AMA House of Delegates

AMA meeting: Delegates renew efforts for antitrust relief

The AMA house says changes are needed to help physicians collaborate on quality and cost-improvement initiatives that will be key to health system reform.

By Amy Lynn Sorrel — Posted June 29, 2009

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Physicians say antitrust relief is going to play a key role in making health system reform succeed.

That's why the AMA House of Delegates at its Annual Meeting voted to have the Association renew its strategies for enhancing physicians' abilities to bargain collectively with health insurers without running afoul of antitrust laws. Delegates also want to see the AMA continue to press the Federal Trade Commission and the Dept. of Justice for a more flexible policy allowing individual physicians to collaborate through joint ventures.

"We hope this will be a part of health reform, and we are prepared to push for that," said AMA President-Elect Cecil B. Wilson, MD.

Organized medicine has made progress in recent discussions with the new leadership at the FTC and Justice Dept., as well as congressional leaders, he said. The house voted to have the AMA report back on those advocacy efforts through the Association's member communications.

Delegates expressed concern that current antitrust barriers make it difficult for doctors to collaborate on quality and cost-improvement measures that are often too expensive for smaller physician practices. The affordability of health information technology initiatives, a key component of health system reform, is one such hurdle, they said.

Being able to negotiate collectively would help put physicians on a level playing field when contracting with large health insurance companies, Dr. Wilson said.

Current antitrust laws are "outdated" and ignore recent changes in the health care environment, according to an AMA Board of Trustees report. Such changes include a largely consolidated health insurance market and new pay-for-performance reimbursement mechanisms that rely on the collection of cost and quality data.

The AMA has proposed to the FTC, the Justice Dept. and lawmakers a range of modifications to antitrust laws and regulations that would give physicians more leeway to integrate, as long as the networks do not exercise market power or result in any anticompetitive effects, the report said.

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Meeting notes: 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]

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