesses. [ Adopted ]

Issue: Medicare rules prohibit patients from compensating physicians above and beyond what Medicare covers, which may discourage physician participation.
Proposed action: The AMA will immediately call upon Congress to remove fee limits under Medicare and to preempt state laws limiting charges for physicians. Progress is to be reported annually to the house. [ Adopted ]

Issue: Antiquated federal rules pose barriers to electronic prescribing.
Proposed action: The AMA will work with federal and private entities to update laws and rules that are roadblocks to e-prescribing, while maintaining a position that physician Medicare or Medicaid pay not be reduced for failing to adopt e-prescribing. The AMAwill begin discussions with the Drug Enforcement Administration to allow e-prescribing of Schedule II drugs. [ Adopted ]

Issue: Physicians can't always access patient's preexisting prescriptions for controlled substances.
Proposed action: The AMA will support changes to state prescription drug monitoring programs to allow physicians real-time access to their patients' controlled substance prescriptions across state lines. [ Adopted ]

Issue: Physicians sometimes have limited knowledge of their rights under Medicare's Recovery Audit Contractor program.
Proposed action: The AMA will support a moratorium on theexpansion of the RAC program and begin a physician education campaign. [ Adopted ]

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Access to care

Issue: More procedures are being performed in ambulatory surgical centers because of cost and quality benefits, but varying state regulations pose barriers to the doctor-owned facilities.
Proposed action: Review data on the effectiveness of ambulatory surgical centers and advocate for federal and state legislation aimed at removing obstacles such as certificate-of-need laws. [ Adopted ]

Issue: Physicians are concerned that the shortage of psychiatric services and beds is gravely impacting emergency department crowding and boarding.
Proposed action: Supportefforts to facilitate access toboth inpatient and outpatient psychiatric services and care for mental illnesses and substance use disorders. Also, address the psychiatric work force shortage and provide adequate reimbursement for the care of patients with mental illnesses. At next year's Annual Meeting, the House of Delegates will get a report on the effectiveness of the measures implemented. [ Adopted ]

Issue: Health plans are denying claims for physician-directed treatment of gender identity disorder.
Proposed action: The AMA supports public and private health insurance coverage for physician-recommended treatment of gender identity disorder. [ Adopted ]

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Public health

Issue: Questions have been raised about the role high-fructose corn syrup may play in escalating obesity rates. A review suggested that increasing consumption of all forms of sugar may be involved, but that high-fructose corn syrup could not be singled out.
Proposed action: Encourage independent research into the effects of high-fructose corn syrup and recommend that people limit consumption of all caloric sweeteners. [ Adopted ]

Issue: Research indicates that recommended levels for vitamin D are too low and deficiencies in this substance may play a role in development of chronic diseases.
Proposed action: Urge the Institute of Medicine to re-examine recommended daily intake values for vitamin D. [ Adopted ]

Issue: Many hospitals require physicians to sign a written version of verbal orders within 48 hours, but physicians regard this as a waste of time and lacking evidence that it benefits patients.
Proposed action: Request from appropriate federal agencies evidence supporting this policy, and, if there is none, ask for the requirement to be rescinded. [ Adopted ]

Issue: Many blood-banking organizations regard the lifetime ban on blood donations from men who have had sex with men since 1977 as no longer necessary to keep supplies safe. It also may be discriminatory and stigmatizing.
Proposed action: Recognize that a five-year deferral is supportable by science. [ Adopted ]

Issue: Those living with chronic medical conditions are more likely to be injured or die during a disaster or in its aftermath. This may be due in part to a lack of access to usual medications.
Proposed action: Recommend patients maintain an emergency pharmaceutical reserve and always carry a detailed list of their medications. [ Adopted ]

Issue: Studies have not found "abstinence-only" education to be effective, but state and federal funding supports it.
Proposed action: Urge that mandates for "abstinence-only" instruction end and that money be redirected to comprehensive sex education. [ Referred ]

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Medical ethics

Issue: To better halt the spread of chlamydia and gonorrhea, the Centers for Disease Control and Prevention recommends expedited partner therapy, in which doctors give patients antimicrobials for their sex partners. The practice, while effective, may undermine informed consent and continuity of care, and violate state laws.
Proposed action: New ethical policy saying doctors should only use EPT if they believe a patient's partner would otherwise not seek treatment. [ Adopted ]

Issue: Some hospitals have asked medical staff members to provide personal financial information as part of conflict-of-interest policies apparently aimed at shutting out doctors who work for competitors.
Proposed action: A Board of Trustees report recommending that only physicians seeking to serve in a hospital leadership position be required to disclose employment, ownership or financial interests, or leadership positions at another hospital. Also, the information requested should be no different from that requested of nonphysicians. [ Adopted ]

Issue: Treating peer physicians poses special challenges to clinical objectivity and confidentiality.
Proposed action: New policy saying doctors should not hesitate to treat peers in emergencies, but should beware of the risk of biased treatment recommendations, take care to respect privacy, and share decision-making as they would with other patients. [ Adopted ]

Issue: Drug- and device-maker funding of graduate and continuing medical education may undermine physicians' professional integrity and subtly bias doctors' practice patterns in ways that are not in patients' best interest.
Proposed action: A new ethical opinion calling on doctors, medical schools and organized medicine groups to end industry funding of residency positions and clinical fellowships, educational programs and physician speakers' bureaus -- except when new diagnostic or therapeutic devices and techniques are introduced, as industry representatives may be the only experts available to teach doctors about them. [ Referred ]

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Medical education

Issue: There are no standards to define pain medicine specialists.
Proposed action: Encourage interested parties to join to define scope of practice and define appropriate credentialing of pain specialists. [ Adopted ]

Issue: There remains a disparity in pay and advancement opportunities between female and male physicians.
Proposed action: Encourage specialty and state societies to find solutions to gender disparity, support doctors in balancing work and life, train women physicians in leadership and contract negotiations, and publicize best practices. [ Adopted ]

Issue: Some residency programs will not accept graduates of international medical schools.
Proposed action: Ask the Accreditation Council for Graduate Medical Education to make IMG status a prohibited discrimination. [ Adopted ]

Issue: Residency programs vary in leave time and whether time off results in repeating training.
Proposed action: Ask the ACGME to standardize leave under the Family and Medical Leave Act, and to encourage the American Board of Medical Specialties to standardize absence policies. [ Adopted ]

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Other actions

Issue: State medical boards differ in their standards for restricting or revoking physicians' licenses.
Proposed action: Explore ways to establish principles for due process protections. [ Adopted ]

Issue: Whether primary care physicians have enough representation on the AMA/Specialty Society RVS Update Committee.
Proposed action: Maintain existing allocation of primary care seats on the committee and continue to support the RUC's work. Its efforts should include advocating for separate payment for physician services that do not require face-to-face interaction. [ Adopted ]

Issue: New AMA leadership
Result: Texas cardiologistJ. James Rohack, MD, was named president-elect. Oklahoma neonatal-perinatal specialist Mary Anne McCaffree, MD, was elected to the Board of Trustees. Re-elected to the board were Colorado psychiatrist Jeremy A. Lazarus, MD, as speaker; Pennsylvania hand surgeon Andrew William Gurman, MD, as vice speaker; and Virginia orthopedic surgeon William A. Hazel Jr., MD. Board chair is Massachusetts obstetrician-gynecologist Joseph M. Heyman, MD; chair-elect is California anesthesiologist and pain management specialist Rebecca J. Patchin, MD; and secretary is Kentucky internist and infectious disease specialist Ardis Dee Hoven, MD.

Issue: AMA membership dues
Result: Dues will not be raised. Regular members will continue to pay $420 a year. Dues will stay at $315 for physicians in their second year of practice, $280 for military physicians, $210 for physicians in their first year of practice, $45 for residents and $20 for medical students.

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