AMA House of Delegates

Physicians representing state and specialty medical societies gathered in Houston for the Interim Meeting of the AMA House of Delegates. The meeting is an opportunity for physicians to have their say.

AMA meeting: Delegate vote refines AMA stance on system reform

Delegates rejected attempts to rescind AMA support of a U.S. House health reform bill and any new government-sponsored health insurance plan.

By Doug Trapp — Posted Nov. 23, 2009

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Hours of intense but civil discussion at the American Medical Association's Interim Meeting ended on Nov. 9 with the House of Delegates affirming its support for the leadership's actions on health system reform and strengthening the Association's reform policies.

Delegates adopted a 14-part substitute reform resolution that largely reaffirms existing AMA stances. It also formalizes some policies, such as AMA opposition to an independent Medicare commission with authority over payment policy. The resolution calls on the AMA to "actively and publicly" push several existing policies, such as physicians' rights to contract privately with patients.

AMA President-elect Cecil B. Wilson, MD, said the vote showed that the Board of Trustees correctly advocated on doctors' behalf in the time leading up to the meeting. "It's an affirmation of the AMA's position in the health system reform debate."

Several state and specialty medical societies backed resolutions that would have rescinded AMA support for the Affordable Health Care for America Act, which the U.S. House of Representatives adopted Nov. 7. The AMA had announced its qualified support for the bill on Nov. 5 but did not endorse the entire measure.

The reference committee considering these resolutions did not recommend their approval, and the House of Delegates rejected proposed amendments with similar language.

David Cook is executive director and CEO of the Medical Assn. of Georgia, which led the coalition of medical societies that were critical of AMA support for the U.S. House bill. He said that despite the coalition's inability to redirect AMA policies, the society's leaders were satisfied they had a chance to present their arguments and help strengthen the policies.

"There's always going to be differences in any organization," Cook said after the meeting. "The important thing for an organization is that people are allowed to express their opinions and have a debate. We understand and respect the position that the House of Delegates took. We don't agree with that, but that's part of the democratic process."

Katie Orrico, director of the Washington, D.C., office of the American Assn. of Neurological Surgeons -- another medical society in the coalition against U.S. House bill support -- said her society's leaders also were pleased with the outcome of the meeting. "We feel that at this point it's certainly more constructive to try to work within the system to have the AMA represent our interests as opposed to just picking up our marbles and walking away."

Both Cook and Orrico said their societies would continue to advocate for their members' views.

Clarifying AMA support

Some delegates said during the meeting that the AMA did not go far enough in explaining its concerns about the U.S. House actions, which included passing a controversial public insurance option but moving a Medicare physician payment solution to a separate bill.

The AMA's show of support angered many members and created an image problem for the Association, said James E. Jarrett, MD, a head and neck surgeon and delegate from the Montana Medical Assn. "The image is that we have supported everything in the bill, whether we intended to or not."

Joseph P. Bailey Jr., MD, a rheumatologist and delegate from the Medical Assn. of Georgia, referred to an AMA news release applauding U.S. House adoption of reform legislation. "In my judgment, that's sort of like being in a lifeboat at sea and applauding the arrival of sharks in the water."

Other delegates, however, cited the AMA's qualified support of the U.S. House bill, noting that leaders appeared on national television to explain that position and that trustees held numerous teleconferences in advance of announcing the support.

Georgia delegates offered an amendment to the combined health system reform resolution that would have clarified that the AMA did not fully "endorse" the U.S. House bill. But the House of Delegates rejected the amendment by a 350-167 vote. Some attendees argued that the media and others would cite the clarification as evidence the House of Delegates did not support the AMA Board of Trustees, possibly damaging the Association's reputation.

Divide over the public option

Another hotly discussed resolution would have instructed the AMA Board of Trustees to determine whether to support reform legislation based on a list of 12 criteria. One of those criteria would have compelled the AMA to oppose any bill with a new publicly funded health insurance plan, including the U.S. House-passed measure. Fifteen state and specialty medical societies authored the resolution, which was not approved.

Nancy H. Nielsen, MD, PhD, AMA immediate past president, said she was troubled by the resolution's apparent rationale. She told delegates, "Do you all think that the board really didn't know this and that we didn't try to adhere to AMA policy?"

Much of the resolution's language was based on existing AMA policy, with one key exception being the proposed opposition to any new government-funded health plan. Delegates at the AMA Annual Meeting in June declined to take a firm stance on a public plan. Instead, the House of Delegates adopted policy supporting "health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice and universal access for patients."

The AMA's position on the public option isn't clear enough, said W. Jeff Terry, MD, chair of the delegation from the Medical Assn. of the State of Alabama. "We're just straddling the fence."

But delegates opposing the resolution said it would impede AMA leadership as it negotiated with Congress on reform legislation.

"I would not want to hamstring our policy decisions based on this one document," said delegate Lori Heim, MD, president of the American Academy of Family Physicians, which introduced resolutions supporting the Board of Trustees' positions. She said Congress may present a public health plan compatible with AMA policy. Other delegates said holding out for legislation that won't conflict with any AMA policy would brand the Association as an organization that always says "no."

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Resolution strengthens AMA health reform policies

The AMA House of Delegates on Nov. 9 adopted a 14-part resolution on health system reform in lieu of several proposed by state and specialty medical societies at the 2009 Interim Meeting. The resolution restates, strengthens and expands certain AMA policies on health reform legislation, including:

  • That the AMA oppose an independent Medicare commission that would take Medicare payment policy control away from Congress and place it in the hands of unelected individuals.
  • That the AMA actively and publicly support the right of patients and physicians to contract privately.
  • That health insurance exchange plans be self-supporting and feature negotiated pay rates. Plans also must not require physician participation or restrict out-of-network access to doctors.
  • That delegates support Association leadership in its efforts to promote AMA health system reform policies.
  • That the AMA oppose redistributing Medicare pay among physicians based on unscientific outcomes, quality and risk-adjustment measurements. The AMA also opposes Medicare bonuses for one or more specialties being offset with cuts to other specialties.
  • That eliminating health plans' preexisting condition denials also means ending inappropriate rescissions.

Source: American Medical Association

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Meeting notes: Other actions

Issue: Courts may judge physicians in medical liability cases by developing new standards based on clinical and practice guidelines, risk management, utilization review and other cost-containment efforts -- especially if congressional health reform legislation does not contain language counterbalancing such arguments. Such federal legislation also could preempt effective state liability reforms.

Proposed action: Advocate for legislative language protecting both existing effective state medical liability reform programs and states' ability to enact such reforms. Lobby for legislation to establish a noneconomic damage cap of $250,000 or lower. [Adopted]

Issue: The potential savings to the health system from national medical liability reform legislation is not known.

Proposed action: Contract with an independent, third-party organization to estimate the impact national tort reform legislation would have on the system, with an update every 10 years. [Adopted]

Issue: The Medicare Modernization Act of 2003 authorized federal payments to states for emergency care for undocumented immigrants. But this support will end in May 2010.

Proposed action: Support congressional legislation to extend federal support for such emergency care. [Adopted]

Issue: Physicians who issue only paper prescriptions for patients in Medicare Part D will face pay cuts starting in 2012, but the U.S. Drug Enforcement Administration still requires prescriptions for many controlled substances to be written on paper. The DEA issued a proposed rule in June 2008 that would establish standards for electronic ordering of such drugs, but the rule has not been finalized.

Proposed action: Report the AMA's progress in advocating for electronic prescribing of controlled substances and on DEA efforts to issue reasonable requirements for electronic prescribers. [Adopted]

Issue: Forty state medical boards ask about physicians' history of mental illness, potentially discouraging doctors from seeking appropriate treatment for psychiatric disorders.

Proposed action: Work with the Federation of State Medical Boards and others to develop less discriminatory application language that is consistent with boards' mission to protect public health. [Adopted]

Issue: Cosmetics makers are not required to disclose the ingredients in their products, and there is no legally required testing to make sure they are safe.

Proposed action: Support pending legislation that would require ingredient disclosure, adverse-event reporting and good manufacturing practices. [Referred]

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