AMA meeting: Special section

Legislative actions

Issue: Medicare's physician payment formula and temporary patches to scheduled pay cuts have produced low pay rates that diminish many doctors' ability to accept Medicare enrollees.
Proposed action: Offer principles for Medicare pay reform without endorsing one specific methodology; continue to advocate for reform of the Medicare payment system; push for improved, confidential data collection; support pilot programs that identify successful approaches to pay reform; support changes in antitrust law that would enhance care coordination; and work to ensure any bundled pay systems do not result in hospital-controlled physician payments. [Adopted]

Issue: Organized medicine wants to see medical liability reform included in health system reform.
Proposed action: Pursue effective medical liability reforms as part of federal comprehensive health system reform efforts. Discuss with federal policymakers a wide range of traditional and alternative measures that will not undercut existing state reforms. Such options might include pilot programs on alternative dispute resolution mechanisms, including health courts. [Adopted]

Issue: Doctors seek alternatives to the medical liability system.
Proposed action: A report calls for further research of Michigan's patient compensation system, a no-fault liability system, before determining if it can be a model alternative for other states unable to achieve traditional tort reform measures. While Michigan's program appears to provide certain patient safety benefits, the report called attention to potential unintended consequences, such as an influx of claims and onerous fees that could outweigh the cost of current medical liability insurance premiums. [Adopted]

Issue: A growing uninsured and underinsured population continues to add to medical liability pressures on physicians.
Proposed action: Explore expanding liability coverage under the Federal Tort Claims Act to cover physicians who treat patients in federally funded health programs, including Medicare, Medicaid, the Children's Health Insurance Program, insurance purchased with pretax dollars and nonprofit facilities. [Referred for decision to Board of Trustees]

Issue: It is unclear whether comparisons of the U.S. health care system and other developed countries are based on truly parallel data. Some countries don't include nursing home care in their health care spending estimates, and others don't count the cost of medical education. This might have resulted in skewed assessments of medical spending in the U.S.
Proposed action: Research the reported cost estimates from other developed countries to clarify what is included in them compared with tallies of U.S. medical spending. Use this information to ensure that the true costs of the nation's health care system are part of the reform discussion. [Adopted]

Back to top

Medical practice

Issue: Guidance and policy is needed on the use and release of physician data.
Proposed action: A Board of Trustees report provides physicians guidance on the release and use of their data, including patient privacy safeguards, data accuracy and security safeguards, transparency requirements, review and appeal requirements, physician profiling requirements, quality measurement requirements and patient satisfaction measurement requirements. [Adopted]

Issue: Solutions are needed to address overcrowding in hospital emergency departments.
Proposed action: A Council on Medical Service report congratulates the American College of Emergency Physicians for developing solutions to the problem of overcrowded emergency departments. The report also supports collaboration between organized medicine and ED staff, and the dissemination of best practices, in efforts to reduce ED boarding and crowding. [Adopted]

Issue: Certain specialists are required to be in-house on a 24-hour basis at some hospitals. Some are not paid for this in-house coverage while others are.
Proposed action: The AMA work with the American Hospital Assn. to require the equitable treatment of all specialists required to provide in-house coverage. [Adopted]

Issue: The growth of the hospitalist movement has resulted in less hospital volume for some physicians. This has made it difficult for low-volume physicians to demonstrate clinical competencies in a hospital setting, as required by some credentialing rules.
Proposed action: The AMA adopt guidelines to assist medical staffs with credentialing and privileging physicians with low activity. [Adopted]

Issue: As employees of physicians, allied staff, including nurse practitioners and physician assistants, have little contact with the activities of organized medical staff, especially concerning patient care, safety, quality and ethical issues.
Proposed action: The AMA study how hospital medical staffs can involve allied staff in oversight activities. [Adopted]

Issue: Radiology benefit managers interfere with patient care and place an unnecessary burden on physicians and compromise patients' health by substituting tests or denying approval for tests.
Proposed action: Oppose routine denials or substitutions by RBMs working for third-party payers, study the prevalence of forced substitution of one study over the one requested, support the use of appropriate-use criteria developed by physicians with expertise in the specialty that pertains to the patient's condition. [Adopted]

Issue: Electronic medical records place the purchaser at the mercy of a vendor when the system needs fixing or upgrading. Open-source coding allows users to make changes and update as necessary.
Proposed action: Ask the AMA to develop open-source EMRs that meet "meaningful use" criteria, and make them available at a nominal cost to physicians. [Adopted]

Back to top

Medical ethics

Issue: Breaches of electronic medical records security can compromise privacy and harm patients physically and emotionally. When such breaches occur, what responsibilities do physicians have toward their patients?
Proposed action: An ethical policy recommending that physicians promptly inform patients of any breach and the potential for harm, describe how the breach happened and what steps patients can take to minimize any adverse results. [Adopted]

Issue: Physician assistants and nurse practitioners are increasingly taking on ownership roles in practices such as retail health clinics. This gives rise to the ethically problematic situation where a doctor is hired to supervise the work of a midlevel practitioner who also owns the practice and is the physician's employer.
Proposed action: An ethical policy that acknowledges the conflicts inherent in such an arrangement. The opinion says physicians have a duty to always exercise their independent professional judgment in patients' best interest, even if it puts them at odds with their employers. [Adopted]

Issue: Some hospital patients with racial or other prejudices are hostile to the physicians assigned to care for them or refuse their treatment, but hospitals do not have uniform guidelines to address these situations.
Proposed action: Direct the AMA to work with other organizations to encourage hospitals and health systems to adopt policies allowing patients to change doctors and have mechanisms to address abusive patient behavior and ensure continuity of care for a patient who declines care from the attending physician. [Adopted]

Issue: So-called chimeric embryos -- created when human genetic material is introduced into a nonhuman embryo or transferred into an enucleated nonhuman egg, creating a hybrid -- are being explored as an alternative to stem cell research techniques that destroy human embryos.
Proposed action: The Council on Ethical and Judicial Affairs said there is a lack of policy or scientific and ethical consensus on chimeras, and the issue affects few physicians. The council proposed examining the issue as part of its review of opinions relating to medical genetics in the AMA Code of Medical Ethics. [Adopted]

Issue: Working with patients to plan in advance for end-of-life care situations is a legally complicated and ethically fraught area for doctors.
Proposed action: Direct the AMA to develop an educational session on advance care planning at an upcoming Annual or Interim Meeting and ask CEJA to update its ethical guidance on end-of-life issues. [Adopted]

Back to top

Public health

Issue: Some organizations are lobbying to have obesity declared a disability, but this designation could interfere with physician counseling on the subject.
Proposed action: Oppose such efforts. [Adopted]

Issue: Concerns have been raised about the safety of conducted electrical devices being used by law enforcement officials and others.
Proposed action: Law enforcement departments and other agencies should design and implement guidelines, training and accountability on the use of these devices. These bodies should also have standard approaches to medical evaluation, management and postexposure monitoring. Additional independent research is needed to better understand the risks and benefits of these devices. [Adopted]

Issue: Male breast cancer is uncommon but tends to be diagnosed at late stages. Awareness of this possibility is low.
Proposed action: Recognize that breast cancer affects men as well as women, some men are at increased risk and heightened surveillance may be appropriate for a minority of men. Support Medicare and insurance coverage for screening and testing services for those at increased risk. [Adopted]

Issue: Hormones have been promoted to prevent aging, but there are many open questions as to the risks and benefits of taking those substances for that purpose.
Proposed action: Disseminate the Council on Science and Public Health report that found scientific evidence was lacking and, in some cases, long-term use may cause harm. Take the position that those who promote these treatments have a responsibility to support claims with well-designed, randomized placebo-controlled trials. [Adopted]

Issue: Americans' overall health continues to decline because of preventable conditions, many linked to overweight and obesity.
Proposed action: Make improving Americans' eating and exercise habits a priority, propose draft legislation that would establish innovative programs to encourage people to adopt healthier habits and work with partner organizations to educate patients on how to improve diet and increase physical activity. [Adopted]

Issue: The obesity epidemic is growing, but people do not have easy access to the nutritional information they need to eat healthily in restaurants.
Proposed action: Create a method for displaying calorie and other relevant information on restaurant menus and menu boards for all food and beverage items. [Reaffirm existing policy on nutrition labeling]

Back to top

Other actions

Issue: Significant work-force shortages across multiple specialties persist.
Proposed action: Ensure that actions to bolster the physician work force are part of any comprehensive federal health system reform proposal. Work to expand graduate medical education slots and rescind related caps to respond to projected access-to-care needs. [Adopted]

Issue: There are some similarities between allopathic and osteopathic medical education systems.
Proposed action: A report calls for collaboration between MDs and DOs and exploring opportunities to align relevant medical education and training practices. [Adopted]

Issue: The Accreditation Council for Continuing Medical Education continues to impose additional requirements and increased fees on CME providers.
Proposed action: Study the impact of new accreditation criteria to determine whether it adds value or could reduce access to local CME providers who cannot afford to comply. Urge the ACCME to reconsider proposed fee increases. [Adopted]

New AMA leadership
Texas cardiologist J. James Rohack, MD, was inaugurated as president. Florida internist Cecil B. Wilson, MD, was named president-elect. Elected to the Board of Trustees were Missouri family physician David O. Barbe, MD; Wisconsin plastic surgery resident Raj Ambay, MD, DDS, as resident/fellow member; and Ohio State University medical student Justin B. Mahida as medical student member. Re-elected to the board were Colorado psychiatrist Jeremy A. Lazarus, MD, as speaker of the house; Pennsylvania hand surgeon Andrew W. Gurman, MD, as vice speaker; Kentucky internist and infectious disease specialist Ardis Dee Hoven, MD, as chair-elect; and Virginia reproductive endocrinologist and obstetrician-gynecologist Robert M. Wah, MD. The new board chair is California anesthesiologist and pain management specialist Rebecca J. Patchin, MD.

Back to top