HONOLULU — The American Medical Association (AMA), the premier national physician organization in the country, voted to adopt new policies on emerging health care topics during the voting session of its Interim Meeting.
The AMA's House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.
The policies adopted by the House of Delegates today include:
ICE agents in medical facilities
Weeks after Immigration and Customs Enforcement (ICE) agents in Texas took into custody a 10-year-old girl with cerebral palsy shortly after she was discharged from a hospital where she just had surgery, the American Medical Association voted to oppose the presence of ICE enforcement at health care facilities. ICE policy states that enforcement actions, including interviews, searches, apprehensions, or arrests, should not occur at sensitive locations, including healthcare facilities and medical treatment centers.
“Our patients should not fear that entering a hospital will result in arrests or deportation. In medical facilities, patients and families should be focused on recovery and their health, not the ramifications of their immigration status,” said Andrew W. Gurman, MD, Immediate Past President of the AMA.
Support for communication and resolution program
The AMA expressed its support for communication and resolution programs as an option to settle disputes before litigation. Many studies show these types of programs are effective way to learn from medical errors and near misses, enhance patient safety and improve the liability system.
“A structured communication and resolution program can help identify necessary patient safety improvements while also improving communication with patients without a resulting increase in litigation. The programs help foster a culture of safety and transparency in a blame-free environment rather than the confrontational litigation route,” said Carl A. Sirio, MD, a member of the AMA Board of Trustees.
Treating opioid use disorder in correctional facilities
As part of its ongoing effort to end the nation’s opioid epidemic, the AMA adopted new policy today affirming that, while in correctional facilities, patients with opioid use disorder should have access to evidence-based treatment, including initiation and continuation of medication assisted treatment, as well as counseling. In addition, when people are released from prison, they should have access to providers so they can access treatment plans for opioid use disorder, including education, medication for addiction treatment and medication for preventing overdose deaths.
“Patients with opioid use disorder should not have their treatment interrupted once they enter prison. Access to evidence-based care is crucial to treatment, no matter what the setting,” said Patrice A. Harris, M.D., chair of the AMA Opioid Task Force and immediate past chair of the Board of Trustees.
Confronting health insurer business practices that can delay patient treatment
Health insurers bear responsibility when they systematically impose bottom-line business practices over accepted medical guidelines that result is an unfair devaluation or denial of legitimate physician services.
In the latest example, Anthem Blue Cross recently notified physicians in several states that effective on January 1, 2018 it would change company policy and reduce payment for valid evaluation and management (E/M) services provided to patients. The change would routinely and automatically devalue E/M services and procedures that are reported to the health insurer under specific circumstances that require a designated code known as modifier 25.
In simpler terms, modifier 25 is reported on a medical claim when a physician evaluates, manages, and treats a patient for separate and distinct health care problems during the same visit. That work takes additional physician time and resources and should be reimbursed. However, health insurers frequently reduce or deny payment for E/M services reported with modifier 25.
“The AMA will work aggressively to prevent implementation of unfair health insurer rules that are detrimental to physicians who are trying to practice medicine according to the needs of their patients.” said AMA President David O. Barbe, M.D., M.H.A. “Health insurers that reduce or deny payment for E/M services associated with procedures performed on the same day are needlessly forcing patients into multiple visits and delaying the provision of necessary care.”
In response, physicians at the AMA Interim Meeting adopted policy to “aggressively and immediately advocate through any legal means possible, including direct payer negotiations, regulations, legislation, or litigation, to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.”
CORRECTION: Previous version of this news release incorrectly stated that Anthem would deny payment for valid evaluation and management (E/M) services.
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