AMA Interim Meeting: Disappointing Results?

I have received an e-mail from a valued colleague and friend criticizing several decisions made at the recent AMA Interim meeting in Hawaii. I have offered my attached perspective:

"As an AMA delegate I would like to offer you a different perspective of the issues outlined in your e-mail and the conclusions you have drawn.Please be advised that my comments are NOT necessarily reflecting the consensus opinion of our delegation. I will try to present the issues as accurate as possible but those comments are subject to addendum, correction or deletion by others delegates.

1. Balanced Billing: Two resolution were submitted for discussion (906, 925). Resolution 906 was submitted by our delegation.The Reference Committee made the following recommendation to the HOD,
"RECOMMENDATION A:

Mr. Speaker, your Reference Committee recommends that the first resolve of Resolution 925 be amended by insertion and deletion on page 1, line 24 to read as follows:

RESOLVED, That our American Medical Association devote the necessary political and financial resources to introduce national legislation at the appropriate time to bring about implementation of Medicare balance billing by January 2009 and to end the budget neutral restrictions inherent in to the current Medicare physician payment structure that interferes with patient access to care. (Directive to Take Action)

RECOMMENDATION B:

Mr. Speaker, your Reference Committee recommends that the third resolve in Resolution 925 be deleted.

RECOMMENDATION C:

Mr. Speaker, your Reference Committee recommends that the fifth resolve in Resolution 925 be amended by insertion and deletion on page 2, line 1, to read as follows:

RESOLVED, That our AMA Board of Trustees report back to the our AMA House of Delegates, by e-mail or fax on a quarterly basis, electronically by March 15, 2008, and at other times as appropriate on their its progress toward the completion of all of these goals. (Directive to Take Action)

RECOMMENDATION D:

Mr. Speaker, your Reference Committee recommends that Resolution 925 be adopted as amended in lieu of Resolution 906.

Resolution 906 asks (1) that our American Medical Association devote the necessary political and financial resources to protect patient access to care by advocating for national legislation or litigation to unconditionally implement Medicare balance billing by January 2009 and to unconditionally end the budget neutral restrictions of the current Medicare Physician Payment structure; (2) that this national legislation or litigation be designed to pre-empt state laws that prohibit balance billing and prohibit inappropriate inclusion of balance billing bans in insurance-physician contracts; and (3) that our AMA develop model language for physicians to incorporate into any insurance contracts that attempt to restrict a physician’s right to balance bill any insured patient.

Resolution 925 asks (1) that our American Medical Association devote the necessary political and financial resources to introduce national legislation at the appropriate time to bring about implementation of Medicare balance billing by January 2009 and to end the budget neutral restrictions inherent to the current Medicare physician payment structure that interferes with patient access to care; (2) that this national legislation be designed to pre-empt state laws that prohibit balance billing and prohibit inappropriate inclusion of balance billing bans in insurance-physician contracts; (3) that our AMA work on federal legislation that would prohibit any law or regulation from interfering with the patient-doctor relationship including any and all fiduciary relationships that are deliberate and contractual; (4) that our AMA develop model language for physicians to incorporate into any insurance contracts that attempt to restrict a physician’s right to balance bill any insured patient; and (5) that our AMA Board of Trustees report back to the AMA House of Delegates, by e-mail or fax on a quarterly basis, their progress toward the completion of all of these goals.

Your Reference Committee heard strong testimony in support of Resolutions 906 and 925. Your Reference Committee appreciates and agrees with the sponsor of Resolution 925 that it is more prudent to advocate balance billing legislation at an appropriate time in contrast to a time certain, as this may hamper ongoing advocacy efforts with respect to other issues currently pending before Congress. Further, your Reference Committee believes that the third resolve in Resolution 925 is overly broad and confusing. Since Resolution 925 mirrors Resolution 906, your Reference Committee recommends adoption of Resolution 925, as amended, in lieu of Resolution 906. Comment: This does NOT imply that the AMA opposes balanced billing. At this point in time we MUST focus on THE ISSUE pending resolution: STOP THE MEDICARE CUTS. Even though, legislators may recognize the need to stop the cuts, they have done little to prevent them. Our AMA representatives including Dr. Cecil Wilson are working tiredlessly to convince House representatives and Senators to fix the SGR and to stop the Medicare once and forever. If we add balanced billing as an additional issue we may loose the battle. We all agree that balanced billing is our final goal but we need to prioritize our efforts and focus our advocacy on ONE and the MOST IMPORTANT issue now.
2. Opposing a single payor system: This resolution was introduced by the Georgia delegation and adopted as amended or substituted by the Reference Committee.

(1) Resolution 717 - Single Payer



RECOMMENDATION A:



Mr. Speaker, your Reference Committee recommends that the second resolve of Resolution 717 be amended by insertion and deletion on lines 24 -27 to read as follows:



RESOLVED, That our AMA distribute our policy positions in opposition to a single payer system on health system reform to all declared candidates for the presidency of the United States of America and formally request their public support of AMA policy positions on single payer system those positions (Directive to Take Action); and be it further



RECOMMENDATION B:



Mr. Speaker, your Reference Committee recommends that the third resolve of Resolution 717 be amended by insertion and deletion on lines 29 – 32 to read as follows.



RESOLVED, That our AMA immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the United States on health system reform, emphasizing pluralism. (Directive to Take Action)



RECOMMENDATION C:



Mr. Speaker, your Reference Committee recommends that Resolution 717 be adopted as amended.



Resolution 717 asks that our AMA (1) reaffirm AMA policy in support of pluralism, freedom of enterprise and its strong opposition to a single payer system; (2) distribute our policy positions in opposition to a single payer system to all declared candidates for the presidency of the United States of America and formally request their public support of AMA policy positions on single payer system; and (3) immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the US.



There was strong testimony in support of the sentiment expressed in the resolution, particularly the reaffirmation of policies referred to in the first resolve. However, compelling testimony cautioned against a negative campaign. Rather than criticizing the single payer approach, it was strongly suggested that the AMA should focus on clearly articulating AMA policies for health system reform to physicians and the public. There was some support for addressing AMA opposition to a single payer approach within the context of the Voice for the Uninsured Campaign.



Your Reference Committee concurs with testimony to keep the first resolve intact, and with testimony stating that any campaign should focus on a positive message promoting the AMA proposal for health system reform. There was testimony advocating linking the positive media campaign to the Voice for the Uninsured Campaign. Your Reference Committee believes that our AMA should have flexibility in implementing the two campaigns.
Comments: During the house debate the resolution was extracted from the consent calendar. Our delegation submitted additional language to be inserted after the following RESOLVED, That our AMA immediately undertake a media campaign designed to educate the American people about AMA policy in opposition to a single payer system and the negative impact such a system will have on the profession of medicine and the delivery of health care by physicians in the United States on health system reform, emphasizing pluralism, creation of a marketdriven system, and continued opposition to a single payor system.(Directive to Take Action). This language was not adopted. I personally do not support a single payor system as THE only modality to reform the US healthcare system. A comprehensive system reform requires the participation of all participants in the healthcare delivery process - government (county, state, federal), insurance companies, employers etc.- . Our AMA is offering a plan to expand health insurance and we should support a PR campaign emphasizing this POSITIVE` message. We should clearly express what we stand FOR and not only what we are AGAINST. This resolution does not imply that the AMA favors a single payor system but in favor of market based approaches utilizing the brain power of potential innovative thinkers to reform our fragmented healthcare system.
3. Presidential Candidates:

(1) Resolution 603 - Presidential Candidates' Views on Health System Reform



RECOMMENDATION:



Mr. Speaker, your Reference Committee recommends that Resolution 603 be referred for decision.



Resolution 603 calls upon our American Medical Association (AMA) to host a US presidential candidate forum of all the candidates at the 2008 Annual Meeting.



Your Reference Committee received testimony that was uniformly positive of the resolution’s goal—making the views of presidential candidates on health reform available to physicians. There was some concern, however, about the method proposed by the resolution—using the next House meeting as the specific vehicle. Additional points raised included a potentially low fiscal note associated with this resolution, the questionable value of such a forum to presidential candidates because of a fairly small audience, the practicalities (audience questions, logistics, security concerns, etc.), and alternatives such as using our AMA web site as a way to share information with all member physicians, not just those in the House.



Your Reference Committee supports referral for decision to allow the Board to investigate the legal issues associated with an organization such as our AMA hosting a presidential candidate forum. There also would be major logistical concerns associated with using the House as a venue for a town hall meeting in June 2008. Referral will give the Board opportunity to study the feasibility of organizing the event as proposed, as well as to identify other ways to make physicians more informed voters and supporters of presidential candidates who espouse their preferred health care system. Referral for decision also will allow the Board to start planning the event, if feasible.

Comment: The recommended referral for decision was debated ad our delegation disagreed with that proposal. Nevertheless, that does NOT mean that our AMA will NOT support such a Forum but is seeking for an appropriate venue and suitable modality to maximize the desired effect of a such a forum. I trust the AMA Board to reach a decision on that matter.

I hope that the above information may help you to reach a balanced conclusion of the actions taken. Our AMA is the ONLY and MOST effective national physicians organization to represent our interest. Dissent and disagreement is inevitable but we all strive towards a compromise based on a common denominator: to represent the interests of the majority of all physicians. Your input is crucial and valuable and please continue sending me your e-mails. I am sure that other members of our delegation will provide you with their perspectives.
Please stay involved and do not drop your membership. Otherwise your voice cannot be heard!"