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Pre-Meeting Information

for Meeting Attendees

AMA Meeting Highlights
Thursday, June 24, 1999

It’s here — House OKs negotiating organization Next step: giving form and substance to the concept Thank you, delegates ‘Is it good medicine?’ Reference committee highlights The financial picture is strong Use the Web site! House elections... Membership Caucus AMA Foundation Cultural Competence Residents poster contest Your new president Section Highlights

It’s here — House OKs negotiating organization
Next step: giving form and substance to the concept">

After a comprehensive House examination of the issue and a passionate floor debate, the physicians of the AMA voted on Wednesday, June 23 to develop an affiliated national negotiating organization to represent employed physicians and where allowed, residents. “This will help physicians advocate more effectively on behalf of their patients,” said AMA President-elect Randolph D. Smoak Jr., MD, following the vote. “But this will not be a traditional labor union. Doctors will not strike or endanger patient care. We will follow the principles of medical ethics every step of the way.” More extensive information about this decision is available.

Thank you, delegates

Many thanks for your participation in this meeting of the AMA House of Delegates. During the last few days, we have addressed a full agenda and made significant progress on several important issues. Your work Wednesday regarding the proposed national negotiating organization is to be commended.

Included in this Meeting Highlights newsletter is a summary of House proceedings from the past few days. Please take it with you and use it as a guide to inform your constituents about actions the AMA is taking on their behalf. As always, we value the important contributions you make to this House and we look forward to your active participation at the AMA’s Interim Meeting in San Diego this December.

Speaker of the House
Richard F. Corlin, MD

‘Is it good medicine?’

Delegates are giving high marks to the video that introduced the “Is it good medicine?” initiative during Sunday’s opening session. At Speaker Corlin’s request, copies of the video will be made available by mail to members of the House following the meeting. We encourage you to use the video with your constituents to help us focus the U.S. health care debate.

Reference committee highlights

Constitution and Bylaws
Sale of health-related products from physicians’ offices. Adopted CEJA Report 1 that offers ethical guidelines for physicians who sell non-prescription, health-related products from their office.

Cloning. Adopted CEJA Report 2 setting forth recommendations on the ethics of human cloning. The Council said physicians should not participate in human cloning, but noted the need for more discussion on the harms and benefits of cloning.

Committee A
Health insurance reform. Adopted BOT 10, CMS 5 and CMS 2, reinforcing strong support for AMA’s health insurance reform proposal for individual insurance. CMS 2 documents the AMA’s recent efforts to expand coverage for the uninsured.

Medicare pharmaceutical debate. Adopted BOT Report 19, calling for the AMA to advocate that Medicare coverage of pharmaceuticals should be addressed in the broader context of transforming Medicare into a fiscally solvent program. The report recommends that the Medicare program needs to be reformed before any additional benefits are added.

Committee B
Fraud and abuse. Adopted Resolution 202, agreeing that the “bounty” provisions of the Health Insurance Portability and Accountability Act of 1996 should be repealed, and that HCFA should be forced to sharply distinguish true alleged fraud from other matters that might be deemed wasteful or in error.

DVA non-physician prescribing authority. Acknowledged the hard work of the AMA, in cooperation with state medical societies and national medical specialty societies, in forcing the Department of Veteran Affairs to retract the proposed rule that would have permitted non-physician health care professionals to prescribe medications.

Disruptive visits to medical offices by government investigators and agents. Adopted Resolution 211, encouraging the AMA to support legislation or other appropriate means to prohibit unannounced visits to physician offices by government investigators and agents.

Committee C
State authority and flexibility in medical licensure for telemedicine. Adopted CME Report 7, which recommends amending AMA policy to call for medical licensing boards to require a full unrestricted license to practice telemedicine in that state.

Clinical skills assessment. Adopted CME Report 5, which recommends a series of actions to assess the value of existing clinical skills assessment examinations, with support for a national examination to test clinical skills.

Hospitalists and medical education. Adopted CME Report 2, which recommends that the AMA collect data on the emergence of educational opportunities for hospitalist physicians at the residency level.

Committee D
Cigar smoking. Adopted Resolution 433, which extends the AMA’s considerable anti-tobacco policy to cover cigars.

Action on states’ allocation of tobacco settlement monies. Adopted Resolution 428, which seeks the emphatic reaffirmation of AMA support for tobacco control. Encourages lobbying activities and initiatives with state and specialty societies, and requests a report to be given at I-99.

Immunization registries. Adopted Resolution 415, which encourages physicians to participate in the development and use of immunization registries for their communities.

Committee E
Drug initiation or modification by pharmacists. Adopted Resolution 509, which recommends the AMA oppose pharmacists being given the authority to initiate or modify drug treatment except on a case by case basis at the specific direction of a physician.

Prescription of schedule II medications. Adopted BOT Report 8, which asks that the AMA encourage the DEA to accommodate encrypted electronic prescriptions for Schedule II controlled substances, as long as sufficient security measures are in place to ensure the information's confidentiality and integrity.

Stem Cell Research. Adopted Resolution 526, calling for the AMA to encourage strong public support for federal funding involving human pluripotent stem cells.

Committee F
AMA vision and strategic directions. Adopted BOT Report 24, which establishes the strategic directions for the development of the “AMA Plan for the year 2000.” This document includes strategies to support the AMA’s envisioned future as the medical profession’s leading force in solutions, knowledge and tools that promote health.

Admission of professional interest medical associations. Adopted CLRPD Report 1, which reflects the House’s commitment to being an inclusive body that is responsive to membership concerns.

Committee G
Medicare review activities. Adopted CMS Report 11, urging HCFA to provide physicians with the opportunity for significant comment and input in the development of the Medicare Integrity Program (MIP), and opposing HCFA's potential use of a "bounty system” for MIP and "incentives" or "award fees" in the PRO Sixth Scope of Work.

Utililization and preauthorization. Adopted Substitute Resolution 705, calling for the AMA to advocate that utilization efforts focus on statistical outliers, rather than blanket review of whole populations of physicians or all instances of particular services; and that the AMA advocate managed care plans restrict preauthorization requests to physicians whose claims have shown to be statistical outliers.

Managed Care Opt Out Rules. Adopted Resolution 707, which calls for the AMA to oppose managed care "bait and switch" practices; to support current proposals to extend the 30 day waiting period that limits when Medicare recipients may opt out of managed care plans.

Committee H
At press time, deliberations on the report of Reference Committee H were not completed. Topics under consideration included Internet prescribing, privacy of medical records, HCFA’s E&M documentation guidelines, and physician concerns about the fraud data bank program.

Committee I
National negotiating organization. In a historic vote, Committee I recommended that the AMA should develop an affiliated national labor organization to represent employed physicians and where allowed by law, residents. A full action plan detailing this powerful new option will be available for delegates within the next 30 days.

The financial picture is strong

For the fourth year in a row, the AMA’s financial picture is a good one, reported Trustee Timothy T. Flaherty, MD. 1998 bottom line revenues exceeded expenses by $9.3 million, and after-tax operating losses of $5.4 million were offset by $14.7 million of non-operating gains. The most significant include an $18.3 million gain on sales of real estate and a net gain on securities of $6.3 million. Projections for 1999 forecast the AMA will experience revenues in excess of expense of $11.3 million, an increase of 21.5% over 1998.

Use the Web site!

Delegates or members who want more information about House actions and activities should visit the AMA’s Annual Meeting Web site. Information at the site ranges from complete reference committee records to transcripts of all speeches.

House elections...

Trustee Results:
President Elect:
     Randolph D. Smoak Jr., MD
Speaker, House of Delegates:
     Richard F. Corlin, MD
Vice Speaker, House of Delegates:
     John A. Knote, MD
Trustee:
     Duane M. Cady, MD
Trustee:
     J. Edward Hill, MD
Trustee:
     D. Ted Lewers, MD
Trustee:
     Donald J. Palmisano, MD, JD
Trustee:
     Joseph A. Riggs, MD
Trustee (Resident Position):
     Liana Puscas, MD

Council Results:
Council on Constitution and Bylaws:
     Ronald J. Clearfield, MD,
     Cecil B. Wilson, MD
Council on Medical Education:
     Emmanuel G. Cassimatis, MD,
     Rebecca J. Patchin, MD
Council On Medical Education Resident Physician Position:
     Francine C. Wiest, MD
Council on Medical Service:
      Joseph P. Annis, MD,
     Cyril M. "Kim" Hetsko, MD,
     Joseph M. Heyman, MD,
     J. Steven Polsley, MD
Council on Scientific Affairs:
      Scott D. Deitchman, MD, MPH,
     John P. Howe III, MD,
     Nancy H. Nielsen, MD, PhD,
     John F. Schneider, MD, PhD,
     Melvyn L. Sterling, MD
Council on Scientific Affairs Resident Physician Position:
     Zoltan Trizna, MD, PhD.

Membership Caucus

The desire for targeted, timely services was a strong theme at the Membership Caucus held Tuesday afternoon. Participants applauded AMA membership staff for recognizing that “one size does not fit all,” and adopting a life-cycle approach to providing service for AMA members. They also encouraged the AMA to consolidate mailings, focus on membership retention, and continue e-mail newsletters and other forms of electronic communication.

AMA Foundation

The AMA received $1.4 million from the AMA Alliance and $100,000 from the Audio-Digest Foundation during the meeting. The Foundation plans to use the funds to continue and expand its programs in education, research and service.

Cultural Competence

At Sunday's opening session, 1998-99 President Nancy W. Dickey, MD, updated delegates on one of the AMA's most important new initiatives: cultural competence. The "Cultural Competence Compendium," a new product of the initiative, offers resources for physicians in identifying issues surrounding different populations so that appropriate, patient-centered care is always provided. For more information, please call Hannah Hedrick at 1-800-262-3211, ext. 4697, or send e-mail to hannah_hedrick@ama-assn.org.

Residents poster contest

Congratulations to the AMA Resident and Fellow Section for its great anti-tobacco poster contest for kids, and many thanks to all the delegates who voted for their favorite poster. The young winner: Vincent Sung of Warrensburg Middle School in Missouri. Students from more than 450 middle schools submitted posters urging their peers to stay away from tobacco. Five of the six finalists will receive a $100 savings bond; the grand prize winner will receive a $500 savings bond.

Your new president

	AMA President Thomas R. Reardon, MD, shared thoughts on his agenda in an inaugural speech to delegates: “This is a dynamic, fast-moving, active organization working to make American health care better. But if we're going to do that and do it right, then we have a full-time job — AMA
actions, like Dr. Dickey's work in expanding access for the uninsured, like our efforts for health system reform . . . like our work for a patients' bill of rights, for quality, ethics and standards, and for private sector advocacy...and over two dozen other key initiatives, like AMAP, EPEC, the ARC and more that we have already made part of the heart and soul of the work of the AMA are the key to safeguarding our professionalism and our pride in this profession — not to mention our patient-physician relationships — in the new day that is dawning. These works represent the living proof of our character, our goals and our hope for the future.”
Thomas R. Reardon, MD AMA President June 23, 1999

Section Highlights

The Medical Students Section adopted a resolution asking that the AMA study and make recommendations on creating proportionally based representation of the medical students in the House of Delegates, such as the ratio used in setting medical specialty representation or other mechanisms. Currently, over 38,000 student members are represented by a single Delegate.

It also adopted a resolution that instructs the section to investigate student concerns over the recent computerized USMLE Step 1, and to present recommendations to the NBME for improving the administration of the exam. Some students have faced technical difficulties while taking the computer-based version of the exam.

Residents and Fellows
The RFS reaffirmed its commitment to reducing the financial burden on residents by asking the AMA to work with the federal government to seek federal income tax exemption for educational loan repayment programs for physicians practicing in underserved areas and lobby for full deferment of student loans through residency and fellowship. The section will develop a grassroots campaign to educate legislators about the debt burden on young physicians.
The RFS strongly opposed the recommendation of the Federation of State Medical Board's Report 98-5, which recommends that residents complete at least three years of training before they can obtain an unrestricted licensure. They also oppose the FSMB's recommendations calling for medical students and unlicensed residents to be reported to state licensing boards.

Young Physicians
At its meeting on Saturday, June 18, the Young Physician Section voiced its support for a collective bargaining unit (CBU) for employed and resident physicians, and for continued AMA efforts to obtain antitrust relief for self-employed physicians.

The section asked that the AMA work to make the credentialing process for hospital and health plans more easily accessible to physicians entering practice, and it recognized the young physicians who recruited 720 new members — more than double the number from last year — through the Outreach Program in 1998-99.

Organized Medical Staff
OMSS approved model language for medical staff bylaws opposing the mandatory use of hospitalists by hospitals or managed care organizations.

OMSS asked the AMA to explore steps for improving the bargaining position of hospital-based physicians and including them in contract negotiations with third party payors.

Medical Schools
The Section on Medical Schools asked the AMA to work with other groups to support legislation aimed at upgrading the research infrastructure, including space and equipment, of medical schools and universities.

It also opposed the expansion of the Freedom of Information Act to require the premature release of research data from federally-funded research projects, and asked that the AMA collaborate with other groups to restore funding for teaching hospitals that was reduced by the Balanced Budget Act.

Minority Physicians
The Minority Affairs Consortium (MAC) played an instrumental role in the approval of AMA policies to increase diversity in medicine, calling for the AMA to:

• Work to promote and fund activities as well as “actively oppose” the reduction of resources and opportunities aimed at increasing the number of under-represented minorities in pre-medical and medical training.
• Urge medical schools to consider the likelihood of service to underserved populations as a medical school admissions criterion.

Women Physicians
The Women Physicians Congress (WPC) governing committee launched the creation of the 1999 “Women in Medicine Month” campaign. The September campaign is set to coincide with this year's 20th anniversary of the first AMA committee on women in medicine issues. The governing committee also announced that nomination solicitations will begin this summer for year 2000 WPC leadership positions.

Also on the WPC agenda were the final review of and the development of advocacy strategies regarding proposed AMA policies on women’s health education and training, gender-based health differences and bone densitometry and mammographic screening issues.

IMGs
Keynote speaker for the IMG Section Assembly was Richard A. Cooper, MD, director of the Health Policy Institute at the Medical College of Wisconsin, who spoke on “The Physician Surplus: An Alternate View.” The section also transmitted three resolutions to the House for consideration. The resolutions called for greater uniformity of licensure standards, an increase in funding for prostate cancer research, and an increase in ethnic medical society representation in the House of Delegates.

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