AMA meeting: Special section

Coverage from the 62nd AMA Interim Meeting, Nov. 8-11 in Orlando.

By amednews staff. Dec. 1, 2008.

Interim Meeting 2008

Top story

Delegates back medical home, want pay issues resolved

Physicians decide more discussion is needed on how payment for care under the medical home concept will affect specialists and primary care physicians.

The American Medical Association united with four other physician organizations on principles for how a patient-centered medical home system should work. But it resolved to study further the contentious issue of doctor payment under such a system.

The AMA House of Delegates, at its November Interim Meeting, adopted principles that call for medical home physicians to implement an infrastructure that allows them to have more continuous contact with patients, coordinate care better across the entire health system and use more evidence-based medicine to guide clinical decision-making, among other responsibilities. The principles state that the doctors in turn should be paid additional fees that appropriately reflect the added value these commitments provide to patients. Read more Meeting notes on medical practice

Meeting coverage

Reforming SGR tops Association's Medicare agenda for 2009
Texting while driving, trans fats on hit list
Meeting notes on legislative actions
Disruptive behavior standard draws fire
Doctors told to reveal financial stake in referrals
Delegates weigh ethics committee's role
Meeting notes on medical ethics
Global warming has health toll, delegates warn
Meeting notes on other actions

Meeting notes

Medical practice

Issue: Physicians who work in multiple locations or states and prescribe controlled substances must use multiple Drug Enforcement Administration registration numbers, which create additional administrative work.
Proposed action: Work with the DEA to allow physicians to have unique, person-specific DEA numbers. [ Adopted ]

Issue: Physicians are concerned that TRICARE is not providing adequate quality care -- especially mental health care -- to eligible servicemen, military retirees and their families.
Proposed action: Support increasing TRICARE physician payment, especially for mental health and addiction services. Encourage TRICARE officials to recruit more mental health treatment professionals and improve physician education on care coordination. Urge TRICARE officials to pay more for childhood vaccines. [ Adopted ]

Issue: Certain nonphysicians with advanced degrees (such as PhDs) confuse patients and hospital staff by referring to themselves as doctors.
Proposed action: Ask hospitals to require that staff who are not MDs or DOs identify themselves to patients as nonphysicians. [ Adopted ]

Issue: Many graduating medical students who intend to practice in underserved areas find that financial and other barriers discourage them from doing so.
Proposed action: Advocate for loan repayment programs, scholarships and tax credits for physicians serving these communities, as well as for reauthorization and expansion of the J-1 visa waiver program. Study and report back in 2010 on what medical schools are doing to attract students who will work in underserved areas. [ Adopted ]

Issue: Physicians with low patient volumes -- including young physicians -- face difficulties obtaining or keeping hospital credentials.
Proposed action: Study the challenges in credentialing low-volume physicians and develop appropriate criteria and methods for doing so. [ Adopted ]

Legislative actions

Issue: Medicare administrative contractors sometimes take months to enroll or re-enroll physicians. Meanwhile, these physicians receive no pay for treating Medicare patients.
Proposed action: Seek legislation requiring MACs to process physician Medicare applications within 30 days or suffer fines and penalties. The legislation should also direct MACs to provide appropriate feedback to physicians on the enrollment process. [ Adopted ]

Issue: Doctors could be held liable for adverse events from drugs and medical devices that have Food and Drug Administration approval.
Proposed action: Support state and federal legislative efforts to grant physicians who appropriately use FDA-approved drugs and medical devices the same level of liability protections for adverse events as awarded to manufacturers for adverse events. [ Adopted ]

Issue: There is no national entity to evaluate medical treatments against each other.
Action: Support a call by the AMA Council on Medical Service for a national research body to do comparative-effectiveness research. [ Adopted ]

Issue: Medical research and use of marijuana is stymied by its classification as a Schedule I drug and by criminal prosecutions of patients and physicians.
Proposed action: Support reclassification and urge law enforcement authorities to cease prosecutions of doctors and patients complying with state medical marijuana laws. [ Referred for study ]

Medical ethics

Issue: The AMA's Code of Medical Ethics has not been comprehensively reviewed in more than 30 years.
Action: The AMA Council on Ethical and Judicial Affairs will undertake a three-year project to reorganize the code to make it easier to use and to consolidate opinions and identify gaps in policy.

Issue: Drug- and device-maker funding of graduate and continuing medical education can pose conflicts of interest for physicians and unconsciously bias the content of educational activities.
Action: CEJA and the AMA Council on Medical Education are working together to issue recommendations at the 2009 Annual Meeting on how best to manage these conflicts. An open call for comments will be posted to the AMA Web site.

Issue: Some hospitals, required to provide uncompensated long-term care for immigrant patients have had the patients deported to home countries, where appropriate care is often lacking.
Proposed action: The AMA should adopt policy opposing the deportation of patients. [ Referred for study ]

Issue: The AMA has no ethical policy explicitly outlining physicians' duty to provide the right care to the right patient at the right time through continuous quality improvement.
Proposed action: A CEJA report spelled out physicians' ethical obligation to provide high quality care. Some delegates objected that the proposed policy placed untenable demands on doctors in underserved areas. [ Referred for study ]

Issue: Health care organizations are increasingly using "secret-shopper" patients to report on physician and hospital performance in areas ranging from customer service and patient-centeredness to hand hygiene and decor.
Proposed action: A CEJA report stated that secret-shopper patients could be used as one way to assess and improve quality. But, the council said, these pseudo patients should not deprive real patients from getting care and should be used only with the approval of physicians. Delegates overwhelmingly objected that secret-shopper patient programs are inherently deceptive and misallocate scarce health care resources.[ Not adopted ]

Other actions

Issue: Adult immunization rates are low, and an increasing number of parents are exempting their children from vaccinations.
Proposed action: Advocate for improving financing of adult immunizations, urge states to restrict nonmedical opt-outs from vaccine mandates and educate the public about vaccine safety. [ Adopted ]

Issue: Physicians lack concrete knowledge about the impact of Massachusetts' individual health insurance purchasing mandate.
Proposed action: Report to the House of Delegates by the 2009 Annual Meeting on the Massachusetts reform's effect on physician pay, physician reporting and compliance requirements, and private health insurance. The report also will cover how many uninsured remain and how much public financing was needed for the reform. [ Adopted ]

Issue: AMA finances
Reported: For 2008, the AMA is forecasting a $8.9 million operating loss, $2.6 million worse than budgeted for the year. Dues revenue is budgeted to decrease 1.8% in 2009.

Issue: Some hospitals have required physicians to sign emergency department call contracts -- sometimes at submarket rates -- or else lose their privileges.
Proposed action: Develop guidelines for contractual standards for ED call, reaffirm physicians' rights to not sign such contracts and to not take ED call if they choose, and oppose any requirement for physicians to take ED call to maintain hospital privileges. [ Referred ]