Meeting focuses on future AMA leadership role.

Meeting Focuses on Future AMA Leadership Role

With a newly appointed executive vice president in place--James S. Todd, MD, previously Senior Deputy Executive Vice President of the organization--the atmosphere in Orlando, Fla., was relatively placid, especially compared to the fury surrounding the June 1990 Annual Meeting of the AMA House of Delegates in Chicago, Ill., which followed the premature resignation of James Sammons, longtime AMA Executive Vice President. Much of the time and energy in Orlando was spent trying to focus and position the AMA to lead American medicine through the 1990s and into the 21st Century. Our report highlights actions taken at the Interim Meeting that may be of special importance to physician executives and to the College.

HCFA Initiatives

A resolution was offered to have the AMA "seek the cooperation of the national medical societies and use all available means to postpone implementation of the Medicare Fee Schedule to a date that will allow for an orderly review and comment on the final proposed fee schedule by the public." The House passed a substitute resolution that merely called for an AMA-directed review and comment by the federation. The House also adopted a resolution that repeated the organization's support of the basics of the Harvard RBRVS study, especially its provisions regarding practice cost index values. Finally, the AMA signaled its intention to continue to oppose implementation of the Medicare Volume Performance Standards as expenditure targets or caps in legislation or regulations. The AMA is also charged by the House with ensuring that malpractice costs are included in the relative value units in a fair and equitable fashion. In a related move, the AMA agreed to continue to seek congressional elimination of state attempts to interfere with balance billing under Medicare. The AMA is also committed to obtaining 100 percent reimbursement for new physicians under the Medicare program. The AMA House stated its commitment in terms of "equal Medicare reimbursement for all physicians."

The AMA's efforts to have Richard Kusserow removed as Inspector General of the Department of Health and Human Services will be pressed even more vigorously. The AMA House of Delegates reaffirmed its opposition to Kusserow, asking in a resolution that "the American Medical Association vigorously continue its actions to seek the immediate resignation or dismissal of Richard Kusserow as Inspector General of the Department of Health and Human Services, and that state medical societies, national medical specialty organizations, the auxiliary organizations, and individual physicians be encouraged to write President George Bush, Dr. Louis Sullivan, and members of Congress in an effort to effect Mr. Kusserow's ouster."

Delegates were especially perturbed by current provisions for a fair hearing under Medicare. After considerable debate, the House resolved that "the American Medical Association urge the Health Care Financing Administration to encourage Medicare carriers to utilize as Hearing Officers licensed physicians of the same specialty and in the same geographical area as that of the physician who requests the fair hearing." The House also stipulated that the educational and medical credentials of the hearing officer be made known to the requesting physician.

Preadmission Review

A resolution calling on the AMA to petition the Health Care Financing Administration for repeal of regulations that require preadmission/preprocedure review was amended to oppose blanket preadmission review of "all or the majority of hospital admissions." The AMA's position is that such requirements do not improve the quality of care and should not be mandated by any payers. The AMA reaffirmed its belief that reviews, where appropriate, should be conducted at the state or local level and should be performed or supervised by physicians. The House also reaffirmed its belief that no prior authorization for admission to a hospital should be required where a physician has designated the admission as emergency in nature.

PROs

Two resolutions, a substitute resolution, and a report were offered on the subject of notification under the PRO law. The House adopted an amended version of the report in lieu of the three resolutions after considerable debate. The final product contained most of the elements of the resolutions. The AMA urges HCFA to modify regulations so that the PRO is required to notify both the physician and the president of the medical staff in the case of confirmed quality problems and that the PRO be required to implement a mechanism to confirm receipt of notification for both potential and confirmed problems by the physician. The AMA will seek an amendment to the law to require notification of the physician within 48 hours for a review when it goes beyond the generic screen. The AMA will also seek amendment of the law to repeal the prohibition on the release of documents or other PRO-produced information to a physicians proposed for sanction.

Practice Parameters

A report from the AMA Board of Trustees on professional liability was adopted after it was amended to have the AMA encourage federal and state governments to "forestall enactment of new legislation that would grant statutory recognition to the use of practice parameters in medical liability actions." The House adopted a Board of Trustees report that called for further research to "evaluate the use of practice parameters in quality assurance programs, utilization review systems, coverage policies, and liability reform." That report reiterated the need for caution with the use of practice parameters in liability actions.

Hospital Medical Staff

Considerable debate took place over the relative rights and responsibilities of hospital medical staffs and governing boards. The House adopted an amended report from the Board of Trustees that said, "Prior to committing its medical staff to obligations to provide medical services, a hospital governing board must discuss with and obtain the expressed and documented consent of the medical staff." The House also instructed its commissioners to the Joint Commission on Accreditation of Health Care Organizations to oppose the accreditation of any hospital that allows unilateral amendment of hospital bylaws by either the medical staff or the governing body.

The House also addressed the issue of compensation for medical staff work by physicians. The House adopted a report that called for medical staff involvement in the nomination and election of compensated medical staff leaders. It also said that the medical staff should be involved in the credentialing of outside physicians used by the hospital for medical staff purposes. Finally, the House said that the medical staff should be involved in funding decisions for medical staff activities.

National Practitioner Data Bank 

The AMA will "vigorously pursue" a $30,000 floor on the malpractice reporting requirement of the Data Bank. It will also work to ensure that data not related to a physician's competence or professional conduct are neither collected nor disseminated, that the dispute process be changed to accelerate a physician's opportunity to attach an explanation or statement to a disputed report, that a mechanism for alerting a physician that an inquiry about him or her is received by the Data Bank, that reports other than license revocation be purged from the Data Bank after five years, and that reporting requirements for the Data Bank be the same for physicians, dentists, and other health care professionals.

Mark A. Doyne, MD, FACPE, and James E. Hartfield, MD, FACPE, are the College's Alternate Delegate and Delegate, respectively, to the AMA House of Delegates. Dr. Doyne is Director of the Health Care Management Group of Ernst and Young, Nashville, Tenn. Dr. Hartfield is Associate Vice President, Clinical Affairs, University of South Florida Health Sciences Center, Tampa, Florida.