Thursday, June 28, 2007

AMA 2007 Annual Meeting Update

Dear Friends and Colleagues;
Attached an AMA endorsed summary of important decisions made at the AMA Annual meeting.
For more information see .
AMA Delegate

* Amendments to Constitution & Bylaws

* The AMA adopted new policy to protect patients’ ability to get legally valid prescriptions filled, or to be referred to an appropriate
alternative, without interference from pharmacists’ objection`to certain medications. This new policy resolves that the
AMA work with state medical societies to advocate for state legislation that will allow physicians to dispense medicine to
their patients when there is no pharmacist able and willing to dispense that medication within a 30-mile radius.
* The AMA adopted policy from CEJA that calls on all physicians to reduce disparities in care in their practices by taking into account language barriers, culture and ethnic characteristics and biased behavior.
* The AMA adopted CEJA policy that makes a physician who gives a diagnostic imaging test to a patient—without referral from another physician—responsible for relevant clinical evaluation, as well as pre- and post-test counseling concerning the test. Post-test counseling, however, may be referred as long as the other physician accepts the referral.
* The AMA reaffirmed policy condemning physicians’ participation in torture and other cruel, inhuman or degrading treatment or punishment of prisoners or detainees. Additionally, the AMA now encourages medical schools to include ethics training on this issue.

* Reference Committee A

* The AMA adopted several recommendations regarding state options to improve coverage for the poor. It urged specialty societies and state and county agencies to support state demonstration projects to expand health insurance to low-income patients. It also would encourage state governments to maintain an inventory of private health plans and design an information clearinghouse for individuals, families and small businesses.
* The AMA voted to research and publicize existing studies on how health care money is spent. The intent is to identify the amount of public and private health care spending that is transferred to insurance administration compared to industry standards.
* After a lengthy and impassioned debate between delegates, the AMA resolved to prepare legislation that will allow physicians to balance bill all payers—including Medicare patients—and seek sponsors for the measure in Congress. The AMA also will support federal legislation allowing physicians and hospitals to cancel or reduce co payments for hardship cases without a change in fee schedules.

* Reference Committee B

* The AMA adopted as official policy principles and guidelines on pay for performance (PfP). It also adopted enhancements to these principles and guidelines, which include, among other items, that the AMA would reject any PfP program put forth by a private or public payer that is not consistent with those guidelines.
* Delegates reaffirmed that a high priority be placed on securing a repeal to the current sustainable growth rate formula, replacing it with a more predictable system that recognizes the true costs of providing physician services.
* The AMA reaffirmed that it will advocate that section 215 of the U.S.A. Patriot Act—which demands that physicians disclose patients’ medical information to law enforcement agencies without telling patients—be replaced or modified if reauthorized by Congress.
* Delegates have referred to the Board of Trustees a resolution that asks the AMA to advocate for state and federal legislation that requires an advance directive at the time of enrollment in a health insurance plan or at the time of application for a driver’s license.

* Reference Committee C

* There is now a shortage of physicians (at least in some regions and specialties) and evidence exists for additional shortages in the future. The AMA will work with members of the Federation and national and regional policy makers to address the current and predicted physician shortages.
* Delegates adopted policy to ensure adequate funding for medical schools, graduate medical education programs and teaching institutions where medical education occurs, including creating mechanisms to fund additional medical school positions. The AMA will seek federal legislation requiring all health insurers to support graduate medical education through an all-payer trust fund created for this purpose.
* The AMA will support national efforts to improve the health services to underserved minority communities and encourage recruitment of qualified underrepresented minorities to the profession of medicine.
* The AMA will partner with all relevant stakeholders to petition Congress to reinstate funding for Title VII and to inform legislators in Congress about how Title VII-supported programs address health professional shortages, increase the diversity of the workforce, equip health professions students to work in health centers and underserved communities and ensure that health professionals are ready to address health-related emerging issues.

* Reference Committee D

* The AMA adopted new policy to reduce health disparities suffered because of unequal treatment of minor children and adults in gay, lesbian, bisexual and transgender families.
* Delegates also adopted policy to promote consumption and availability of nutritious beverages as a healthy alternative to carbonated sodas and sugar-added juices in public schools.
* Delegates referred to the Board of Trustees a recommendation to study the utilization of new and old Medicare preventive service benefits, including the Tobacco Cessation Benefit. The goal is to provide proper quality preventive services to Medicare patients.
* Delegates adopted a revised policy to encourage periodic pediatric eye screenings based on AAP, AAFP and AAO evidence based guidelines, with referral to an ophthalmologist for a comprehensive, professional evaluation as appropriate.

* Reference Committee E

* A Council of Scientific Affairs Report deals with the safety and efficacy of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents. This report was adopted, with the caveat that while the AMA supports the Food and Drug Administration’s (FDA) black box on SSRIs, it wants the FDA to monitor the impact of the black box, to ensure it does no affect appropriate access to patient care.
* Direct-to-consumer advertising was another important area of debate. The AMA will evaluate strategies to minimize the potential negative impact of direct-to-consumer marketing.
* There were several dietary supplement resolutions handled by the reference committee. In general, our AMA’s goal has been to change the existing Dietary Supplement Health Education Act (DSHEA) to make the regulation of dietary supplements comparable to the drug model and the AMA continues to make significant effort to address the DSHEA inadequacies.
* Delegates adopted policy that addresses the need to clean up the Internet regarding the illegal sales of prescription drugs,such as utilizing actions with credit card companies.

* Reference Committee F

* The AMA has recommended investigating the feasibility of developing and marketing a health insurance plan tailored for medical students. The AMA will work with the AMA Insurance Agency and issue a report at the 2005 Interim Meeting.
* Due to proposed congressional action, the AMA will work with specialty organizations to express concern to the NIH and others, to oppose mandatory submission of manuscripts, and to address the issue of direct linking from PubMed Central to not-for-profit journals.
* The AMA adopted the recommendation to work with state medical societies and their legislatures to ensure that the title “physician” is used only by those who have completed a qualified medical school and have received an MD or DO degree.
* The AMA will encourage the media strongly to require that an`actual degree be affixed to the name of all individuals who`endorse health-related products.

* Reference Committee G
* Delegates adopted policy that supports the principle that when`physicians receive financial assistance from inpatient facilities to`obtain health information technology or “HIT” systems, their`choice of which system to purchase should not be unreasonably`constrained, nor should they, the physicians, be required to`share confidential patient information with the facility.
* With the aim of ensuring that “cost-based medicine” is`not allowed to masquerade as “evidence-based medicine,” the`AMA adopted new policy that asks the AMA to work with`state and specialty societies and other organizations`to educate the Centers for Medicare & Medicaid Services,`state legislatures and state Medicaid agencies about the appropriate use of evidence-based medicine, in addition to the dangers of making policies based on cost-based medicine inappropriately characterized as evidence-based.
* The AMA will encourage JCAHO to require that certain issues related to medical staff governance be delineated in medical staff bylaws, rather than in separate administrative documents. Among the issues the AMA will recommend for inclusion are application, reapplication, credentialing and privileging standards; fair hearing and appeal processes; and the structure of the medical staff organization.
* The AMA agreed to study both the responsibilities of the physician who allows a manufacturer’s representative to observe and provide technical support in patient treatment, as well as the manufacturer’s representative’s duties to the patient and physician.

Bernd Wollschlaeger,MD,FAAFP

Wednesday, June 13, 2007

HSAs In The News

Dear Friends and Colleagues:
Attached an interesting article from todays Wall Street Journal reviewing the obstacles regarding the implementation of Health Savings Accounts.
These are the facts:

* Only about 8-10 Million Americans are enrolled in Health Savings Accounts and that number increased among US workers only slightly, to 2.7 million in 2006 from 2.4 million in 2005.
* Few employers are focusing on the costly measures -- such as offering better coverage or more consumer education, and instead shifting healthcare costs to the employees.
* Where employees do have a choice, only 19% choose the newfangled plans, the Kaiser study estimates. In the Federal Employees Health Benefits Program, which has offered the plans for several years, only about 50,000 of its eight million members were enrolled in them in 2006. Guess, our elected officials prefer to use traditional plans ,whereas us common folk should swallow the bait.
* Employers are often HSAs as the cheapest and only insurance alternative forcing employees to use them, even though those plans are not suitable for them.40% of employees in a consumer-directed plan say it was the only choice available from their employer!!!

HSAs may be ONE solution among the many insurance options available for US consumers, but should not marketed as THE solution.
Personally, I would like our government to spend as much energy and money promoting existing and traditional solutions as they do with HSAs.
If cost shifting is the goal, then the common folk will loose.

Health Savings Plans Start to Falter
Despite Employer Enthusiasm for Consumer-Directed Approach, Patients Express Dissatisfaction With How the Accounts Work
Wall Street Journal June 12, 2007; Page D1

President Bush and many big employers have hailed "consumer-directed" health plans and savings accounts as an effective weapon in the battle against runaway medical costs. But several years after the plans got off to a fast start, the approach appears to be stumbling -- largely because of consumers' unease in using them.

Eight million to 10 million Americans are enrolled in consumer-directed plans, which involve a high-deductible insurance policy that can be combined with a savings account to help pay for out-of-pocket health costs. The plans, which have lower premiums but shift more of the responsibility for health-care spending onto consumers, got a big boost in late 2003 after Congress created portable health-savings accounts that participants can use to sock away pretax dollars and let them grow tax-free. Employers often put money in the accounts to subsidize the higher deductibles.

[Speed Bump]
Enrollment in consumer-driven health plans
• Number of U.S. workers (excluding dependents) enrolled in such plans through work was 2.7 million in 2006, vs. 2.4 million in 2005.

• 40% of employees in a consumer-directed plan say it was the only choice available from their employer.

• Where employees have a choice of health-plan options, only 19% choose consumer-driven plans.

Source: The Kaiser Family Foundation

The plans are accomplishing some of what they intended: A raft of data show that people enrolled in the plans do tend to spend less on care than others. That is encouraging more employers to introduce such plans to their workers over the next two years.

But low enrollment and low satisfaction among workers who are offered them raise the question of whether consumer-directed plans will stall before they ever hit the mainstream. Few employers are focusing on the costly measures -- such as offering better coverage or more consumer education -- that may be needed to accelerate these plans.

The numbers of U.S. workers enrolled in such plans through their jobs (excluding dependents and those in firms with fewer than three workers) grew only slightly, to 2.7 million in 2006 from 2.4 million in 2005, according to the Kaiser Family Foundation. Most do it because either their companies give them no choice or the premiums are the cheapest. Enrollment is growing faster on the individual market and among sole proprietors, but that may be because the plans are often the only affordable option.

Where employees do have a choice, only 19% choose the newfangled plans, the Kaiser study estimates. In the Federal Employees Health Benefits Program, which has offered the plans for several years, only about 50,000 of its eight million members were enrolled in them in 2006, according to industry estimates. At lightbulb-maker Osram Sylvania, just 5% of employees enrolled in the plans in 2006, their first year.

In addition, those who are in consumer-directed health plans often report lower satisfaction and confusion about how the plans are supposed to work. The general idea is for patients to conserve money in their savings accounts, which are meant to pay for care until they reach their high insurance deductible. In theory, patients who shop carefully could have money left over, which they can keep and let build into savings for bigger health-care costs down the line.
[Consumer-Directed Plans]

In a survey published last month by Towers Perrin, an employee-benefits firm, employees enrolled in them said they felt less capable of finding a quality doctor or hospital, though they often were in the same network as colleagues in other plans. Only 29% said they tried to save money in their accounts for future medical expenses.

Though the consulting firm says consumer-directed plans have much potential, its executives were surprised consumer responses were so negative.

"If I were a product manager in any other industry and saw scores this low in customer satisfaction and understanding, I'd be thinking of pulling that product from the shelves or retooling it," says David Guilmette, managing director of Towers Perrin's health-care consulting practice.

One reason for the frustration is the uphill battle many consumers describe in trying to shop for their health care. Six years ago, Howard Katz, an industrial-design research consultant in rural eastern Pennsylvania, bought a family health plan with a savings account and a deductible that is now $5,650. But getting specific price information on which to base purchase decisions for MRIs, doctor visits and blood work has been difficult, he says.

And the money in the health savings account gets spent; only once has enough remained to roll over to the next year.

Now, he says, he has rejoined a company as an employee after working on his own, and one of the perks is regaining traditional health coverage. "Now I don't have to act like a medical examiner anymore," he says.

Proponents of consumer-directed plans point out that their overall enrollment continues to grow at a faster clip than enrollment in HMOs did when they were introduced in the 1970s. Among those who enroll, the vast majority stay in and don't switch back to another type of plan.

In cases where employers spend months informing workers about how the plans work and offer them more financial incentives than just cheaper premiums, workers report higher satisfaction and often get more preventive care than people in other plans. "But the vast majority of companies still do not have the time, effort or resources to prime the pump," says Larry Boress, president of the Midwest Business Group on Health, a coalition of large employers.

A growing number of industry experts believe that for consumer-directed plans to succeed, they have to offer coverage that is at least as rich as traditional plans. That means providing upfront coverage of most preventive services and treatments and a generous contribution to employees' accounts.

"If you're just trying to cost shift, and you only get 10% of your employees in, they are the youngest and healthiest, and you haven't accomplished anything in terms of health-care costs," says Bill Sharon, a senior vice president at Aon Consulting, the human-resources consulting arm of insurance broker Aon Corp.

Osram Sylvania introduced a consumer-directed health plan with a health savings account with premiums 15% to 20% cheaper than its traditional plans, but employees were responsible for the entire deductible. Just 5% of employees enrolled. In preparation for 2007, it introduced another similar plan alongside it, but with 100% preventive-care coverage and a $600 contribution into the health reimbursement account, and older generation of the health savings account.

"We'd heard concerns from employees that they weren't going to get the right care," says Julie Thibodeau, co-director of human resources at Osram Sylvania. This year enrollment between the two consumer-directed plans rose to 15%.

Aon has offered its own employees two consumer-directed options since 2002, with deductibles between $2,500 and $6,250. Nearly 20% of employees are enrolled in one, and the majority of them have money left to roll over from the $500 to $2,500 that Aon contributes to their account each year. Employee premiums are about 30% lower than in the more-traditional plans Aon offers, says John Reschke, Aon Corp.'s vice president of benefits. Considering that the coverage is at least as rich for most employees as in the traditional plans, "we should have a lot more people enrolled," he says. "But this is a different kind of insurance, and it can be scary at first until people understand."

Write to Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com1