Highlights of the 2000 AMA Interim Meeting
California Resolutions
1. Payment for Autopsies: Reaffirmed existing policy in lieu of a California resolution asking the AMA to seek legislation to require that (1) health insurance providers fund and reimburse for partial and/or complete autopsies as a separate payment category; and (2) Congress and HCFA obtain Medicare funding for partial and/or complete autopsies as a separate payment category rather than as part of the DRG (Diagnosis Related Group) payment. (Res. 105)
2. Medicare+Choice Risk Contracts: Reaffirmed existing policy in lieu of a California resolution asking the AMA to work with HCFA to amend HCFA regulations to allow physicians to negotiate with patients for the rates, which are mutually agreeable to both the physician, and the patient. (Res. 119)
3. Greater Access to Methadone Treatment: Reaffirmed existing policy in lieu of a California resolution asking the AMA to (1) encourage adequate funding for appropriate governmental agencies to establish programs of office-based physician prescription or physician order of methadone maintenance, which would include adequate training and certification of physicians interested in participating in the program, as well as training for the office staff of such physicians, counselors and pharmacists who will interact with methadone patients; and (2) urge the state and federal governments to modify or grant waivers to any state or federal laws and regulations that impede the effective operation of such office-based physician prescription or physician order of methadone maintenance, such as state and federal laws and regulations that would limit physician participation. (Res. 404)
Other Key Actions:
Pharmaceutical Spending in the United States: Adopted amended Council on Medical Service Report 3 which presents a comprehensive study of the problem of increasing pharmaceutical costs that specifically addresses: (1) international differences in prices paid for identical drugs; (2) introduction of new pharmaceuticals that are significantly more expensive than the ones they replace; (3) direct-to-consumer advertising; (4) so-called "lifestyle" drugs such as Viagra and Propecia; (5) the bioavailability, equivalency, and efficacy of generic drugs; (6) impaired access to necessary pharmaceuticals by all patients; and (7) the possible purchase of FDA-approved drugs across national borders by individual U.S. citizens, as well as the wholesale purchase of such drugs by pharmacies from foreign suppliers. (CMS 3)
Recognition of Medicare HMO Patients: Adopted a substitute resolution 121 directing the AMA to ask HCFA to develop a mechanism, such as a toll-free telephone number physicians can call, to assure that when patients leave traditional Medicare for a Medicare HMO, the patient’s treating physicians and other providers can verify any change in that patient’s insurance status.
Education of Physicians About HCFA Documentation Pilot Studies: Adopted substitute resolution 815 which asks the AMA to recommend to physicians that they not participate in any pilot study of HCFA’s 2000 E&M Guidelines that does not grant them immunity from prosecution, or that places them at risk for Medicare post-payment review audits (except in cases where knowing and willful fraud is proven), until and unless they understand and are prepared to assume the potentially serious risk of significant fiscal penalties, sanctions or exclusion from programs, and criminal action against them. The AMA will immediately undertake an aggressive campaign to educate physicians as to the legal risk of participating in pilot studies or HCFA’s 2000 E&M Guidelines that do not grant them immunity from prosecution.
Substitute resolution 815 further asks the AMA to reaffirm, that in cooperation with the Federation, it will continue to work through the CPT Editorial Panel and with HCFA to develop a simplified E&M documentation guideline within the most recent CPT framework that is clinically relevant, realistic, and practical.
Substitute resolution 815 also asked the AMA to continue to advocate with HCFA, for implementation of a plan whereby (1) the carriers may identify "outliers" using methods at their discretion; (2) carriers would review these statistical outliers against their own internal criteria; (3) carriers would refer suspect E&M services to peer reviewers identified by state medical associations with input from state specialty societies; the physicians selected should be board certified, actively practicing and should represent a cross section of practitioners by locale; (4) the carriers would pay for this review; (5) any post-payment review of E&M services would rely on similar peer review before any adverse actions are taken; (6) the initial purpose of the peer review should be educational; and (7) there should be an appeal process at all levels of review.
The AMA also reaffirmed its existing policies: 70.929, 70.933, 330.920, and 330.921, on E&M Guidelines. (Substitute Res. 815)
Report of the Commission on Unity: The AMA House of Delegates established the Commission on Unity in December 1998 and charged it with developing a plan to transform the Federation into a stronger, more effective system for the future. The Commission used a methodology called idealized design to describe a System of Medical Organizations that, although similar to the current Federation, would strengthen and enhance the interaction among member organizations. The Commission on Unity Report requests endorsement of its concept as the foundation for developing a more specific plan for consideration at A-2001. The Commission believes that a more specific plan should be developed with the direct participation of the organizations that would be directly affected by it.
Adopted the following recommendations:
1. The Commission on Unity’s design for strengthening organized medicine shall be a conceptual starting point for transforming the current Federation.
2. The AMA Board of Trustees shall assume leadership responsibility for working with other federation organizations and shall convene the leadership of federation organizations to determine if and how the design of the Commission on Unity can be achieved and to provide a reality test of the design.
3. To assist the Board, a Special Advisory Group shall be appointed by the Chair of the Board of Trustees. It shall include broad representation of the Federation as well as the Chair and at least one other member of the Commission on Unity. The Federation representatives shall be selected from nominees submitted by Federation organizations and the Chair of the Special Advisory Group and shall be selected by the members of the Group.
4. The AMA Board of Trustees shall give the following areas high priority:
a. Determining what organization will become the Core Organization;
b. Developing a process for involving Participating Organizations in the development of the annual advocacy and communications plan;
c. Developing a formalized process for consulting with Participating Organizations on key issues;
d. Describing the structure and functions of a Committee on Organizational Conduct and Cooperation and a dispute resolution process.
e. Describing how the Core Organization’s business relationships with the Participating Organizations should be formalized and expanded; and
f. Identifying the best membership model for the success of the Commission’s design.
5. The AMA Board shall submit a progress report at the 2001 Annual Meeting of the AMA House of Delegates. At the 2001 Interim Meeting, the Board shall provide a report that includes the detailed proposal for a final design, how the design could be achieved, a risk/benefit analysis, and a set of recommendations for consideration by the House.
6. The Board shall determine the likely costs associated with completion of this work and a specific approach for obtaining financial support from participating Federation organizations.
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