American Medical Association Meeting Focuses on Health Reform
On November 7-10, 2009, ANA GOVA staff represented the ANA at the 2009 Interim House of Delegates Meeting of the American Medical Association in Houston, Texas. These meetings provide a window into how the AMA develops and influences health care policy, including areas of mutual interest and potential concern, and issues directly affecting the practice of nursing. Health care reform and the AMA’s position on H.R. 3962 were the number one topic of debate. The 2010 annual meeting is scheduled for June 12-16 in Chicago.
The 523 attending AMA delegates (of 544 credentialed) represented state medical societies, medical specialty societies, government physicians, and other physician organizations. Additional attendees (about 500) included alternate delegates, medical students and residents, spouses, guests, press, and official observers. The 23 official observer organizations include five nursing organizations, but the other four did not attend: AANA (American Association of Nurse Anesthetists), AORN (Association of periOperative Nurses), NCSBN (National Council of State Boards of Nursing) and CGFNS (Council of Graduates of Foreign Nursing Schools).
Reports and Resolutions:
Official AMA policy is set through adoption of resolutions and committee reports. Reference committees hear debate on proposed reports and resolutions, then committee staff prepare a consent calendar with recommendations for approval by the full HOD. Individual items can be extracted for separate debate and voting. Information about the meeting, including resolutions and reports, is available on the AMA website.
Reference Committee B / Legislative Advocacy:
Health System Reform Legislation: The AMA’s public support of H.R. 3962 was the most contentious issue of the meeting, with six hours of debate in the reference committee. Many AMA delegates objected to the public option, although proposals to officially oppose both the bill and the public option were subsequently defeated. Others objected to the bill’s failure to address malpractice reform or the SGR (sustainable growth rate) formula that results in annual cuts to Medicare reimbursement rates. AMA President Dr. James Rohack (a Texas cardiologist) clarified that the AMA “supports” H.R. 3962 but still sees many problems with the bill.
The HOD adopted one major health system reform proposal, Resolution 203, with amendments. Its key initiatives “Resolves” provide for:
- Health insurance coverage for all Americans, and ending denials and rescissions for pre-existing conditions, etc.
- “Assurance that health care decisions will remain in the hands of patients and their physicians, not insurance companies or government officials”
- Quality improvement, prevention & wellness incentives
- Repeal of the SGR
- “Implementation of medical liability reforms to reduce the cost of defensive medicine”
- Streamlining the insurance claims process
- A health insurance exchange must be self-supporting, and include optional participation and negotiated rates and contracts for physicians
- Rights of private contracts between patients and physicians Opposition to:
- “a new single payer, government-run health care system”
- Medicare payment cuts for failing to report quality data under a dysfunctional program (PQRI) or according to arbitrary outcome measures, self-referral restrictions, or utilization triggers; or to redistribute payments among physician groups (e.g., bonuses for primary care providers.)
Resolution 205-Change of Term Health Care Provider:
Called for eliminating the term healthcare provider and practitioner when describing doctors; apparently withdrawn by its sponsor, the Florida delegation.
Electronic Prescribing, Resolutions 210 and 211:
Adopted, calls for improved regulations and consistency between CMS and DEA.
Resolution 213- Physician Supervision Over Certified Registered Nurse Anesthetists:
Adopted with amendments to provide: “Resolved, That our AMA urge the federal government to repeal the opt-out provision of the Medicare Conditions of Participation requirement that certified registered nurse anesthetists practice under direct physician supervision.”
Reference Committee F/Finance & Governance:
Report of the Speaker’s Task Force on the Replacement Meeting: Adopted, calls for the Interim Meeting to be held in conjunction with the AMA National Advocacy Conference in the Washington, DC area, beginning in 2012, with attendance limited only to AMA delegates and AMA members.
Resolution 602-Empowering AMA Membership in the Grassroots:
To create an “ongoing ‘real-time’ national legislative forum” for AMA members was referred for further study.
Reference Committee J/Medical Service & Practice Advocacy:
Board of Trustees Report 9-Clarification of the Title “Doctor” in the Hospital Environment:
Was adopted, leaving AMA action on this issue to current efforts by the Scope of Practice Partnership, versus a projected $20 million campaign to educate consumers, use of AMA nametags by physicians, etc. This report resulted from passage of Resolution 846 (I-08) at the 2008 Interim Meeting, and there was little discussion and no controversy on this report.
Resolution 805-Emergency Department Readiness to Care for Children:
Adopted with amendments; calls for “designation of both a physician and a nurse coordinator for pediatric emergency care” at all hospital emergency departments.
Resolution 806-Principles for Developing a Sustainable and Successful Hospitalist Program:
Substitute version adopted, brought by AMA Organized Medical Staff Section. Its “Vision” recognizes that “care and treatment of medical inpatients requires coordination among all of the clinical professionals” — including nurses — and calls for hospitalists to “play a role in addressing nurse satisfaction” when “nurse turnover is an issue at the hospital.”
Resolution 821-Definition of Physician:
Adopted, limits “physician” to MDs and DOs, excluding optometrists, chiropractors, podiatrists, dentists, and oral surgeons.
Reference Committee K/Professional Standards Advocacy:
Board of Trustees Report 2, Standards of Care During a Mass Casualty Event: Adopted; contains an entire section on the ANA’s policies and contributions to this effort.
Council on Science and Public Health Report 3-Use of Cannabis for Medicinal Purposes: Adopted with amendments; calls for NIH research on the use of cannabis for pain relief, nausea, etc., and reevaluation of its classification as a Schedule 1 controlled substance, to facilitate further research.
Resolution 906-Regulation of Endocrine Disrupting Chemicals: Adopted with amendments, calls for developing collaborative policy with input from a variety of scientific and health experts, and consolidating federal regulatory oversight into one central office.
Resolution 907-National Cosmetics Registry and Regulation:
Was referred to the AMA Board of Trustees for further consideration and action.
Resolution 913-Prevention of the Expansion of GME Funding to Non-MD/DO “Residency” Programs:
Substitute adopted: “Resolved, That our AMA insist that any new GME funding to support graduate medical education positions be available only to the Accreditation Council for Graduate Medical Education (ACGME) and/or American Osteopathic Association (AOA) accredited residency programs. And “Resolved, That our AMA believes that funding made available to support the training of health care providers not be made at the expense of ACGME and/or AOA accredited residency programs.” During the reference hearing for this resolution the participants reaffirmed their support for GME and its use in non-acute sites.
Resolutions 922 and 928-Mandatory Immunization:
Were referred to the Board of Trustees for further study.
Reference Committee on Constitution & Bylaws:
Resolutions 3 & 8-Limiting Futile Care at the End of Life/End of Life Discussions: Were not adopted.
AMA Litigation Center:
In the public meeting of the AMA Litigation Center, no scope of practice issues or matters were discussed, including the AMA Scope of Practice Partnership. The center has $1.1 million in current resources to provide legal and financial assistance for lawsuits involving important legal precedents, of general interest to the medical community, or brought by a state or medical specialty society. Their major cases involve class actions against managed care organizations, economic credentialing, physician privacy, and the Federal Trade Commission “Red Flags Rule.” AMA members urged AMA action to end the McCarron-Ferguson Act’s antitrust exemption for insurance companies, and one commented that the “litigation center is one of the great benefits of belonging to the AMA.”
AMA Council on Legislation:
Members of this council, which advises the AMA Board of Trustees, identified three main areas of AMA advocacy on federal legislation: medical liability reform (the “number one issue” for the AMA); comparative effectiveness research (CER); and physician workforce issues. The AMA’s main goals for liability reform are: 1) caps on non-economic damages; 2) collateral source reform; 3) sliding scale for attorney fees; 4) period adjustment of future damages; and 5) reasonable statutes of limitations. Only California and Texas have enacted caps on non-economic damages. The AMA has adopted legislative principles on CER, calling for it to be objective and independent of government control, with patients and physicians playing a “central decision-making role.” AMA’s goals to curb physician shortages include deferral and deductibility of education loans and interest, lifting GME caps and expanding GME sites beyond hospitals, and permanently extending the J-1 visa waiver. Some physicians were concerned about the definition of the term “meaningful use” for health IT, and the AMA plans to comment on this issue during the rule making process.
Eileen Shannon Carlson, RN, JD
Tags: AMA, American Medical Association, GME, H.R. 3962, November-December 2009, SGR
