AMA House of Delegates

AMA meeting: Principles aimed at better physician-hospital relations

The new policy could help doctors resist what they perceive as hospital leaders' attempts to undermine physician autonomy and interfere with patient care.

By Kevin B. O’Reilly — Posted Dec. 3, 2007

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The American Medical Association House of Delegates adopted 12 detailed principles aimed at easing strained physician-hospital relationships, protecting medical staff self-governance and improving health care quality and patient safety.

Until last month's Interim Meeting, the AMA had no house policy outlining the organization's stand on physician-hospital relations.

Physicians believe the new principles guiding how they work with hospital leaders should "expedite discussions with the AHA, the Joint Commission and the Centers for Medicare & Medicaid Services and ultimately signal to the health care community that there is an urgent need to find and build upon common ground between physicians and hospitals," the adopted resolution says.

"This is a vital struggle," said Brian D. Johnston, MD, a California emergency physician and delegate from the Organized Medical Staff Section. "If physicians lose self-governance, our patients will be harmed, our hospitals won't function as well and we won't be able to practice medicine to the best of our ability."

The new policy comes on the heels of a pitched battle between organized medical staffs and hospitals over revisions to Joint Commission Standard MS.1.20, approved in June. The standard centers on what components of governance must be included in organized medical staff bylaws -- and therefore voted on and approved by physicians -- and what can be addressed in the administrative rules, regulations and policies that hospital boards and medical executive committees decide.

Physicians are largely perceived to have won that struggle, and the AMA's newly adopted principles, which are four pages long, are aimed at further solidifying doctors' stance in future negotiations.

At the heart of the matter is a conflict "between what medical staffs believe is necessary for patient care and patient safety versus what the board of a hospital wants," said William B. Monnig, MD, an alternate delegate for the Kentucky Medical Assn. and former OMSS chair.

Protecting doctors' financial data

In other house action related to hospitals, delegates directed the AMA to press the Joint Commission, hospitals and health systems to interpret the accrediting body's patient-safety standards consistently, especially the commission's controversial standard on medication reconciliation.

William E. Jacott, MD, the Joint Commission's special adviser for professional relations and a former AMA trustee, said the body "believes that medication reconciliation remains a very important national patient-safety goal." He added that the commission is "well on the way to satisfying concerns" that delegates expressed about surveyors' inconsistency in interpreting the standard.

Surveyors receive targeted training on a continuing basis, Dr. Jacott said. He noted that recent feedback from more than 50 health care organization representatives could lead to changes in how the Joint Commission evaluates the medication reconciliation performance of inpatient versus ambulatory settings.

The house also authorized the AMA Board of Trustees to take steps to protect medical staff members' financial data disclosed on conflict-of-interest statements from being used by hospitals to punish doctors for referring patients outside the hospital or health system, a process sometimes called economic credentialing.

There have been "multiple examples of abuses of confidentiality and accumulation of financial data" on doctors, said California alternate delegate Peter N. Bretan Jr., MD, in support of AMA action on the issue.

The resolution -- referred to the board -- calls on the AMA's representatives to the Joint Commission to push for a standard protecting the confidentiality of medical staff members' proprietary financial information. The measure also calls on the AMA to press for state and federal regulations on the issue.

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12 tasks for an organized medical staff

  • Work with the hospital governing body to improve patient safety and health care quality.
  • Be primarily responsible for credentialing, privileging and overseeing clinical quality and patient safety.
  • Address the community's health care needs and be involved in hospital strategic planning.
  • Communicate with the hospital governing body in a timely and effective manner.
  • Establish bylaws that are binding and are not undermined by conflicting hospital bylaws or policies.
  • Have inherent rights of self-governance, such as shaping bylaws, and disciplinary actions.
  • Create bylaws that bind the medical staff as a whole, its individual members and the hospital governing body.
  • Determine the financial support required for the organization to carry out duties.
  • Elect member representation to attend, speak and vote at hospital governing board meetings.
  • Have individual members be eligible for full membership on the hospital governing body.
  • Develop disclosure and conflict-of-interest policies for physicians in leadership.
  • Address disputes with the hospital governing body through well-defined processes.

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Meeting notes: Medical practice

Issue: Health plans' use of claims data to rate how efficiently physicians provide care can be inaccurate and mislead patients.

Proposed action: Actively oppose all so-called economic profiling and widely publicize how the practice may harm patients. [ Adopted ]

Issue: Doctors often waste time navigating pharmacy chains' automated phone menus to call in prescriptions.

Proposed action: Work with the executives of multistate pharmacy chains to standardize the option allowing doctors to quickly bypass automated messages and phone in a prescription. [ Adopted ]

Issue: Physicians want to reduce administrative burdens and registration fees for physician identifiers such as a Drug Enforcement Administration number.

Proposed action: Work with agencies to require only one DEA number that would be physician-specific, and study whethermultiple physician identifiers areneeded or could be eliminated. [Adopted ]

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External links

"Revisions to Standard MS.1.20 Approved," Joint Commission (link)

"The Medication Reconciliation Process Flow Chart," Joint Commission, in pdf (link)

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