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 AMA Interim Meeting November 2012

ASSH-AAHS Delegates’ AMA REPORT
2012 AMA Interim Meeting
November 10-13, 2012
 
The highlights of the meeting:
 
  • ASSH went from 18% AMA membership to 26% over the past year, and was granted 5 more years in the AMA House of Delegates.  Because this membership drive was highly successful, and because it was taken on very visibly by AMA Speaker (and hand surgeon) Andrew Gurman, your caucus discussed the possibility that this may help Dr. Gurman were he to pursue the AMA Presidency, when he finishes his term as Speaker (this is a common pathway, but recall that, unlike ASSH and AAHS, all AMA elections are contested, and candidates are not vetted by a nominating committee, so the outcome is never certain until the elections are held.  Most elections have many candidates, and runoffs are common.)
  • There is a move to change the schedule of the AMA meetings, in order to reduce the number and expense.  One proposal is to move the annual meeting to the fall, and eliminate the fall meeting altogether, possibly at the same time broadening the scope of the spring advocacy meeting in Washington.  This topic has been discussed many times. It is not clear if the current proposal will advance, but even if it does, due to current hotel contracts and the coordination of AMA and state society meetings, it will likely take several years for any change to occur.  Your Hand Caucus was generally in favor of such a change, because of the savings in time and money it would entail.
  • The AMA continued to discuss the idea of billing using ICD-9, and not moving to ICD-10, perhaps waiting 5-10 years and then migrating to ICD-11.
  • An issue spine surgeons had with a new CPT code, supported by industry but opposed by surgeons was discussed again. Many delegates wanted the AMA to direct CPT to change its policies regarding accepting codes when these are not supported by clinicians, but this would pose major legal and conflict of interest problems, since AMA owns CPT. In order for CPT to be accepted by payers (and especially the government) it must be clear that AMA has no influence on, and does not even attempt to influence, CPT processes, policies, or decisions. Thus, once again the topic was discussed, but no action was taken
  • For the first time in many years, AMA full dues paying members actually increased. The final numbers are not in, but the increase will likely be around 3%. This is in combination with a larger increase in total members in both 2011 and 2012, the difference being in the number of students and residents, who pay only nominal dues.
  • Despite the rise in membership, the AMA once again changed the criteria for membership of specialty societies, maintaining the requirement for a minimum of 100 AMA members, but lowering the required percentage of AMA members from 25% to 20%. This will make it easier for specialty societies to retain membership in the HOD.
  • AMA was successful in its effort to push back implementation of ICD-10, and passed a new resolution at I-11, as a result of which AMA will advocate that ICD-10 should be dropped altogether in favor of ICD-11
  • Physicians attending an open forum Sunday heard about recent antitrust cases in which the Litigation Center of the AMA and State Medical Societies is standing up for physicians and patients.  In particular, attendees were briefed on the court case North Carolina State Board of Dental Examiners v. FTC, in which the FTC has tread on the authority of state regulatory boards to oversee professional licensure, patient safety and the practice of medicine.  The AMA filed a friend-of-the-court brief in favor of the licensure board. A second case, FTC v. Phoebe Putney Health System, will be considered by the Supreme Court of the United States.  The Litigation Center filed a friend-of-the-court brief in favor of neither party, instead cautioning the court that hospital competition is important for physicians and patients and underscoring the necessity of letting state medical boards carry out their responsibilities.
  • The American Medical Association adopted a set of principles for physician employment, five of which address conflicts of interest.  The policy seeks to help doctors manage the “divided loyalty” they may face as employed physicians. (ama-assn.org/resources/doc/hod/ama-principles-for-physician-employment.pdf)
    1. A doctor’s paramount responsibility is to his or her patients.  Additionally, given that an employed physician occupies a position of significant trust, he or she owes a duty of loyalty to his or her employer.  This divided loyalty can create conflicts of interest (such as financial incentives to over- or undertreat patients) that employed physicians should strive to recognize and address.
    2. Employed physicians should be free to exercise their personal and professional judgment in voting, speaking and advocating on any matter regarding patient care interests, the profession, health care in the community and the independent exercise of medical judgment.  Employed doctors should not be deemed in breach of their employment agreements, nor be retaliated against by their employers, for asserting these interests.
    3. In any situation where the economic or other interests of the employer are in conflict with patient welfare, patient welfare must take priority.
    4. Doctors should always make treatment and referral decisions based on the best interests of their patients.  Employers and the physicians they employ must ensure that agreements or understandings (explicit or implicit) restricting, discouraging or encouraging particular treatment or referral options are disclosed to patients.
    5. Assuming a position such as medical director that may remove a doctor from direct patient-physician relationships does not override professional ethical obligations.  Physicians who hold administrative leadership positions should use whatever administrative and governance mechanisms exist within the organization to foster policies that enhance the quality of patient care and the patient care experience.
  • AMA Council on Medical Services developed recommendations regarding a voluntary defined contribution option within Medicare, which was adopted by the HOD.
  • AMA Delegates voted to support expansion of Medicaid coverage to all those with income less than 133% of the poverty level.  This will reduce the number of uninsured, and improve access to medical services for a highly vulnerable subset of our population.
  • AAHS Delegate Peter Amadio, MD is the past Chair of the Specialty and Service Societies, and the current Chair of the new Integrated Physician Practice Section.  Hand surgeon Andrew Gurman, MD remains Speaker of the HOD.
  • Dr. Lichtman was appointed to a three year term on the Committee for Compensation of AMA Officers.   He will serve as chairman in his final year.
  • Members of the Hand Caucus continue to serve on various reference committees thereby exerting an influence on HOD business
  • As always, AMA appoints members of, and is therefore a great opportunity to position hand surgeons on, key bodies such as Joint Commission, RUC, CPT panel, specialty Boards and Residency Review Committees.  As these opportunities arise, your delegations will circulate the notices.

Your AMA representatives continue to believe that the AMA provides an important and irreplaceable service to the medical profession in general and hand surgeons in particular. 
Even if you disagree with AMA policy, participation is the only way to effect change.  And AMA remains the only medical organization whose policy is formed by input from other organizations (indeed, as much as possible, from the input of ALL physician organizations), even while there is no reciprocal obligation or expectation that organizations providing input to AMA should in any way be bound by AMA policy (though it would be nice if doctors could, like hospitals, insurance companies and the drug/device industry, speak with one voice).  Hand surgeons currently play a major leadership role within AMA.  But the ability of the AMA to work for physicians, and to represent physicians effectively, is determined in a large part by the percentage of American physicians who belong to the AMA.
 
Your AMA representatives encourage all physicians to do their fair share and support the AMA as members, and to participate in the debate to define and create the future of American medicine.  Remember, all American physicians benefit from the activities of the AMA, whether they are members or not.  It is not fair for the burden of all this activity to be borne by the few, for the benefit of the many.  We look forward to continuing to serve you in the AMA House of Delegates in the coming year.
 
Respectfully submitted,
Peter C. Amadio, MD and Nicholas Vedder, MD; AAHS delegate and alternate
David M. Lichtman, MD and Stewart Haskin, MD; ASSH delegate and alternate