AMA House of Delegates
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Peter Lavine, MD, an orthopedic surgeon and alternate delegate from the Medical Society of the District of Columbia, voiced his opposition to ACOs. Photo by Denis Poroy / www.denisporoy.com

AMA meeting: Delegates approve guidelines for ACOs

The Association needs to be proactive, "whether you are in agreement with the concept or not," an alternate delegate says.

By Victoria Stagg Elliott — Posted Nov. 22, 2010

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The AMA adopted principles for accountable care organizations, which AMA President Cecil B. Wilson, MD, said were both helpful and timely.

Health system reform legislation calls for ACOs to be established by Jan. 1, 2012. The AMA's guidelines, based on those adopted by the California Medical Assn., say an ACO's goals are to increase patients' access to care, improve the quality of care and ensure it is delivered efficiently. ACOs must be physician-led and encourage collaboration, the new guidelines say. Medical decisions should put patients' interests first without conflicting with commercial concerns. Participation by physicians and patients should be voluntary.

The principles state that any money saved by an ACO should be retained for patient care and distributed to ACO participants. Additional upfront resources to encourage ACO development and spending benchmarks should be adjusted for geographic and patient-risk differences.

A draft of ACO regulations is due in early 2011, and Dr. Wilson told delegates he would be heading to Washington, D.C., after the Interim Meeting to brief members of the administration.

"With this, we know where we stand on what we think accountable care organizations should look like," he said.

Some delegates said it was crucial for the AMA to have policy ready on the subject. "Whether you are in agreement with the concept or not, it's coming," said urologist Peter Bretan Jr., MD, an alternate delegate for the CMA. "The AMA needs to speak and distribute data and have guiding principles. We need to be proactive, or we are going to have something that none of us are going to like."

Other delegates suggested more study, and still others suggested that the AMA come out opposing ACOs.

"It's the whole HMO concept redressed, and it's a bad way to practice medicine," said Peter Lavine, MD, an orthopedic surgeon and alternate delegate from the Medical Society of the District of Columbia.

Delegates also asked the AMA to clarify its support of antitrust relief for doctor-led ACOs, which it stated in a letter to the Federal Trade Commission and other agencies. Flexibility in antitrust and self-referral laws and civil monetary penalties is viewed as crucial to allowing small- and medium-sized practices to participate in this aspect of health reform yet retain some independence.

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ADDITIONAL INFORMATION

Meeting notes: Legislative actions

Issue: The National Health Services Corps scholarship program encourages primary care physicians to practice in underserved areas, but the program is still underutilized. The Patient Protection and Affordable Care Act will expand it by $1.5 billion during the next five years.

Proposed action: Work to increase physician, medical school and medical student representation in the decision-making process of the program to help make it more popular and more efficient. [Adopted]

Issue: Debt incurred by patients for health care is far less predictable and more complex than most consumer debt, but it can impact financial health significantly. In addition, consumers looking to improve credit scores would be more likely to pay off medical debt first if these amounts were cleared from their records within 30 days rather than the usual seven years.

Proposed action: Support the principles that are stated in the Medical Debt Relief Act, which passed the House on Sept. 29 and has been referred to the Senate. [Adopted]

Issue: The Patient Protection and Affordable Care Act requires companies offering group and individual health insurance with dependent coverage to continue offering this until the child is 26. The law does not apply to those covered by Tricare.

Proposed action: Support legislation providing coverage of military children under Tricare in line with that offered by private health plans. [Adopted]

Issue: The Patient Protection and Affordable Care Act is a flawed piece of legislation that did not sufficiently address medical liability reform, the sustainable growth rate and problems with antitrust rules.

Proposed action: Identify flaws in PPACA and advocate that they be fixed. [Adopted]

Issue: Hospitals declaring bankruptcy that do not pay for "tail coverage" leave physicians personally liable for any claims made after the institution closes.

Proposed action: Seek federal legislation amending the bankruptcy code such that medical liability premiums paid for physician employees will be considered a priority claim and paid immediately out of the proceeds of a bankrupt hospital's estate. [Adopted]

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