AMA House of Delegates

Dolleen Licciardi, MD, delegate for the Louisiana State Medical Society. Photo by Ted Grudzinski / AMA

AMA toughens stance on retail health clinics

The Association plans to take its concerns about treatment shortcomings directly to insurance companies.

By — Posted July 4, 2011

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The American Medical Association adopted policy in 2007 opposing the practice of insurers encouraging the use of retail clinics by waiving or reducing co-pays. The Association now will take direct action against the practice by communicating directly with insurance companies on what it sees as the consequences of steering patients to nonphysician-staffed clinics.

Policy adopted by the AMA House of Delegates on June 21 says that by directing patients to seek care outside primary care relationships, decisions may be made with limited information, and tests or procedures may be duplicated, leading to higher health care costs for a decreased level of quality.

Though a small number of clinics are staffed by physicians, most are staffed by nurse practitioners and physician assistants. Insurers have said they support this model of care because it is a lower-cost alternative to emergency departments or physicians' offices when patients have minor ailments. Some insurers even have opened their own clinics.

In committee testimony on the issue, pediatrician Dolleen Licciardi, MD, a delegate for the Louisiana State Medical Society from Destrehan, spoke on behalf of the delegation in favor of the resolution.

In Louisiana, she said, pharmacists are allowed to provide care by administering shots, such as vaccines, without a doctor's order.

"The scope of practice is changing more and more," she said. "It's an important issue, and remember it's not just the nurse practitioners and physician assistants, it's the pharmacists now."

Others who spoke in favor of the policy said it helped strengthen the medical home model that places the primary care physician in charge of coordinating the patient's care.

Existing AMA policy says clinics should have established protocols for ensuring continuity of care with physicians, and have a referral process in place for patients in need of a primary care physician.

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Meeting notes: Medical practice

Issue: Reducing state Medicaid programs as a cost-saving measure might cost states more in the long run if patients who are knocked off Medicaid are forced to receive care from emergency departments.

Proposed action: Direct the AMA to study successful Medicaid patient-centered medical home models, including pregnancy medical home models, and report back. [Adopted]

Issue: Interpreting services for patients with limited English proficiency often cost more than what Medicaid pays for the visit, causing the physician to incur a financial burden.

Proposed action: Direct the AMA to support efforts encouraging hospitals to pay for interpreting services for the follow-up care of patients physicians are required to accept as a result of the patient's emergency department visit. [Adopted]

Issue: A previous report from the AMA Council on Medical Service regarding increased violence directed toward physicians in the hospital environment did not address incidences of violence and threats toward physicians in office settings.

Proposed action: Direct the Association to survey its membership regarding the threats and violence in nonhospital work environments and draft a written report for the 2012 Interim Meeting with suggested solutions. [Adopted]

Issue: Advance care planning is critical to improving end-of-life care. But such discussions do not occur as often as they should because they are not compensated due to an inaccurate caricature of the talks as constituting "death panels."

Proposed action: Encourage the Centers for Medicare & Medicaid Services to designate such voluntary discussions as covered services in the 2012 physician fee schedule. [Adopted]

Issue: Physicians should be protected from retaliation for exercising their independent judgment in medical staff affairs.

Proposed action: Direct the AMA to endorse a clause to be included in physician employment agreements that guarantees physicians independent judgment in all organized medical staff affairs. [Referred]

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