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 AMA Meeting June 2006

Report to ASSH Council
AMA Meeting
June 10 - 14, 2006

Submitted by Fred B. Kessler, MD
ASSH Delegate to the AMA House of Delegates

I attended the Specialty Service Society meetings; Texas Delegation meetings; Orthopedic Section Council; Plastic Surgery Section Council And Caucus; and the Surgical Caucus. At each of these, the 68 total reports from the Board Of Trustees and various councils as well as the over 98 resolutions were discussed in order to determine how to vote on them in the House of Delegates.

We also had our second Hand Surgical Caucus meeting. This was attended by all hand surgeons that went to the AMA meeting whether if they are a state or specialty society delegate or alternate. There were nine of us that attended. We discussed the resolutions. There were none that directly applied to hand surgery. I will later list in this report those matters of business that have some meaning for us.

The Washington D.C. successes were not many this year.  The major was to hold off the fee decrease we were expecting. Though we were saved about 2%, it is going to catch up this year. All other matters that were pending are still doing so particularly those affecting liability insurance matters. The AMA is continuing to pursue this issue; however, I think some new track is going to need to be taken. PAY FOR PERFORMANCE was discussed in various aspects in almost all venues.

The AMA is against it but Washington is for it. As a result, the AMA is working to make the various facets as palatable as possible. The Hand Surgical Caucus consensus was that it is hopeful that the ASSH is participating in some fashion in the development of guidelines and means of reporting in the PAY FOR PERFORMANCE activity.

There is a consortium made up of several specialty societies including AAOS as well as a group that the Americal College of Surgeons is guiding, that are working on these matters.

A representative from Aetna presented a brief program on "efficiency." His message was that employers believe the high cost of medical care is due to inefficient function. He indicated that insurance and managed care companies are responding to this concern. He then described a formula to determine "efficiency." Basically, this measures the number of "episodes" (patient encounters) against the cost. It seems to be another method of economically profiling doctors. Of importance is that this is ongoing now and the results will be seen when doctors are "fired" because of their inefficiency.

Another report was presented by Dr. Donald Berwick, a representative of IHI, on the 100,000-patient project. About 3,000 hospitals volunteered to participate in this evaluation whereby they reported all episodes where patients would have died if one of six selected matters were not promptly and properly tended to. These included rapid emergency team response within the hospital; prevention of ventilation pneumonia; IV site infections; and wound infections. We were told that by proper management, 40,000 lives were saved this past year. I expect this will be reported in the general media and the impact could be adverse when these are presented with the concept that there are issues and why was not something done sooner.

I will now review the actions taken by the HOUSE OF DELEGATES that I think will be of interest to you. These are only resolutions that were passed by the HOD, which means that the Board of Trustees will actively work to accomplish the request of the resolutions by lobbying in Washington and dealing with appropriate other organizations, or doing whatever else may be required to accomplish the goal. I am sure you know the passage by the House of Delegates does not bring these issues to fruition.

1. AMA communicate with state motor vehicle departments to propose that they give information regarding advance health directives and provide means for people to note those when getting driver's licenses.

2. Physicians may not withhold medical information from patients though disclosure may be temporarily delayed when appropriate.

3. Physicians should be cautious about participation in tissue donor involved operations when these tissues come from public solicitation and the physician should not compromise on any accepted medical principles involved even though an organ may be available.

4. Restrictive covenants involving medical practice breakups are unethical.

5. To use medicare enrollment process as a means of establishing advanced medical care directives.

6. Inclusion of wives in invitations to manufacturers or drug company dinners is unethical.

7. Support consistent format for determining and reporting healthcare administrative costs so that all will know the non-medical costs of healthcare delivery.

8. Pursue possibility for doctors to participate in medicare on an individual patient basis without penalty.

9. Advocate for telephone rather than current mandatory written appeals to correct minor medicare report, errors, or omissions.

10. Support requirement to purchase a minimum catastrophic as well as preventive health insurance coverage for all earning greater than 500% of the federal poverty level.

11. Make available in the AMA members only Internet the means and penalties of opting out of medicare.

12. Simplify denial or pre-certification process of FDA approved prescription medications by medicare part D prescription drug plans and other insurance companies.

13. To change J-1 visa requirements for continuous service requirement to allow for cumulative time acquirement in order to avoid entrapment in intolerable employment conditions.

14. Because of nurse anesthetist doctoral programs, all healthcare providers should wear a badge indicating whether or not they are an M.D. or D.O. physician.

15. Obtain regulation or legislation precluding a specialist assistant in radiology or other non-physician practitioners from rendering reports on any image from diagnostic imaging techniques.

16. Seek liability protection for those physicians who serve as volunteers such as for disaster relief without pay.

17. Ensure the Patriot Act allows physicians to discuss with patients all aspects of secret searches of medical records.

18. Require criminal background checks on all medical students.

19. Study reentry of physicians after absence from practice considering issues related to retraining, certification, and credentialing.

20. Streamline maintenance of certification with consideration to cost inconvenience and disruption of practice.

21. Work to prevent reduction in medicare graduate medical education payments by the disallowing of reimbursement for the time residents spend in didactic learning.

22. FDA should not permit political considerations to override scientific evidence in making policy decisions.

23. Support development and use of universal contact pads for all defibrillators.

24. Development of standards of formats, data manipulation, and computer downloading of all MRIs.

25. Establish national physician identification card.

26. Discourage physicians from reporting on and making claims on needle electromyograms they did not perform or directly supervise.