On behalf of the officers and trustees of the American Medical Association, welcome to Chicago for the first Annual Meeting of the new millennium – and the 202nd meeting of the AMA House of Delegates.

As you know, the AMA has focused much of its efforts this year on a strategic repositioning – a process that helped us trim excessive spending, focus on core programs, reallocate certain responsibilities and operate in a fast and cost-effective way. Since the Interim Meeting last December, we have made notable progress in establishing a realistic budget, emphasizing program priorities and encouraging a lean and efficient organization with a bias toward action and results.

The repositioning task was a difficult and complex one. We experienced reductions in staff, professional services, travel and temporary help. Wherever possible, outmoded programs and functions were eliminated, organizational structures simplified, and processes streamlined. Use of outside consultants was greatly curtailed, and the quantity of market research studies reduced. Wherever we could, we looked for ways to save on postage, materials and labor costs.

But, as you will see from the depth of activity in this report, we’ve emerged strong and well poised to lead organized medicine into the new millennium – aggressively advocating for patients and physicians and pursuing our professional standards and public health initiatives.

This newly repositioned AMA of the year 2000 – leaner and more strategically focused – has enjoyed many successes so far this year. Some highlights that you will read about in this report:

AMA membership continues to grow. 1999 membership numbers are the highest since 1995 and should only improve as we continue to develop ways to teach our member physicians to “sell” membership on the grassroots level. The first of those recruitment sessions will take place during the Annual Meeting. Also this week, we’ll be unveiling our new Lifetime Membership option, another way for physicians to demonstrate their lifelong commitment to the medical profession and enjoy the AMA’s services and benefits for a lifetime – and recognize a considerable cost savings in the process.

AMA advocacy efforts remain strong and focused. The AMA continues to aggressively press members of Congress to finalize a meaningful patients’ bill of rights and to take action on the Campbell bill, the important antitrust legislation that would let physicians bargain collectively with health plans. Our Private Sector Advocacy staff continues to push for a level playing field between physicians and health plans, and our Medicare reform activities are stronger than ever. For example, the AMA was instrumental in achieving the 5.8 percent Medicare Sustainable Growth Rate for 2000, an enormous improvement over an SGR of 2.1 percent that HCFA published last fall.

AMA builds partnerships in technology. To survive and flourish in the Internet-based digital world, the AMA continues to enhance its superior Web site, and is looking for synergies and partnerships that will better position the AMA in the electronic economy to help meet needs, solve problems and provide benefits for America’s physicians and their patients. We continue to work closely as an equity partner with Medem, an Internet venture created by the AMA and six of the nation’s leading medical societies, that will enable physicians to use electronic messaging and engage in other secure transactions. And through our strategic partnership with Intel, we are addressing the important issue of privacy by creating physician digital certificates. In addition, we are reviewing several additional e-business ventures that, in a strategic and interrelated way, offer us opportunities to develop valuable new products and services for our members, their patients and our profession.

These are just a few highlights of the attached report that offers a comprehensive look at AMA activities during the first half of 2000. Please read on for more details, and thank you for your participation as a valued member of the AMA’s House of Delegates.

Government Affairs

• Successfully lobbied the House Judiciary Committee in reporting H.R. 1304, the “Quality Health Care Coalition Act of 1999” (the Campbell antitrust bill), by a vote of 26-2. The bill is scheduled for floor action in June. As of May 30, 220 Representatives had cosponsored the Campbell bill. More than 40 cosponsors of H.R. 1304 have been added since Congress reconvened in January.

• In response to HOD directives, Senator Hatch has amended the Pain Relief Promotion Act to provide additional protections for legitimate pain relief services. These amendments also reaffirm state authority to regulate the practice of medicine and raise the burden of proof for prosecutions.

• We have continued our lobbying of House and Senate conferees concerning the “Patients’ Bill of Rights” (H.R. 2990). Lobbyists have been meeting with individual House and Senate conferees on a regular basis to obtain up-to-date information, as well as present the AMA’s views. Conferees have reached a tentative agreement on external appeals and medical necessity, and we will continue to apply pressure on conferees in order to reach an acceptable complete PBR package. In addition to targeting conferees, lobbyists have targeted vulnerable Senators seeking reelection this year. Though they are not conferees, they can certainly speak to the leadership and Senate conferees about their basic electoral survival.

• The issue of health system errors is expected to be addressed in the PBR conference report. In keeping with AMA policy, lobbyists have been providing conferees with relevant information concerning a framework for resolving the problems.

• AMA has successfully defeated repeated attempts by House Commerce Committee Chairman Tom Bliley to open the National Practitioner Data Bank (NPDB) to the public. Lobbyists have educated members of Congress on information in the NPDB, as well as why such information will not resolve health system errors.

• Fraud & Abuse activities: (1) Successfully defeated Clinton administration budget proposals for new user fees on physicians, hospitals and other providers. (2) Continued our advocacy to ensure that the federal government focuses its law enforcement efforts on truly fraudulent behavior and not inadvertent billing errors. (3) As directed by the AMA House of Delegates, have been taking a comprehensive approach on the fraud and abuse issue with Congress, including comprehensive congressional oversight of HCFA.

• SGR activities: Pursuant to AMA advocacy, Congress directed HCFA to publish a new SGR for CY 2000 and to update its estimates of allowed spending for the last nine months of 1999 to reflect actual data. HCFA recently announced the new SGR. At 5.8 percent, the CY 2000 SGR is an enormous improvement over the fiscal year 2000 SGR of 2.1 percent that HCFA published last fall.

  HCFA also recently announced the projection of a positive conversion factor update in FY 2001 of 1.8 percent. Without the AMA’s advocacy efforts on SGR, the update projection would have been negative, not positive.

• In direct response to aggressive AMA lobbying, HCFA recently committed to Congress that it would restore the toll free phone lines to answer physicians’ Medicare questions.

• AMA successfully led a coalition to secure the withdrawal of a proposed Health Resources and Services Administration (HRSA) regulation that would require entities to identify and report to the NPDB the physician or physicians responsible for a malpractice settlement (whether or not the physician was named in the lawsuit).

• AMA secured a 45-day extension for the comment period of the administration’s proposed regulation on privacy and confidentiality. The extension allowed the AMA to further develop and coordinate the medical state and specialty societies opposition to the proposed rule. Medicine’s unified concerns have resonated with critical members of Congress.

• AMA and HCFA undertook and completed negotiations for HCFA’s use of CPT on the Internet. All indications are that negotiations have been successful.

• Through aggressive challenging of the Office of the Inspector General (OIG) Chief Financial Officer’s Audit, the AMA raised considerable awareness about the audit and physicians’ concerns with the federal government’s current tactics on “waste, fraud and abuse.”

• Joe Heyman, MD, chair-elect of the Council on Medical Service, was appointed by the Secretary of the Department of Health and Human Services (DHHS) to the Practicing Physician Advisory Council (PPAC).

Political affairs

• After nearly a year of consistent grassroots advocacy activity, we continued to build support and momentum for the Campbell antitrust bill. Through the efforts of physicians and state medical society staff, members of congress became increasingly aware of the magnitude of support by the medical community for this vital legislation. Letters, e-mails and faxes generated through the Grassroots Action Center, as well as phone calls placed through the Grassroots Hotline, had a measurable impact on the number of co-sponsors added to the bill prior to passage by the House Judiciary Committee.

• AMPAC year-to-date membership among the Federation is running ahead of the same from 1999, and is running at an all-time high among AMA Directs.

• Single-week activity on the AMA in Washington Web site exceeded 50,000 hits for the first time since the site was unveiled in 1999.

• Launched the Virtual ARC, the online Web-based information resource for state legislative campaigns. The site is now online as a member-only service. We are continuing to expand our use of electronic communications tools, including blast e-mail and listservs, to better provide information to members and medical societies.

• Introduced the Compliance Interactive Tutorial System (CITS), a member-only Web-based interactive fraud and abuse product, in January 2000. Additional modules/content were added in March, April and May.

• Launched the National House Call, converting the AMA from an “institution” to an “activist” organization. Policy meetings with the nominated candidates’ staffs occurred this spring. We continued our outreach and partnership with physicians, Federation and patients.

• Convened the successful and well-attended 27th Annual State Health Legislation Meeting in Miami for physician leadership and medical society executives/government affairs staff. This meeting provided an effective forum for information exchange among physician leadership, as well as a strategy forum for medical society government affairs staff to advance the association’s policies at the state level.

• Hosted two meetings of the ARC Executive Committee to discuss roll-out of the Virtual ARC, Y2K campaigns, state and federal medical record confidentiality initiatives, and the Institute of Medicine report on patient safety.

• Hosted a scope of practice fly-in meeting with a number of medical specialty organizations to discuss issues such as long term trends in state and federal scope of practice legislation and regulations, the use of quality/cost data in advocacy in this area, and how organized medicine can work together more effectively on scope of practice issues. Created a listserv devoted to scope of practice issues to alert participants to legislative or regulatory scope initiatives and to facilitate information sharing.

• Provided detailed assistance with drafting/introduction of joint physician negotiation (state-action doctrine) legislation in several states. Currently, 14 states have introduced legislation based on the AMA’s model bill on this issue.

• Provided comments and testimony to the National Conference of Insurance Legislators (NCOIL) to defeat a resolution calling for NCOIL’s opposition to the Campbell bill and similar state-based efforts. Successfully delayed vote on this resolution, pending receipt of further information from the AMA, as well as our presence/testimony at NCOIL’s July meeting. We have provided NCOIL with substantial information about pending state initiatives and their legal foundation, which has become recognized as a valuable resource to NCOIL.

• Testified in person and via conference call before Alaska Senate regarding S.B. 256 to permit physician joint negotiations in Alaska. Met with four individual senators following testimony to describe function and need for such legislation. Bill passed out of Senate and awaits hearing in House. AMA has been asked to testify when the House hearing takes place.

• Drafted comments and briefing materials for AMA trustees for a presentation before the National Association of Insurance Commissioners (NAIC) regarding PBR and emerging health care issues for 2000 and beyond. The presentation was very well received and successfully refuted several arguments posed by the HIAA and AAHP.

• Participated in quarterly meeting of NAIC health care working groups. Completed comments to Managed Care Organizations Working Group regarding licensure and solvency of managed care organizations. AMA presence and verbal input has been requested at next NAIC meeting in June.

• Provided information to NAIC Working Group on Pharmaceutical Issues to facilitate discussion of pharmacy benefit managers (PBMs) and restrictive formulary issues. AMA has been asked to continue to provide information and contribute to Working Group discussions at future meetings and interim conference calls.

• Worked as a team with AMA lobbyists and other advocacy staff to perfect H.R. 1304, the legislative language of the Campbell antitrust relief bill, fend off hostile amendments, develop talking points and write advocacy letters to Congress and the Administration, all of which taken together achieved passage of the bill by the House Judiciary Committee on a 26-2 vote. Worked in a similar and concerted fashion to advance the bill to House floor consideration.

• Successfully negotiated amendments with Senate Assistant Majority Leader Nickles and Judiciary Committee Chairman Hatch to perfect H.R. 2260, the “Pain Relief Protection Act of 2000,” as requested by the AMA House of Delegates (Res. 215, I-99). As a precursor to this advocacy, convened multiple meetings of interested state and national medical specialty societies to draft and review benchmark amendment language. With the AMA’s help, the bill was favorably reported from the Senate Judiciary Committee and Senate floor consideration is expected shortly.

• Wrote and cleared for signature more than 40 formal AMA advocacy letters to Congress and some 25 AMA letters to Federal agencies and outside organizations, including voluminous comments in opposition to HHS proposed privacy regulations, reflecting extensive AMA and specialty society input.

• Developed and wrote 11 AMA statements and briefed AMA board members and officers for six live appearances before Congressional committees and Federal agencies, including two hearings in response to IOM patient safety report and one on NPDB.

• Planned and staffed January and March full Council on Legislation meetings held in Washington, D.C., and produced materials (including draft/model Federal and States legislation) to respond to some 16 separate House of Delegates directives for action.

• Reviewed, produced explanatory information and assisted Council on Legislation in forming recommendations on some 20 major bills currently before Congress on a wide range of important issues.

• Conducted bi-weekly telephone conference calls with Council on Legislation’s Executive Committee to keep it apprised of ongoing legislative and regulatory developments in Washington, D.C., and the states.

• Wrote and presented to the Board of Trustees comprehensive reports, detailing the Council on Legislation’s recommendations on the above items, for the board’s further review and consideration.

• The AMA and the Pennsylvania Medical Society (PaMS) jointly requested that the U.S. Department of Justice investigate the conduct of two Blues plans that separately dominate the eastern (IBC in Philadelphia) and western (Highmark in Pittsburgh) markets of the state. The AMA and PaMS believe that IBC and Highmark may have agreed not to compete with each other, thus further cementing their dominant market positions to the detriment of patients and physicians.

• Continued working with state medical societies on regulatory and legislative efforts to challenge health insurer “all products” provisions, in Florida, Connecticut, Kentucky, Virginia and Michigan. Continued to develop and refine arguments opposing use of these clauses.

• Worked with Florida and New York, as well as a number of specialties, on downcoding and bundling issues. Worked with other units in the AMA to develop a coordinated approach to these issues.

• Due to significant member demand, substantial work has been completed in the first quarter on the “new and improved” version of the AMA’s “Model Managed Care Contract.” The document will be unveiled at an educational program during the Annual Meeting of the House of Delegates on Saturday, June 10. It will be posted on the AMA Web site and widely promoted.

• Assisted the Medical Society of New Jersey (MSNJ) in protesting United Healthcare’s “coordinated care” model in New Jersey – including United’s requirement that E&M codes 4 and 5 be supported with additional documentation – and attended a meeting with MSNJ and United staff.

• Assisted the North Carolina Medical Society (NCMS) with a number of significant local problems with CIGNA, including contacting corporate CIGNA and securing attendance of its representatives at a meeting with NCMS leadership, which was also attended by AMA, to discuss this wide array of problems and ways to solve them. Among other results of the meeting, secured membership in the NCMS by the local CIGNA medical director.

• Assisted Delaware Medical Society in developing strategies to confront poor quality of lab services by dominant lab services company in the state.

• Finalized “Business Strategies to Level the Playing Field: An Overview,” which explains the basics of the business integration strategies available under current law.

• Completed extensive start-up work for PRN, including fully staffing the organization (three new full-time employees), securing all necessary insurance policies and benefit packages for PRN, initiating first organizing effort, and engaging in membership recruitment for sustaining members.

• Coordinated breakout session at National Leadership Development Conference on PRN and case studies of successful physician-led private sector strategies for dealing with dominant insurers in Kansas City and Texas.

• Produced a pamphlet explaining residents’ organizational opportunities and potential organizational pitfalls pursuant to the Boston Medical Center decision granting residents the right to engage in collective bargaining.

• Produced AMA brochure promoting the formation of PRN.

• Made multiple presentations to groups of 30-70 residents at three teaching facilities. Have worked with the residents at one of these facilities to institute a housestaff organization that may seek assistance from PRN to establish its group as a labor organization.

• Worked with an employed physician group to educate its physicians about their options. They are now working with PRN to determine the possibility of forming a labor organization.

• Provided educational assistance to the administration at a teaching institution where CIR was ultimately unsuccessful in its efforts to organize residents at that institution.

• In late May, the AMA and Texas Medical Association sent a joint letter and memorandum to Texas Attorney General (AG) John Cornyn outlining a number of serious concerns that we have about the Assurance of Voluntary Compliance (AVC) settlement agreement entered into between the AG and Aetna/US Healthcare. The letter and memo make clear that TMA and AMA do not believe that the AVC should be held up as a national model or model for future settlements between the Texas AG and health plans.

• Second Edition, “AMA Model Managed Care Contract: The Revised Contract,” which will be widely available at the AMA Annual Meeting, addresses critical issues that have emerged since the 1997 first edition of the model contract, including “all products” provisions, “silent PPOs,” and downcoding and bundling. The Revised Contract also includes 16 supplemental pieces on these and other critical issues. The contract and supplements are designed both to assist individual physicians in their contract negotiations and to support local and national advocacy initiatives.

• The AMA has weighed in on behalf of Iowa physicians in an ongoing battle over the issue of assignment of benefits. In response to a prohibition on assignment of benefits by the states largest health insurer, both the Iowa House and Senate overwhelmingly passed legislation that would require insurers to permit beneficiaries/patients to assign benefits to treating physicians. Iowa Governor Vilsack vetoed the legislation. In early June, the AMA sent Gov. Vilsack a letter expressing its disappointment over the veto and urging him to reconsider his position in the future.

• The Council on Medical Service has continued its proactive role in the development of AMA socioeconomic policy recommendations. New reports prepared by the council address physician responsibility for nursing agencies, hospital-based physician contracting, payment for annual physical examinations and related preventive services, and the benefits and limitations of an individual mandate for individually-owned health insurance. Of greatest significance, is a comprehensive report containing a number of scenarios from the AMA’s “Tax Credit Simulation Project,” as well as a series of principles to guide how health insurance tax credits should be structured.

• Finished the initial development of a tax credit simulation model, and prepared coverage and cost impact simulations of alternative health insurance tax credit scenarios for the Council on Medical Services. Held the first meeting of the AMA’s Tax Credit Simulation Workshop for influential policy analysts focusing on tax credit reform proposals. Co-authored CMS Report 4 A-00, “Principles for Structuring a Health Insurance Tax Credit,” and prepared CMS Report 4 – A-00, Technical Appendix: “Tax Credit Simulation Model.”

• Prepared conference materials for presentation of the AMA’s proposal for individually owned and selected health insurance at the Robert Wood Johnson Foundation’s Health Coverage 2000 Conference in Washington, DC. Worked with The Lewin Group to enable a cost analysis of AMA’s tax credit proposal as the second phase of the Health Coverage 2000 Conference activities.

• Prepared recommendations to the Board of Trustees and Council on Legislation regarding criteria to be used in evaluating Medicare outpatient prescription drug benefit proposals.

• Helped 12 state medical societies in prompt payment survey development, data analysis, and report presentation. Four states passed prompt payment legislation; two states passed legislation still awaiting their respective governor’s signature; and one state passed legislation, which was vetoed by the state’s governor.

• Initiated “AMA Member Pulse,” a Web-based physician survey that provides AMA members with an opportunity to contribute to AMA advocacy efforts and to learn the views of their colleagues on important and emerging health policy issues.

• Analyzed the factors influencing the Medicare’s SGR 2001 update and provided preliminary estimates to advocacy staff. Tracked changes in SGR and provided projections and other analytic support to relevant advocacy staff. Provided data/analytic support to DC and RUC staff and others on Medicare practice expense payment issues including “halting practice expense transition.” Completed a report analyzing potential changes in the practice cost component of RBRVS that might result from alternative options to updating the SMS data previously provided to HCFA.

• Prepared a draft report for Membership analyzing the impact of the Partnership for Growth (PFG) program on AMA membership between 1987 and 1997. The report is a compilation of work presented by Health Policy Studies to the Membership Development and Service group over the course of several meetings during late 1999. Our findings strongly suggest that the PFG did not affect AMA membership.

• Prepared a draft report on the relationship between AMPAC and AMA membership. We found that AMPAC membership has a statistically significant positive marginal impact on AMA acquisition in the following year. However, the data don’t eliminate the possibility that AMPAC participants would join AMA in any event.

• Effective in January with the introduction of the 2000 Medicare Payment Schedule, HCFA implemented 85 percent of AMA/Specialty Society RVS Update Committee (RUC) relative value recommendations.

• In February, AMA published the 2000 edition of “Medicare RBRVS: The Physicians’ Guide.” This year the book was published two months early due to coordination efforts led by the Department of Relative Value Systems.

• The RUC held a successful meeting in February with 120 physicians in attendance as well as 60 specialty society staff and other health care professionals. In addition to the work of the three RUC subcommittees, the RUC approved the work and practice expense data for 28 new and revised CPT codes.

• The AMA/Specialty Society RVS Update Committee participation in the second, Five-Year Review of the Resource-Based Relative Value Scale (RBRVS) was kicked off on March 21 with HCFA’s submission of more than 1000 CPT codes to review, including a major study undertaken by the American College of Surgeons. More than 65 national medical specialty societies responded to the process in which they indicated which codes their members are specifically interested in reviewing. This five-year review process, coordinated by the RUC, affords specialties an opportunity to identify and correct anomalies and other misvalued services in the RBRVS. The RUC will examine specialty society recommendations in August and October.

• Completed SMS physician survey oversamples and added special questions for medical society and academic clients.

• Worked with representatives from emergency medicine, pathology, radiology and anesthesiology specialty societies to develop special versions of the medical practice survey instrument to accommodate their special practice circumstances.

• Worked with an economist at Pennsylvania State University to develop the impact estimates of H.R. 1304 (the Campbell bill), published as “A Cost Analysis of Health Care Professional Bargaining Legislation.” The estimates have seriously challenged HIAA’s position on the legislation.

• Worked with Private Sector Advocacy and the Pennsylvania Medical Society to identify and analyze data on market consolidation as part of the request to the Federal Trade Commission that the Commission investigates IBC and Highmark market consolidation in Pennsylvania.

• Heightened liaison activities with groups of physicians, financial and insurance industry representatives, and policy research organizations advocating Medical Savings Account (MSA) expansion.

• Analyzed budgetary and payment impacts of converting Vermont’s Medicaid payment schedule to Medicare fee schedule levels for Private Sector Advocacy and the Vermont Medical Society.

• Continued discussions with HCFA officials on updating the practice expense relative values with additional SMS physician survey data.

• Prepared a review of and submitted letter to the JAMA editor on “Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians, A Randomized Trial,” JAMA, January 5, 2000. Revised for resubmission the manuscript “HMO Penetration and the Geographic Mobility of Established Physicians” to Journal of Health Economics, an analysis of the effects of HMO penetration of physicians decisions to relocate or to leave patient care.

• As a result of our advocacy efforts, key AMA policy was incorporated into the AAHCC/URAC External Review Organization Standards in several critical areas, such as protecting the patient-physician relationship and assuring clinical expertise of review staff.

• Completed comprehensive update of “Principles of Medical Review booklet” — now ready for publication

• Participated in meeting of the Massachusetts Medical Society that adopted policy supporting tax credits for individually owned health insurance.

• Market Research and Analysis unit completed research studies that examined physicians’ perceptions and expectations of the AMA with regards to programs; communication, involvement and participation; evaluated physicians’ perceptions of the CPT Information Service as a member benefit; measured physicians’ interest in a personalized AMA Web site; and obtained medical staff’s opinion of the AMA’s physician profiling service.

  Market Research also completed a test of its electronic survey software by conducting a survey concerning AMA membership determinants on the Members-Only section of the AMA Web site. The unit is currently working with IT and Internet Services to enhance the AMA’s electronic survey capability.

• Prepared a review of the Charles River Associates’ report, “The Physician Negotiation Act of 1999,” on the cost of DC Bill 13-333 and provided the review to the Medical Society of the District of Columbia for use in testimony at a legislative hearing on the bill.

• Provided updated practice expense per hour data from the AMA’s Socioeconomic Monitoring System (SMS) to HCFA for use in calculating Medicare practice expense relative value units for an upcoming proposed rule.

• The Greater Albuquerque Medical Association (GAMA) used its prompt payment survey results, in association with the New Mexico Medical Society (NMMS) to pass prompt payment legislation with the support of the New Mexico health plans. New information suggests that GAMA’s survey process and the AMA’s involvement had a direct and quite positive impact on the AMA. GAMA reports that AMPAC contributions (and GAMA members sending in AMPAC contributions) have doubled from last year at this time (based upon an analysis by GAMA). GAMA Executive Director Tom Bodnar indicated that it appears this increase is a direct result of the success of the prompt payment initiative in New Mexico and the support and assistance of the AMA and its staff. Health Policy staff worked with GAMA staff on the survey process and assisted in presenting the survey findings to GAMA’s Managed Care Task Force, which then met with local health plans to present the survey findings.

• Completed implementation and refinement of issues management system including electronic mechanism to file field trip reports and track specific issues. Major issues tracked and managed included E&M documentation guidelines, JAMA editor dismissal, PRN, AMAP, Facial Plastic Surgery Archives, membership, AMA insurance products (eye care and mental health parity).

• Solicited states and specialties for sponsorship of Intel Road Shows.

• Held the National Leadership Development Conference (NLDC). In terms of program substance to attendees, the 2000 NLDC was a big success. Total registration was 848; somewhat down from last year, but a good showing given the Miami venue, spring break and the averted USAir flight attendant strike.

  This is the first year staff aggressively sought corporate partnership to underwrite the program. All such activity was cleared via the Corporate Review Team, the executive vice president and the chair of the Board of Trustees. A total of $240,000 was raised:

  • Glaxo Wellcome $100,000
    
  • Neoforma $100,000
    
  • Pfizer $ 25,000
    
  • Medem $ 10,000
    
  • Amgen $ 5,000
    Total $240,000

  Glaxo/Wellcome and Pfizer are already committed to the 2001 program in Washington, DC, and staff are already engaged in seeking additional corporate sponsorship.

  The evaluations will be professionally analyzed, but cursory review demonstrates a strong level of satisfaction. Surprisingly, the Tom Peters presentation received an overall high rating, which is contrary to some emotional, repetitive comments heard about this particular segment.

  This was the first year a segment of the NLDC was planned with the AMA Alliance. The session on SAVE/Col. Grossman was well received, and staff is reviewing whether it should be expanded into a general session at 2001.

  The “Pride in the Profession” session was extremely successful and well received. The Executive Committee has approved further development of this program into a formal award that will be funded by Pfizer/Mike McGee, MD.

• Held the Specialty Society Presidents’ Forum on July 29-30 in Chicago with 100 attendees. Thirty-three evaluations were returned with an overall 4.06 average on a 5-point scale.

• Convened and staffed the AMA/Specialty Society Work Group on Universal Coverage, which included representation from six major specialty organizations and culminated in a consensus statement and press conference in June.

• Developed proposal for electronic version of “AMA/Federation News.” Worked with Member Communications to refine and implement.

• Developed with Membership pilot programs for selected specialty societies that involved financial rebates to specialties for every new member recruited. Identified six groups to solicit.

• Staffed three meetings of the Group Practice Advisory Committee to the Board of Trustees. Focused communications with group practice community in the wake of AMA establishing a collective bargaining unit. Initiated development of global strategic plan for group practices that emphasizes communications, education, membership, policy and advocacy. Continued meetings and discussion with Medical Group Management Association and the IPA Association of America regarding collaborative alliances. Developed and launched “Group E-News” to 5,000 group practices. Introduced “Med.EDU News” with Medical Education Section, and initiated development of Internet site.

• Published three documents to be distributed to medical specialty associations related to nonphysician clinicians: “Select Studies Related to Physician Assistants and Advanced Practice Nurses,” “Physician Resources for Collaborating with Nonphysician Clinicians,” and “Resource Guide to Select Nonphysician Clinicians.”

House of Delegates (HoD)

• Communications: The frequency of communications from AMA headquarters has been measurably increased using blast e-mails and blast faxes as well as traditional mailings. The chair of the Board regularly reports the actions of the Board meetings to the members of the House and advocacy letters to government officials are sent for the information of the delegates and alternate delegates. Working with Member Communications, we revamped the “Speakers Letter” into a cleaner, more modern looking publication. At the House meeting, a summary of House actions is now prepared and distributed before the delegates go home.

• Speakers Advisory Committee recommendations: The Speaker established an advisory committee to examine and evaluate the procedures of the House of Delegates to look for ways to improve the efficiency. This activity gave the House the opportunity to look at itself in an organized manner and decide what if any changes would be beneficial to the operation of the House of Delegates and its contributions to the governance of the association. Some of the proposals were accepted and others rejected, but the overall process was a healthy reexamination of this important function within the AMA.

• Special Publications: The backlog of House “Proceedings” was eliminated with the publication and distribution of four “Proceedings” in 1999. The 1999 edition of the “Pictorial Directory of the House of Delegates” was distributed. This publication is now available on the AMA Web site and is updated regularly. Future “Proceedings” will also be available electronically for ease of access instead of book form.

• The number of new student members increased by nearly 6000 members in 1999. Membership numbers for medical students at year-end 1999 totaled 44,154, which equates to a 59 percent AMA market share. The new on-site benefit, “Stedman’s Concise Medical Dictionary,” increased recruitment of 4-year members by nearly 1,000. Meanwhile, the spring recruitment program addresses membership transition into residency by offering multi-year student members their initial year of RFS membership “free” with completion of a brief survey. This recruitment program is in the second year of a three-year pilot.

• The Medical Student Section was pleased to provide a new Leadership Award program, sponsored by the AMA Foundation, that sent 25 students and 25 residents to the 2000 AMA NLDC. The new award program focused on non-clinical leadership skills in medicine or community service. Special programming was offered at the NLDC in addition to an awards banquet. The objective of the program is to encourage involvement in organized medicine and continue leadership development among this very important life cycle segment.

• The MSS has selected Children’s Health Insurance Program (CHIP) education, outreach and enrollment as its new National Service Project for 2000-02. CHIP was enacted in 1997 to begin addressing the needs of our nation’s children in families with incomes too high to qualify for Medicaid but too low to afford private health insurance. The MSS will kick-off the CHIP Project at the MSS Annual Meeting when the MSS, Illinois KidCare, the Children’s Defense Fund and Chicago Coalitions conduct a community service project at the Lincoln Park Zoo. Medical student volunteers will spend their day at the zoo enrolling uninsured families and their children in the Illinois KidCare program and increasing overall awareness of CHIP. Throughout the year, the MSS will continue its efforts to promote CHIP through community service activities at the local level, and an effective program module has been developed to assist chapters with their projects. The long-standing MSS Policy Promotion Grant program will continue to fund chapter community service projects ($250 grants) including CHIP outreach activities.

• On the Washington front, the MSS Government Relations Internship Program is entering its third summer session. Through this program, stipends up to $2500 are available for selected students to participate in their own legislative internship programs and seminars conducted at the AMA Washington office. Nine medical students will participate in 2000 with internship sites including the office of Senator Dick Durbin, the Health Care Financing Administration and the Children’s Defense Fund.

• Finally, the “AMA Medical Student” newsletter was developed in 1999 for mailing to all medical student members. Two editions (summer and fall 99) were distributed, but funding to continue the communication piece in 2000 is unavailable. The newsletter enabled the MSS to target the entire medical student membership and inform them of AMA and MSS activities and accomplishments. AMA-MSS E-mail Updates are currently being received by nearly 10,000 student members every two weeks. The MSS continues to increase its e-mail distribution list.

• The Resident and Fellow Section is comprised of the 34,000 residents and fellow physician members of the AMA. The section’s mission is to educate and advocate on behalf of resident and fellows on issues concerning graduate medical education and national health policies.

• Over the past year, the RFS continued to help develop Independent Housestaff Organizations (IHO) by providing specific information and assistance to more than 25 institutions. In addition, the RFS educated more than 20 resident groups on the recent NLRB ruling and gave extensive information regarding PRN and other resident representational options.

• The RFS also presented, with a generous grant from the AMA Foundation, resident and fellows with the AMA Foundation Leadership Award. This award was given to 25 resident and fellow physicians who exhibited outstanding leadership abilities in organized medicine, civic or non-clinical medical school or hospital activities during the year. Award winners were given the opportunity to further develop their leadership skills through participation in the NLDC.

• The RFS was instrumental in assisting with the overall increase in resident membership, signing membership agreements with Ochsner Clinic (New Orleans, LA) and The Ohio State University (Columbus, OH), and the three levels (county, state, AMA) of organized medicine – bringing more than 600 new resident members into the AMA. The RFS also worked with Membership Development and Services Group to develop new membership information products for resident and fellows.

• The section represents more than 50,000 physicians under the age of 40 or in their first five years of practice. The AMA-YPS completed fulfillment of more than 3,000 copies of its publication, “Contracts: What You Need to Know,” to its members.

• In January, AMA-YPS published and mailed a targeted newsletter to all its members. This newsletter focused on both AMA and YPS activities relevant to young physicians. A second newsletter is being produced and will be distributed to young physicians through its listserv and the AMA and YPS Web sites. In addition, YPS continues to send its biweekly blast e-mail to approximately 10 percent of its young physician members. YPS is focusing on increasing its communications to members via e-mail.

• AMA-YPS worked closely with the AMA and Glaxo Wellcome to identify and select participants for the 2000 Glaxo Wellcome Emerging Leaders program. The YPS chair participated in the program. In addition, AMA-YPS has taken the lead in maintaining communication and involvement with the young physicians participating in the program.

• AMA Outreach recruiters recruited approximately 600 new AMA members this year. Also, the YPS Governing Council is working on a membership implementation program that would increase membership recruitment and retention activities to resident and young physicians.

• The AMA-YPS successfully passed nine of its 10 resolutions brought forward at the AMA Interim meeting. These resolutions included: making permanent the young physician seat on the AMA Board of Trustees, establishing AMA policy that set criteria to facilitate new physicians’ entry into practice, and asking the AMA to study medical staff development plans and their impact on physicians entering practice.

• The OMSS convened an ad hoc task force to review the section and recommend changes that will reinvigorate the section and contribute to the AMA’s effectiveness.

• OMSS continued to focus on the implementation of AMA policy that outlines organizational principles for physician involvement in health plans and integrated delivery systems. The Governing Council has met with the American Association of Health Plans, Health Insurance Association of America and the Blue Cross and Blue Shield Association to explore workable models. Section comments on the National Committee for Quality Assurance draft standards have been incorporated into AMA comments.

• The section initiated principles for AMA to use in establishing policy regarding restraints and seclusion. It contributed to AMA comments on the HCFA interim final rule and the JCAHO standards on restraints and seclusion.

• OMSS initiated AMA policy that health plans should be legally responsible to pay directly for physician services in the event of an insolvency of fiscal intermediaries like groups, independent practice associations and physician practice management companies.

• Communication between group practice administrators and physicians has been strengthened through two email communications, “Group E-News” and “Med.Edu News,” the latter of which focuses solely on faculty practice plan physicians. Both of these news sources can be found on the new Group Practice Internet site, which was released in February and allows group practice physicians to access education and advocacy information at their leisure.

• “How to Prevent Fraud and Abuse in a Medical Group” was presented in March as the first of several teleconferences planned by the office for group practice physicians and their staff. The next such event is planned for July and will focus on “Building a Successful Web site.”

• The Advisory Committee on Group Practice Physicians continues to advise the organization and the Board on relevant group practice matters. This past year, the committee testified before the CMS on the rising costs of pharmaceuticals and published an article stating their concerns in “TIPS on Managed Care.”

International Medical Graduates (IMGs)

• The IMG Section has focused on the emerging issue of Florida’s legal carve out for dual track licensure of IMGs. In concurrence with AMA policy, the section has and will continue to push for uniform standards in the licensure of all physicians, recognizing that alternate licensure paths debase existing standards. Additionally, the section has been in communication with the Massachusetts Medical Society and the New England Journal of Medicine regarding classified advertising that discriminates against IMGs. Finally, the section has supported the efforts of the 372 IMGs who have participated across all of the AMA’s peer-to-peer recruitment programs. The IMG Section and its Governing Council will continue to address IMG-specific grievances regarding discrimination in the practice environment, in training programs and in obtaining licensure.

• An ancillary membership category available to AMA members 55 years and older, SPS provides a quarterly newsletter for its nearly 7,000 members. The SPS Governing Committee develops content for the newsletter “Senior Physician News,” administers a dedicated group travel program, and continually explores new ways to increase the visibility of its constituency. SPS coordinates the 50-Year Recognition Award, an honorary activity for members at least 50 years out of medical school, which features a special cruise in the fall and a luncheon at the Annual Meeting. As part of a new membership initiative, SPS developed a self-mailer membership solicitation that included the AMA membership kit mailed to our 46,000 dues-exempt, retired AMA members. This initiative drew more than 400 new members. Finally, in collaboration with AMA Marketing and as a special benefit to SPS members, eight AMA publications of particular relevance to senior physicians have been offered to SPS members at a 5 percent discount over the AMA member price.

• Now with more than 2,200 members, the Minority Affairs Consortium (MAC) continues to represent a broad constituency of minority physicians and spearhead efforts to incorporate the minority perspective in AMA policy and program development. The MAC communicates monthly with its members through electronic newsletters and the minority physician Web site. A MAC member survey established that the MAC should be addressing the particular professional challenges of minority physicians and patients and promoting diversity in the profession.

• Most recently, MAC has focused on minority health disparities and legislative advocacy. Due to the MAC efforts, the AMA is now actively supporting several House bills dealing with care for underserved populations and the role of minority physicians in managed care. In addition, MAC recently presented its first Minority Health Student Writers awards. The program is designed to promote minority health research and provide encouragement and mentoring to medical students. Two student award winners were announced early this year.

• A new group of physicians will assume the leadership of the MAC at the conclusion of the A-00 meeting. Three of the new Governing Committee members have been elected, two by the MAC membership. The remaining members were appointed from nominations by their respective AMA sections or national minority physician medical associations.

AMA Women Physicians Congress (WPC)

• Membership in the AMA Women Physicians Congress (WPC) continues to grow, increasing by 22 percent in the past year. WPC membership now stands at more than 3,000. A primary goal of the WPC is to provide leadership training and opportunities to women, in proportion to their growing number in medicine. As part of that commitment, the WPC recently held its first election of a new Governing Committee. Nominations for all eight positions were solicited from the membership, and a successful mail ballot election was held in April.

• The influence of the AMA Women’s Caucus, convened by the WPC Governing Committee at each Annual and Interim Meeting, also continues to grow. Most recently, delegates met to determine a possible endorsement process for AMA candidates for office. In addition, the WPC Liaison Officer network, more than 35 women physicians appointed by their medical societies, also provides an opportunity for leadership and participation. Liaison Officers met with the current Governing Committee at an event held in conjunction with the NLDC.

• Planning for the 2000 Women in Medicine Month campaign is underway. This annual event continues to draw participation throughout organized medicine and the profession. This year’s event will recognize physicians for their “above and beyond” contributions to their profession and communities. The WPC is also in the process of launching an AMA members-get-members campaign.

Corporate Services

The Corporate Services Group continues to provide the AMA with high levels of support for meeting and building services. These services have been efficiently managed, resulting in substantial cost savings to the association. Facility Planning and Coordination has maximized the resources of the building’s space and furniture. We have been able to create 50 new offices and workstations while operating at a 98 percent occupancy. Construction and Buildings Services has implemented an energy saving lighting system that will offer a cost savings of $50,000. This area upgraded equipment programs to meet the Y2K compliance for the association, and initiated building environment improvements. Meeting Services continued to provide cost savings in the areas of airline and hotel rates. The cost for travel was $2.5 million savings from full coach fares. Hotel rates for AMA meetings averaged 28 percent below the industry rate. The Meeting Management staff continued to effectively negotiate favorable terms for AMA in the areas of hotel attrition and penalties, minimizing our liability for lower attendance or canceled meetings. Telecommunications identified and installed a network for the Chicago to D.C. data connection at a 40 percent cost reduction with no service degradation, resulting in $70,000 annual savings.

Foundation, Corporate and International Relations

The Foundation, Corporate and International Relations group is setting strategies for relationships with foundations and corporations to broaden support for selected AMA programs. The group also serves in an advisory role to senior management and the Board on corporate relations matters.

The group currently has fundraising responsibilities for a wide range of AMA activities, including the National Leadership Development Conference, Health Sector Assembly, Internet Health Road Show, media briefings, Science Reporters Conference, awards and education programs. Nearly all AMA opportunities are included in a fundraising publication called “Advancing Medicine and Public Health: Opportunities to Work with the American Medical Association.”

AMA Foundation

In keeping with its mission of advancing health care through support of education, research and service programs at home and abroad, the AMA Foundation’s commitment to the medical community has never been stronger. In addition to providing more than $2 million in support for medical education this year, the Foundation has launched several new programs. The Seed Grant Research Program provides funding to medical students and young physicians for applied and clinical research projects. The Leadership Development Program provides opportunities for medical students and residents to participate in educational and leadership programs within organized medicine. Similarly, the Community Service Program helps to support projects that seek to improve patient care and respond to the needs of communities in health education and preventive health programs.

Today, the AMA Foundation is directing its focus to programs that strengthen the patient-physician relationship. Although this is a broad and multifaceted arena, the Foundation will begin its efforts by introducing its first multiyear Signature Program. This program will address the need for new and meaningful models for patient-physician interaction and highlight the need for patients to be able to partner with their physicians in health care.

Additionally, the Foundation will celebrate its 50th anniversary during the coming year and plans a number of special events to commemorate its numerous accomplishments. Office of International Medicine The Office of International Medicine (OIM) has been working to position the association as one of the leaders in international health and to impact the level and quality of health care worldwide through a wide variety of activities. For example, the OIM is coordinating the implementation of a cross-departmental International Strategic Action Plan, involving the introduction of AMA standards, products and services to the global market through Membership, CPT, CME, and Publishing and Data Services. The OIM holds International Strategy Team meetings every other month to discuss the progress of the team’s 11 international initiatives.

This year, the OIM also initiated the Dr. Nathan Davis International Awards in Medicine and Public Health. The OIM received 129 nominations from around the world for these awards. The Outstanding International Physician recipient is Inge Genefke, MD, DMSchc, secretary general for the International Rehabilitation Council for Torture Victims (IRCT), recognized for advancing the field of treatment of torture survivors. The Polio Eradication Initiative, a global partnership led by Rotary International, the World Health Organization (WHO), the Centers for Disease Control and Prevention, and the United Nations Children’s Fund (UNICEF), is the Outstanding Global Health Initiative award recipient. These awards will be presented June 10.

Since January 2000, the OIM has hosted five groups of international guests to the AMA: two from China, one from Sri Lanka, one from Australia, and one from Argentina. One of the Chinese delegations included Zhang Wenkang, MD, the Chinese Minister of Health and president of the China Medical Association.

The OIM continues its international advocacy efforts through its involvement with the World Medical Association, the WHO and other international organizations.

Risk Management

Building upon ongoing risk management activities such as contract review, the corporate review process, and internal audit, the AMA has been working with a national firm (Arthur Andersen) to implement a more formal Comprehensive Risk Management Program. Based on national best practices, the consultants have provided advice on AMA’s risk culture, conducted a preliminary risk assessment, and evaluated AMA’s current risk management approach.

Based upon this study, the Audit Committee has recommended and the Board has approved AMA’s Comprehensive Risk Management Program. Key attributes of the program are:

• A definition of risk management as follows: “Responses to the threat that an event or action will adversely affect an organization’s ability to achieve its objectives and execute its strategies successfully. Business risk arises from the likelihood that something good won’t happen as it does from the threat that something bad will happen.”

• Explicit risk management oversight responsibilities for the Board and its Audit Committee, and managerial accountability for the EVP, senior staff and managers.

• The creation of a staff risk management unit reporting to a senior vice president who reports directly to the executive vice president, with the executive vice president providing regular monitoring reports to the Audit Committee.

The Professional Standards Group continues to focus its efforts on providing physicians with the foundations of professionalism. The group’s strategic plan provides a continuum of support for the medical profession that 1) stresses the encouragement and development of medical knowledge, 2) integrates that knowledge into medical practice and public health, 3) measures and analyzes clinical outcomes to improve medical performance and knowledge, and 4) encourages refinement of health and medical practice based on evaluation and data.

Science, Technology and Public Health Standards

The Science, Technology and Public Health Standards area is charged with promoting medical science, collecting that knowledge, and disseminating it to physicians. It is also responsible for public health advocacy initiatives that bring medicine and public health together.

Medicine and Public Health

Bioterrorism - Under the auspices of the Council on Scientific Affairs, the AMA held a series of “town meetings” in conjunction with the Medic WMD (Weapons of Mass Destruction) 2000 Conference on Bioterrorism sponsored by the Department of Defense, April 2-6 in Arlington, Va. A broad cross section of specialty, state and county medical society representatives, and community responders, as well as members of the military, who are engaged in disaster response planning and deployment for such events, attended the meetings. The focus was on how organized medicine and community-based physicians can become better prepared (through education and development of core competencies) and more active in local disaster response planning. Specific elements addressing treatment (drugs, vaccines, liability issues) and local response (national stockpile preparation and local delivery) also were discussed.

Medicine/Public Health Initiative - The AMA and the American Public Health Association co-chair the Medicine/Public Health Coalition, which includes key national leaders in medical education, research, managed care and public health. The past six months have been used to re-evaluate the direction of the initiative and secure extramural funding.

Medicine and Public Health Surveys - State Medical Societies: Data are being obtained on priorities of state and medical societies regarding public health and prevention issues. Information will be used to better serve the needs of state societies. Physicians: A survey was sent to a random sample of 6,000 physicians to determine their involvement in public health and prevention activities. Physicians also were asked how the AMA could better serve medical and community health needs. Data will be used to promote recruitment and retention of members.

Science in Clinical Practice

Science Forum at the 2000 Annual Meeting - The Council on Scientific Affairs is co-sponsoring a forum at the Annual Meeting with the Specialty and Service Society on improving patient safety and reducing medical errors. The recent Institute of Medicine Report will be reviewed, the perspectives of several individuals involved in patient safety initiatives will be provided, and methods of identifying and tracking potential medical errors discussed. Panel discussion and audience Q&A will be used to identify what can be done to foster improvements in this area.

Drug Policy - The AMA is working with federal agencies and specialty societies on the important public health issue of antibiotic resistance. Drug-policy issues that the AMA continues to address include drug formularies, electronic prescriptions, Internet prescribing, prescribing of controlled substances for pain, immunization of adults and children, therapies for asthma and foodborne illnesses, patient medication information, medication errors, direct-to-consumer advertising of prescription drugs, the professional package insert, off-label uses, dietary supplements, genetically modified foods, and selected issues in infectious disease (e.g. hepatitis C, use of safety needles).

United States Adopted Names (USAN) - The “2000 USP Dictionary of USAN and International Drug Names,” released in May 2000, contains all names USAN adopted through the USAN program since the previous edition in 1998. The USAN program continues to participate in review of potential brand names with the Institute for Safe Medication Practices, and has developed new liaisons with the Brand Institute and Crescent Pharmaceutical Branding to eliminate names that may cause medication errors due to confusion, and can thus compromise patient safety.

Genetic Medicine - The AMA continues to promote greater integration of genetics in clinical practice by participating in the Department of Health and Human Services Secretary’s Advisory Committee on Genetic Testing. A report of the committee is currently out for public comment, and the final draft will be submitted to the secretary. The committee is addressing the issue of regulation of genetic testing and concerns for adequate safeguards for confidentiality of information. A collaborative project among the AMA’s Science, Ethics and Publishing units that emphasizes the continued need for genetics education for the practicing physician is currently underway. It will be Web-based and CME-eligible.

Clinical Research - The first meeting of the Institute of Medicine Clinical Research Roundtable, which grew out of recommendations from the Clinical Research Summit, will be held in June. The results of a survey of Federation members to identify the “Top 5 Clinical Issues” are being compiled for publication.

“Guides to the Evaluation of Permanent Impairment” - The 5th edition of the AMA’s “Guides to the Evaluation of Permanent Impairment” is scheduled for release during the second quarter of 2000. Chapters have been updated and made more consistent and easier to use.

Organ Donation - The AMA is hosting another blood drive at the 2000 Annual Meeting as part of ongoing activities of AMA’s “Live and Then Give” campaign targeted at increasing physician awareness of the continued need to be organ and tissue donors. Results of a survey to determine how many states have launched organ donation campaigns and what the AMA can do to assist them are pending.

Educating Physicians and the Public

Foodborne Illness - As part of the President’s Food Safety Initiative and supported by a House Resolution from I-97, the AMA - in collaboration with the Centers for Disease Control and Prevention, the US Department of Agriculture and the Food and Drug Administration - has produced an educational primer on diarrheal foodborne illnesses, which is targeted at primary care physicians. This project is near completion and is currently in external review by experts in foodborne illness, as well as many specialty societies. This document is tentatively scheduled for distribution in summer 2000.

Physicians’ Health - The AMA and the Canadian Medical Association cosponsored the 6th International Conference on Physician Health, March 26-April 2 in Seabrook Island, S.C. The conference successfully addressed a host of topics, ranging from stress and burnout to physical disability and wellness. The theme, “Recapturing the Soul of Medicine,” proved relevant to physicians’ situations worldwide, attracting some 300 participants, including 43 Canadians and 19 from other countries (Australia, England, Finland, Germany, New Zealand and Norway).

Federation of State Physician Health Programs - Following action by the House of Delegates in 1998, the Federation of State Physician Health Programs is now housed in the AMA, working with the existing Physician Health Program. The Federation coordinates activities among the various state medical society-sponsored physician health programs to build common practices and policies and carries out liaison activities with licensing authorities.

Internet - The Web sites “Resources on Alcohol and Tobacco,” “Adolescent Health On-Line,” “Public Health at the AMA” and “Resources on Infectious Diseases” continue to offer physicians and the public information on a variety of medical and public health issues. The infectious disease site includes information on the ongoing federal Hepatitis C Lookback Program. The Council on Scientific Affairs (CSA) site provides summaries of all 117 CSA reports produced by the council from 1994 through 1999. The full text of 59 of these reports is also posted, as well as complete bibliographic information for the 58 CSA Reports published between 1991 and the present.

Special Themes to Promote the Health of the Public

Health Literacy - The AMA has developed a Speaker’s Kit, “Face to Face With Health Literacy,” to raise physicians’ awareness about the prevalence of health illiteracy and how it may directly affect their relationship with patients. The kit includes a video with vignettes illustrating the range of persons affected by this issue and the problems they experience in the medical encounter. It also contains the Council on Scientific Affairs’ report, “Health Literacy” (A-98), and other written materials for self-study and discussion. The kit is being presented at the 2000 Annual Meeting to encourage physicians to assume an active role in raising awareness among their peers and within the community.

Youth and School - The AMA organized two town meetings for the Commission for the Prevention of Youth Violence, in March in Chicago and in May in Houston. To study the context, causes and solutions for youth and school violence, the AMA has convened a partnership with the American Academy of Pediatrics, American Academy of Family Physicians, American Psychiatric Association, American Academy of Child and Adolescent Psychiatry, American Public Health Association, American Nurses Association, AMA Alliance, American College of Physicians, American Society of Internal Medicine and the office of the U.S. Surgeon General. A report to the nation containing recommendations for action will be issued in fall 2000.

Family Violence - The AMA’s Family Violence Advisory Council met in Oklahoma City in April, hosted by the Oklahoma State Medical Association. The council discussed a number of issues, including expanding its purview to deal with other forms of violence, not only family violence. The council also agreed to work with the Institute of Medicine, which has recently launched a training program to address physicians’ needs in dealing with family violence.

Firearm Safety - As of May 1999, 71,000 copies of the AMA’s “Physician Firearm Safety Guide” had been distributed to physicians. Several hundred copies also were distributed at the American Spinal Injury Association meeting in April. This guidebook, which covers the epidemiology of firearm injuries and deaths, clinical risk assessment, management of high-risk situations, and patient/parent education and counseling, is the eighth in the family violence series.

Alcohol - The 10-campus community partnership grantees of the program, “A Matter of Degree (AMOD): The National Effort to Reduce High-Risk Drinking Among College Students,” held a national meeting to train student advocates and plan future advocacy activities. The program and grantees received extensive media coverage as an effective strategy to reduce student alcohol abuse while national binge drinking rates rise. AMOD has become part of a new Mothers Against Drunk Driving (MADD) National College Commission on Binge Drinking, which will make action recommendations in fall 2000. Planning has begun for a 10-site local communications campaign to begin this fall. The 12-state “Reducing Underage Drinking through Coalitions” (RUD) grantees received extensive media coverage for their efforts to reduce the alcohol-related problems caused by college spring breaks. The Texas Coalition has begun working with the state and Mexican government and coalitions from other border-states to reduce cross-border underage drinking problems. RUD cosponsored an eight-state education meeting to discuss effective strategies to increase alcohol excise taxes. State medical societies were invited to participate. RUD will hold a second annual National Youth Assembly to train youth advocates. Both programs participated in the launching of a new national initiative, “Leadership to Keep Children Alcohol Free,” involving the spouses of more than 25 governors, and led by staff of the Robert Wood Johnson Foundation and the National Institute on Alcohol Abuse and Alcoholism. Federation members have received materials to help them participate in the state activities and the Physician Leadership on Substance Abuse. The AMA also released its second report on physician involvement in its Office of Alcohol and other Drugs programs and participated in planning for the “Alcohol Policy XII Conference: Alcohol and Crime.”

Tobacco Use Prevention and Control - The states continue to grapple with spending the tobacco settlement funds. The AMA has testified in legislative hearings on the subject in Kansas and West Virginia, and has met with legislators in Illinois. The states served by the AMA SmokeLess States initiative continue to lead the way in securing funds for tobacco control through the settlement: Ohio, Indiana, Wisconsin, Georgia, Maryland, Nebraska and New York have come through with significant funding. The AMA responded swiftly after the Supreme Court ruled against FDA authority over tobacco products by issuing a press release and co-sponsoring a newspaper ad urging Congress to pass legislation clearing the way for FDA jurisdiction over tobacco. The AMA supports recent legislation that Congressman Greg Ganske, MD, (R, Iowa) introduced to that effect. The FDA and tobacco will be a top priority for the AMA Washington office’s efforts this year.

Planning continues for the 11th World Conference on Tobacco OR Health to be held August 6-11, in Chicago. The AMA, the American Cancer Society, and the Robert Wood Johnson Foundation invite all interested members to attend the meeting, which has attracted global attention and support. Registration is available online at www.wctoh.org or at (312) 464-5848.

Health Needs of Medically Underserved Populations

Special Needs of the Elderly - More than 7,000 copies of the AMA’s “Diagnosis, Management and Treatment of Dementia: A Practical Guide for Primary Care Physicians” have been distributed. A self-assessment questionnaire for caregivers that can be administered in the physician’s waiting room is being developed. More than 34,000 copies of the second edition of the AMA’s “Guidelines on the Medical Management of the Home Care Patient” have been ordered by physicians and other health care professionals. The AMA continues to participate in the HCFA-sponsored Coalition for Quality in Medication Use.

Special Needs of Adolescents - In December 1999 the AMA completed its five-year GAPS in School-Based Health Centers project by writing and distributing an implementation guide. The AMA’s National Coalition on Adolescent Health met in Washington, D.C., in December 1999. The AMA Child and Adolescent Health Program’s Partners in Program Planning for Adolescent Health (PIPPAH), supported by the Maternal and Child Health Bureau, continues to initiate activities designed to build a multidisciplinary infrastructure with nursing, law, nutrition, social work and psychology to improve the health status of adolescents.

Ethics Standards

The Ethics Standards Division, including the Council on Ethical and Judicial Affairs (CEJA), the Ethics Resource Unit and the Institute for Ethics, is the leading voice on medical ethics in the country and provides the basis of the AMA’s professionalism efforts.

Ethics Resource Unit

Council on Ethical and Judicial Affairs (CEJA) - The purpose of CEJA reports and opinions is to provide the moral anchor for the profession. In developing reports, the council has responded to resolutions adopted by the House of Delegates, as well as national ethical debates. In an ongoing effort to respond to the wide variety of concerns that affect physicians, as well as provide them with useful guidelines, the council continues to expand both the channels through which it receives input and disseminates its policies. For instance, the council’s Web site is now the repository of all unpublished reports. The House of Delegates at the 1999 Interim Meeting adopted four reports, and five more reports are in preparation for the 2000 Annual Meeting. Finally, the next edition of the “Code of Medical Ethics” will be distributed at the Annual Meeting and an annotated version ready by mid-summer.

End-of-life care - One component of the AMA’s efforts to improve quality care at the end-of-life is the Education for Physicians on End-of-life Care (EPEC) Project. Through funding from the Robert Wood Johnson Foundation, the EPEC Project provides practicing physicians with a core set of skills needed to provide quality end-of-life care. In March, a regional train-the-trainer program was offered to 110 physicians and other health care providers. In April, approximately 40 physicians from the initial EPEC train-the-trainer conference attended a Faculty Development Conference on Effective Teaching Skills. All AMA physician members received a copy of the “EPEC Curriculum” on CD-ROM as a benefit of their 2000 membership. The AMA provided 30,000 complimentary CD-ROMs to all state, county and specialty societies, directors of all residency programs, and department chairs of all medical schools in the country. The EPEC Project is supporting the adaptation of the “EPEC Curriculum” for unique physician and patient populations including African-Americans, Hispanics and Catholics.

Ethics Standards is moving towards establishing an AMA-wide working group on end-of-life care, composed of internal and external experts in the field. This working group will address a variety of programmatic issues in end-of-life care, including advance care planning, health literacy, and patient safety.

Ethics Forum column in AMNews - Ethics Forum, a monthly column in AMNews, continues to address practicing physicians’ questions and dilemmas. Two questions are addressed in each issue; on a rotating basis, responses come from CEJA members, Ethic Standards staff, and outside experts and scholars.

Soliciting Physicians’ Ethical Attitudes and Knowledge (SPEAK) Initiative - The SPEAK Initiative is designed to assess physician attitudes and behaviors on a variety of ethics and professionalism issues. Recruitment continues for a national cohort of physicians who will be surveyed on a periodic basis, resulting in the development of relevant and practical outreach, research programs and policy initiatives.

Genetics Web site - The Ethics Resource Unit plans to create a physician-targeted CME Web site on relevant genetic-based diseases, the first of which will be breast cancer. Initially, the site will contain static information, but will become more interactive as external funds are obtained. The Web site should be accessible by mid-summer at www.ama-assn.org/ethic.

Code of Medical Ethics curriculum - The Ethics Standards Division is developing an ethics course based on the AMA’s “Code of Medical Ethics.” This interactive course will be offered on the Internet, with the possibility of physicians obtaining CME credit. At least seven modules will allow physicians to familiarize themselves with the core ethical concepts that make up the code in a way that will be immediately applicable to their everyday practice. The first modules will be available by the end of the year.

Institute for Ethics

Ethical Force (E-Force) Program: Performance Measures for Ethics - An article describing the Institute’s groundbreaking Ethical Force Program (E-Force) was published in the American College of Physicians/American Society for Internal Medicine’s journal, Effective Clinical Practice, in December 1999. This program continues to build bridges with ethicists, academics, clinicians and managers around the country through its innovative research agenda. The E-Force mission is: “To improve health care by fostering the ethical behavior of all participants. The program identifies and promotes ethical expectations and performs research to develop valid and reliable measures of their achievement.” The 21-member E-Force oversight body includes representatives from numerous relevant groups, and it has selected two initial domains for performance measures development: protection of privacy and confidentiality throughout the health care system, and the integrity of systems for benefits determinations.

• Privacy: With the help of its Expert Advisory Panel on Privacy and Confidentiality, the E-Force oversight body has approved a set of potentially measurable expectations for the protection of privacy throughout the health care system. Methods and a plan to field-test performance measures in this area, to ensure the measures’ reliability and validity, are in development.

• Benefits: The Expert Advisory Panel on benefits has met three times, and a draft set of measurable expectations is being developed.

In addition, focus groups with insurance brokers were conducted in early 2000 to determine how these key health benefits decision-makers assimilate and use quality information in selecting which health plans to recommend. The results from these groups are being prepared for publication in the peer-reviewed press. The E-Force Codes of Ethics project also is nearing completion. This consisted of the first-ever complete collection of the Codes of Ethics of every member of the Federation, as well as a number of complete sets of ethics policies from managed care plans and large physician group practices. These codes and policies have been systematically analyzed and compared, and a full report on this research will be available for members soon. Finally, a collection of physician group practice mission statements, ethics policies, patients’ rights statements, and other relevant documents has been prepared for member use and is available on request.

The Virtual Mentor - Mentoring is a powerful and time-tested way for people to learn personal and professional skills. Mentors provide valuable guidance and advice by helping students reflect on personal and professional issues. The Virtual Mentor, a collaborative effort by Ethics Standards and Medical Student JAMA, continues to be the most visited component of the Medical Student JAMA online. The Virtual Mentor is an interactive, Web-based forum for analysis and discussion of clinical and professional issues that medical students encounter during their training. The Virtual Mentor content areas are designed to inform, awaken and energize medical students to engage in a learning dialogue with experts in medicine, law and bioethics.

Working Group on Organizational Ethics - The Working Group on Organizational Ethics was formed to study the interactions between clinical and business ethics and to develop a coherent theory of health care organizational ethics. The group was developed to include representatives from business ethics, clinical ethics, institutional ethics, health care organizational administration and government regulatory agencies. Three meetings of the working group have been held to date. A paper outlining a theory of health care organizational ethics has been developed and is in press. A limited number of printed reports will be provided free on a first-come, first-served basis to members and interested parties in the ethics community, and the complete report will be available through the Ethics Web site in June. In addition, a white paper based on this work will be submitted for publication to a peer-reviewed journal.

Fellowship Program - The institute’s Fellowship Program provides an opportunity for two-to-four individuals each year to advance their scholarly pursuits in bioethics through independent research and writings. Fellows participate in the institute’s programs and activities that are related to their studies. Fellows attend weekly seminars, weekly case consultation conferences and biweekly journal club activities. Fellows also may involve themselves in ongoing research and educational projects, such as the Virtual Mentor and the E-Force Program. Senior fellows also teach seminar series on topics such as health care economics and ethics or the history of medicine and bioethics. Among current fellows, one will start medical school and another will start working at an ethics think tank in September – and the third, a medical historian, has worked extensively with the AMA archives. All fellows have presented at ethics conferences during their fellowship year. Three new fellows for 2000-01 have been recruited and will start in September.

Research on physician agency - Physicians often are required to maneuver through an increasingly complex maze of issues to advance their patients’ interests and serve the public good. In a series of three national physician surveys, Institute for Ethics researchers and ethicists are exploring how physicians are responding to pressures such as utilization review requirements and financial incentives, and how these pressures affect physicians’ actions as patients’ agents.

Oath Project - One characteristic that distinguishes professionals is the act of “professing” to abide by a set of ethical values and ideals. In medicine, this has historically been in the form of taking the Hippocratic Oath. Although the oath itself was a protest document in its inception in ancient Greece, it has evolved as the basis of ethical conduct for physicians. To this day, medical students swear to abide by an oath during graduation ceremonies. According to a 1993 study, however, many medical schools in the United States and Canada administered oaths other than the Hippocratic Oath. These non-Hippocratic oaths may espouse a different set of ethical values and priorities. The authors of this study were concerned by “the dilution of the core values of Hippocratic medicine,” and warned against the fragmentation of ethical values and principles that should serve as a common basis for all physicians. The Ethics Standards Division is embarking on an effort to collect and analyze the oaths used at all U.S. medical schools. Once we have collected the oaths, we will conduct a critical analysis of the oaths by experts in the fields of medicine, ethics and law.

Publications - In the past six months, numerous articles by scholars and researchers at the Ethics Division have appeared in leading peer-reviewed journals. Two notable articles are the November 1999 article “Physician Professionalism in Society,” published in the New England Journal of Medicine, and the April 2000 publication of “Physician Manipulation of Reimbursement Rules for Patients: Between a Rock and a Hard Place” in JAMA. The latter explored how often and why physicians report that they sometimes must manipulate insurance reimbursement rules to get needed care for their patients. This article received favorable coverage in many major media outlets, including the network newscasts, ABC News Nightline, NPR’s All Things Considered, Marketplace, the BBC World Service, and many local and national newspapers, wire services and radio news programs.

Medical Education Group

The Medical Education Group is responsible for the development, promulgation and implementation of policies fulfilling the profession’s responsibility to ensure the competence of its members. Guided by the Council on Medical Education, the unit addresses issues related to accreditation, publication of educational data, and professional development. Medical Education is the key liaison with the Accreditation Council for Graduate Medical Education, the Accreditation Council for Continuing Medical Education, the AAMC and the Liaison Committee on Medical Education – and provides the staff support for the section on medical schools.

Environment of Medicine/Medical Education

Impact of major health system changes - Throughout 1999 and the first half of 2000, the Council on Medical Education prepared reports and position papers on the influence of major health system changes on medical education.

Medical education financing - The Council on Medical Education, in consultation with the Medical Student Section, is preparing a comprehensive report for I-00 reflecting the council and section’s ongoing examination of methods of decreasing the cost of medical education to students.

Ensuring training in managed care settings - The Council on Medical Education continues to address concerns about productivity standards imposed on physicians by managed care organizations that keep the physicians from having time to teach in their offices and clinics.

Progress in diversity in medical education - The AMA continues to be committed to encouraging increased recruitment and retention of faculty members from underrepresented minority groups as part of efforts to increase the number of individuals from underrepresented minority groups entering and graduating from U.S. medical schools.

Annual updates in the Journal of the American Medical Association (JAMA) - The annual medical education issue of JAMA contains data and articles with workforce and other policy implications and serves as a major contribution to medical education literature. The 2000 medical education issue will focus on how medical education is addressing the internal and external challenges to the profession of medicine.

Physician Workforce Issues

Enforcing Accreditation Council for Graduate Medical Education (ACGME) Program requirements  Because excessive work hours affect the ability to learn and provide care, the Council on Medical Education prepared a report for I-99 asking the ACGME to collect and report annually the number and variety of violations of duty hour requirements identified by each of the 27 Residency Review Committees. The AMA also will study the impact of prolonged work hours, including moonlighting, on resident physician performance and well-being.

National Resident Matching Program - The AMA has distributed to medical students (via the Medical Student Section) copies of the forthcoming National Resident Matching Program (NRMP) brochure summarizing NRMP policies and procedures, along with information about the process for reporting violations of those policies and procedures.

Principles for Graduate Medical Education - The Council on Medical Education prepared a report building on a 1990 report and including current AMA policy, to inform AMA appointees and GME institutions about various committees and councils that deal with GME matters.

Hospitalists - The Council on Medical Education is monitoring the evolution of hospitalist programs, with the goal of identifying successful models. The AMA will encourage dissemination of information to medical students, resident physicians and practicing physicians about the implications of the emergence of hospitalism.

Curriculum and Professional Issues

Cultural competence - The AMA “Cultural Competence Compendium,” published in June 1999, is a resource to enhance the ability of physicians to provide individualized care that respects the multiple cultures of their patients. Medical Education staff continues to be involved in developing cultural competence standards and curriculum materials.

Career information for premedical and medical students - In collaboration with the Association of American Medical Colleges, the AMA has developed MedCAREERS, which provides career and specialty information to medical students. Starting in the 1999-2000 academic year, the information is being delivered through Web-based materials and educational programs at individual medical schools.

Contract to evaluate UME-21 initiative - The AMA is collaborating with the Center for Medical Education Research at Jefferson Medical College to evaluate the UME-21 initiative at eight medical schools. UME-21, which is funded by the Health Resources and Services Administration, aims to change the clinical phase of medical education to better prepare students for practice in the changing health care environment. The evaluation runs through 2001.

AMA medical school visitation programs - The visitation program provides the Council on Medical Education and the AMA Board of Trustees with a unique avenue for two-way communication with medical schools. The number of visits per year has increased from six in 1986 to 18 in 1999. A total of 121 visits to 96 different schools have been scheduled through July 2000. After July, the program will take on a different format administered by the Board office.

FREIDA Online - Available through the AMA home page, FREIDA Online (Fellowship and Residency Electronic Interactive Database Access) is used extensively to search more than 7,600 ACGME-accredited programs and 200 board-approved combined specialty programs. FREIDA 2000 also offers summary statistics on training in each specialty/subspecialty and up-to-date workforce data on recent graduates by specialty/subspecialty. FREIDA Online allows AMA student members to request up to 30 free mailing labels and allows program directors to make basic changes to their information online.

Joint GME survey - The AMA and the Association of American Medical Colleges will be collaborating on an online annual survey of accredited residency programs. Data will be exchanged through a seamless connection between the two Internet sites. The AMA will be responsible for quality assurance for both resident and program data.

Gifts to physicians - The Council on Medical Education continues to address issues related to gifts to physicians from industry and has recommended that the AMA proceed with developing working groups to inform physicians of the AMA’s ethical opinions on appropriate relationships.

Enhanced AMA Physician’s Recognition Award (AMA PRA) and improved online resources - CME Select contains online CME courses; AMA PRA information and applications; CME resource guides; and activity surveys for providers of accredited CME activities. The National CME Online Locator, a searchable Internet database on the AMA home page, includes more than 2,000 national AMA PRA category 1 activities offered by sponsors accredited by the ACCME.

CME Credit for Journal Study - Seven AMA journals now offer AMA PRA category 1 credit: Journal of the American Medical Association, Archives of Family Medicine, Archives of Dermatology, Archives of Internal Medicine, Archives of Neurology, Archives of Ophthalmology, and Archives of Surgery.

Licensure publications - “U.S. Medical Licensure and Requirements by State,” an improved annual publication now desktop published by the medical education staff, includes key state-by-state statistics on licensing requirements, fees, license renewal, continuing medical education requirements, number of physicians licensed, and exam pass/fail percentages.

Genetics education for health professionals - The AMA continues its support of and involvement in the National Coalition of Health Professional Education in Genetics (NCHPEG) with a seat on the steering committee. NCHPEG serves as a forum for the exchange of information, the creation and sharing of genetics education resources, and the consolidation of commitment among health professional leaders to the urgent need for education in genetics. The AMA will participate in developing tools and resources to integrate genetics content and technologies into the knowledge base of health professions.

Accreditation Processes and Related Health Professions

Affiliation with accrediting bodies - The AMA continues to play a fundamental role in setting standards for medical education and ensuring adherence to these educational standards through sponsorship of the liaison committee on Medical Education, Accreditation Council for Graduate Medical Education, and Accreditation Council for Continuing Medical Education.

Health professions education database and standards publication - The AMA is the only U.S. organization that has collected and disseminated information on educational programs for multiple disciplines related to medicine, or “allied health” fields. The “Health Professions Education Directory” provides information on more than 5,800 accredited programs and their 2,800 sponsoring institutions (which enroll more than 200,000 students) in 52 professions.

Quality and Managed Care Group

American Medical Accreditation Program (AMAP)
At its February 2000 meeting, after extensive discussions, including analyses by outside consultants, the Board of Trustees voted to immediately cease funding of the AMAP accreditation business. At its March 2000 meeting, the Board of Trustees took actions on AMA’s future role in standard setting and performance measurement, an AMAP exit strategy, and future communications regarding Board of Trustees’ actions on AMAP.

4,171 physicians have participated in AMAP. More than 2,800 have either been accredited (2,062) or not accredited (888).

Clinical Quality Improvement Forum (CQIF)
On April 28, the AMA held the Clinical Quality Improvement Forum: Addressing Patient Safety. The CQIF is a national-level conference that incorporates discussion across the quality continuum, including clinical practice guidelines, performance measures and outcomes. The agenda included nationally recognized physician leaders involved in patient safety initiatives representing federal agencies, hospitals, managed care, accrediting organizations, medical specialties and others.

The Practice Guidelines Partnership (PGP)
The Practice Guidelines Partnership has invited participation from the American Association of Health Plans and the National Committee for Quality Assurance for 2000, and has updated its mission to include coordination of clinical practice guidelines in the context of clinical quality improvement. The May 12 partnership meeting included discussions on patient safety and on the role of clinical practice guidelines in relation to performance measurement development.

National Guideline Clearinghouse(NGCTM)
The National Guideline Clearinghouse™ policy board met on February 24. NGC sponsors — the AMA, the American Association of Health Plans and the Agency for Healthcare Research and Quality — heard a project update indicating that the NGC has logged more than a million visits and more than 10 million requests since its inception January 1999. Discussion of the guideline summary and synthesis verification process was followed by a discussion and planning session related to an upcoming Technical Expert Panel meeting scheduled for July 13. The AMA has surveyed physicians on the NGC to determine their interest in, and use of, the clearinghouse. Physicians who have used the NGC were very positive about its content and format and the AMA’s support of this project.

Clinical Practice Guidelines Directory, 2000 Edition
The “Clinical Practice Guidelines Directory,” 2000 edition, was published in May. This directory includes more than 2,000 guideline listings from approximately 90 physician organizations and others.

Clinical Performance Measurement Directory, 2000 Edition
Published in November 1999, this directory includes descriptions of more than 330 clinical performance measurement activities from approximately 180 physician organizations and others.

Quality Care Alert
The “Quality Care Alert” is a widely disseminated newsletter designed to close the gap between clinical knowledge and practice. Fourteen of the 18 specialty societies working on the third issue of the “Quality Care Alert” (colorectal cancer screening and surveillance) have approved the content of the issue and submitted their society logos for inclusion in the publication.

National Forum for Health Care Quality Measurement and Reporting (NQF)
The National Quality Forum was incorporated as a new organization in May 1999 and is governed by a 17-member board of directors. The NQF was created to develop and implement a national strategy for measuring and reporting health care quality. The AMA, JCAHO and NCQA hold non-voting, liaison seats on the NQF board. AMA President-elect Randolph D. Smoak Jr., MD, is a board member. The board will revisit both the number and designation of liaison seats in May 2001.

Additionally, the AMA is a member of the forum. Member organizations participate in the forum through one of four member councils: the Consumer Council, Purchaser Council, Provider and Health Plan Council and Research and Quality Improvement Council. The AMA is represented on the Provider and Health Plan Council by AMA President Thomas R. Reardon, MD, who serves as convener of the council. This council is charged with promoting valid, comparative data needed to improve health care to significantly advance health care quality improvement and reduce the cost and burden of reporting on duplicative measures.

Performance Measures Advisory Committee (PMAC)/Specialty Advisory Committee (SAC), and Specialty Forum (SF) Activities
The AMAP Performance Measures Advisory Committee (PMAC), Specialty Advisory Committee (SAC), and Specialty Forum (SF) continue to provide methodological and clinical expertise toward the development of physician performance measures. Volunteers from these advisory committees have developed Criteria for Performance Measurement Systems, a position paper on risk adjustment, and a performance measurement set for adult diabetes. Work groups to develop performance measurement sets on chronic stable coronary artery disease and prenatal care and testing continue to meet.

Additionally, PMAC/SAC/SF members have selected future topics and related work groups consistent with Performance Measurement Coordinating Council (PMCC) priority areas.

Performance Measurement Coordinating Council (PMCC)
The PMCC, a collaboration between the AMA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the National Committee for Quality Assurance (NCQA), established Clinical Logic Work Groups for diabetes and coronary heart disease. Work groups are charged with determining the feasibility and specifications necessary to enable single data collection measures with different purposes. Single data collection for multiple purposes holds the promise of reducing burden on physicians and reducing costs for data collection across the health care system. The AMA took the lead in structuring the work completed by the Diabetes Clinical Logic Work Group, which was well received by the council and now serves as a model for future clinical logic expert panels.

At the March 2000 meeting the PMCC 1) discussed the AMA’s continued membership on the council, and the AMA reiterated its intent to remain firmly committed to the development and implementation of quality performance measures, 2) determined it would develop a proposal outlining its standards-based approach for effective patient safety programs for consideration by the National Quality Forum, 3) approved a draft “Adult Diabetes Consensus Statement” and related pilot test; 4) accepted the following list of topic areas to serve as a guide for sponsoring organizations’ activities and formation of PMCC panels:

• Pregnancy and Neonatal
  
• Cerebrovascular Disease
  
• Asthma
  
• Hypertension
  
• Affective Disorders
  
• Common Outcomes
  
• Breast Cancer
  
• Colorectal Cancer
  
• Measures of Information Technology Evolution
  
• Pain & Palliation (Cancer)
  
• Health Risk Behavior Modification
  
• Sexually Transmitted Diseases

Member Communications

As part of the recent repositioning, Member Communications was expanded to include staff from Employee Communications and Marketing Services. With these changes, the unit is enhancing integrated communications with AMA members and other important internal stakeholders. Key to this effort are partnerships within the AMA – including Federation Relations, Professional Relations and Membership – to better coordinate all communications for AMA audiences.

Member Communications’ former Web site – “Voice of the AMA” – has been revised. Renamed “News from the AMA,” the site provides a direct portal at the AMA home page for AMA members, the public and the press looking for the latest information about advocacy, initiatives and AMA products. AMA leaders’ speeches are available, as are daily news stories, media releases, statements and electronic versions of all print materials produced by the department.

Ongoing projects and publications:

• “AMA E-mail News Briefs,” an electronic newsletter for AMA members. This weekly e-mail newsletter is sent electronically to 60,000 physicians. An effort is under way to add new e-mail addresses to this list. “AMA E-mail News Briefs” offers diverse, value-added news in a concise format that links readers to the AMA Web site for more extensive information.

• “AMA/Federation News,” an electronic newsletter for Federation leaders. This weekly electronic newsletter, produced in close collaboration with AMA Federation Relations, brings members of the Federation (executives, communicators and presidents at state, local and specialty societies; AMA Alliance leadership; AMA Board of Trustees) timely news and useful information from the AMA. The newsletter is supplemented by e-mail “alerts” transmitted to the Federation during crisis situations or when there is breaking news to share.

• “Meeting Highlights,” an on-site newsletter for the AMA House of Delegates. This newsletter, with a total distribution of 1,000, is intended to provide delegates and alternate delegates with information on significant House actions that they may pass on to their member constituents. In addition to the newsletter, Member Communications is developing new strategies to more effectively utilize the House of Delegates as a key strategic resource for communication of positive AMA information to members. Recently, delegates and alternates have been receiving an electronic letter from the AMA board chair following each board meeting. The communications have been very well-received.

• “AMA Young Physician,” “AMA Medical Student,” “Women Physicians Congress Update,” “Minority Affairs Consortium Update,” targeted section newsletters. Member Communications has created customized newsletters for the AMA’s various special sections, which are being “rolled out” section by section. The newsletters offer concise news and an emphasis on developing “two-way” communication between section leaders and their constituents.

• Communications Briefings, “news sharing” meetings for AMA staff. These regularly scheduled “news exchange” meetings, open to all AMA departments, encourage the integration and synergistic distribution of AMA information externally to members. The meetings have been credited with helping to break down “information silos” at the AMA.

• “AMA for You” and “AMA Action,” regularly scheduled print publications. “AMA for You” runs twice a month in AMNews. “AMA Action” is a two-page feature that runs the final week of each month in JAMA. Stories and graphics highlight AMA advocacy, news about the Federation, AMA initiatives and benefits of AMA membership.

• “From the President,” Web site of the current AMA president. Features in “From the President” include monthly messages from the president on current issues in organized medicine, an electronic forum allowing AMA members to discuss these issues and news about the president’s activities and appearances. The site also provides the opportunity to communicate with the president directly by e-mail.

• Support for AMA campaigns. Member Communications played a vital role in supporting special AMA advocacy campaigns, including national efforts to pass a strong patients’ rights bill and promote Medicare coverage and payment fairness legislation. The department produced comprehensive materials, including press releases, op-eds, talking points, speeches, print advertisements, displays and targeted blast faxes and e-mails.

The speechwriting team produced 220 presentations and backgrounding scripts in the last year. Strategic messages included patients’ bill of rights and Campbell Bill status reports, Physicians for Responsible Negotiation, private sector advocacy initiatives, Health Sector Assembly plans and outcomes, Medicare and HMO reform proposals, Internet implications and programs, and a variety of public health issues.

Addresses by AMA leaders included major presentations to 18 state and 14 county or local medical societies, 13 specialty societies, 21 business or professional groups, and 48 medical/health/public health audiences. In addition, 57 presentations were produced for major AMA meetings – and the team produced 28 special projects requested by AMA executives.

The speechwriting staff has been reduced from four full-time to two full-time speechwriters; freelance writing support also has been reduced.

Public Information

During 1999, the Department of News and Information continued to provide strategic communication strategies and proactive media support for the AMA’s advocacy efforts. Effective use of staff, resources and activities – including editorial board visits to USA Today, the Washington Post, Los Angeles Times, Chicago Tribune, Orlando Sentinel, Houston Chronicle and Miami Herald; news conferences; media briefings; op-eds and letters-to-the-editor in USA Today, The New York Times and Chicago Tribune, news releases and statements – helped advance AMA messages on key socioeconomic and public health initiatives.

News and Information handles approximately 150 calls per week and has garnered major media coverage for the AMA’s initiatives and policy positions. Our trustees represented the AMA with dozens of appearances on network news broadcasts and interviews in the nations’ most widely read papers including ABC, NBC and CBS evening news; Nightline; The Today Show; CBS This Morning; Good Morning America; Meet the Press; Face the Nation; MSNBC; Fox; CNN; CNBC; The New York Times; the Wall Street Journal; the Los Angeles Times and many others. Among the issues:

• Patients’ Bill of Rights and the Campbell Bill – News and Information used an array of mechanisms to educate Congress, the media and the public about the essential elements of patients’ rights and antitrust legislation. Some of the communications tools included news conferences, radio spots, op-eds, print advertisements, news releases and statements.

• National House Call – News and Information staff members worked closely with the National House Call staff to promote program activities. Their efforts resulted in 13 editorial board visits, at least 40 media broadcasts and approximately 63 articles in print media. National House Call “advertorials” were placed in 12 major, local newspapers and USA Today — and nearly 13,000 brochures carrying the National House Call’s messages were distributed.

• Digital Certificates and Medem.com – Two new initiatives developed by the AMA received strong media coverage and were supported by News and Information, which provided spokespersons, Q&A, remarks and backgrounders.

• Ethics – News and Information continues to promote Education for Physicians on End-of-Life Care (EPEC), a comprehensive, long-term initiative to educate the nation’s physicians on how to better care for dying patients. Efforts to promote the EPEC program resulted in a comprehensive article in the Chicago Tribune – and The New York Times is due to print a story soon. News and Information also continues to play an essential role in promoting the AMA’s position on physician-assisted suicide, and the ethics of treating terminally ill patients.

Weekly Publicity – The Science News Department produces 48 news release packets during the year to highlight news from JAMA and the Archives Journals. The packets are sent to approximately 4,000 reporters and medical institutions around the world. The packet is available on an embargoed basis to registered reporters on EurekAlert!, the Web site run by the American Association for the Advancement of Science. It is also available post-embargo to physicians, reporters and consumers on the AMA’s JAMA and consumer Web sites. The department also produces 48 video news releases per year, seen weekly by an average of 25.5 million Americans, highlighting an important story in JAMA.

Major stories from JAMA that have been promoted over the past six months include Raloxifene and osteoporosis, hypoglycemic drivers and prescription of antidepressants and stimulants to preschoolers. The publicity generated positive impressions of the AMA in practically all forms of media.

AMA Radio News – The Science News Department also produces daily audio segments for AMA Radio News, which is the AMA’s radio report used by 500 radio stations across the United States. Two of the more recognizable users are Voice of America and the U.S. Army, which relays the JAMA report to every military base in the country.

Media Briefings – The Science News Department coordinated several very successful media briefings, most coinciding with articles appearing in JAMA. Authors of newsworthy research were invited to present their findings. Recent briefings include heart disease and the plight of the academic medical centers.

JAMA Patient Page – A patient’s page in JAMA, written and produced by Science News, now appears on a weekly basis. The page is intended to introduce patients to current and newsworthy medical research from JAMA.

A primary goal of the Information Technology Group is to seek improvements to information systems to enhance customer service and achieve cost reductions. Several strategic goals, including the migration from a mainframe to Unix platform and the leveraging of thin-client Web technologies, continue with these goals in mind. Several recent examples of successes in these areas are noted below:

The database licensing production system was migrated from the mainframe to our new Unix platform utilizing the AIMS data warehouse. Enhancements incorporated in this new system include new product offerings, Internet and CD product delivery, and the ability to produce products on demand using up-to-date data. Previously, the mainframe only allowed for weekly update of product data, and most customers received magnetic tape files delivered via the postal system. Regular savings will be achieved from a reduction in mainframe outsourcing fees and postage savings resulting from electronic delivery. Customer service will be enhanced via more rapid product delivery and new product offerings.

A Web-based physician profile ordering and fulfillment system, know as eProfiles, has been launched. This system utilizes a self-service model by which our customers can look up physicians online, order profiles, receive electronic delivery of the profile, and make account payments online – 24-hours a day – without intervention from AMA staff. The eProfiles system is our first system to leverage the AIMS Internet capabilities. Future Internet systems that leverage this technology base include our AMA Press catalog, CPT products, Physician Select, and online membership registration and billing. Revenue from profile products will be enhanced via new product offerings incorporated into this new system, a personalized product-pricing model, and the self-service that is known to increase sales and customer satisfaction. Cost savings will result from less AMA staff time required to perform product generation and fulfillment.

Improvements to our interoffice network and Internet connections are complete. Conversion from a T1 line to a higher speed DS3 line effectively doubled our communications bandwidth to and from the Internet. This upgrade was necessary to maintain our service levels as Internet usage increased. Re-negotiation of service providers for interoffice communications lines resulted in savings of approximately $7,000 per month, off-setting the increased cost for the higher speed Internet line.

Restructuring of our Data Center operations was performed to achieve annual cost savings. These changes included moving from 24 hours a day, 7 days a week, (24 x 7) to 18 x 5 coverage. Changes to system job schedules and increased use of automation made this change possible. Additionally, in-house data entry services were reduced. This was accomplished through outsourcing and leveraging Internet technologies to shift the burden of data entry to the point of data creation (e.g., online surveys vs. paper surveys).

The AIMS Project encompasses the reengineering of the AMA’s primary mainframe systems for maintaining physician, resident and student data. It also incorporates functions for membership billing, payment processing, data analysis and database licensing. Several major milestones have been achieved. The largest and most extensive components moved from development into user acceptance and system testing. These components include membership solicitation; billing and payment processing; the physician, resident and student management systems; and computer-aided matching system. Production implementation of these final components of AIMS will be phased in during this fall and next spring.

Membership Development and Service

The new Lifecycle Strategy for membership was announced at the Interim Meeting. This strategy allows us to focus our activities on key stages within a physician’s career such as medical student, resident, young physician – and it moves away from the “one size fits all” approach we have used for so many years. We also committed ourselves to excellence in member service and two-way member communications.

Our efforts are paying off. Last year our membership reached 293,695 – an increase over the previous three years – and we are projecting that we will equal or surpass that number for the 2000 membership year with our concerted efforts to work with our Federation partners.

For the second year in a row, we are on track to finish the year with an increase in the number of physicians returning to the AMA after having left us for one or more years. This sends a strong message that our membership efforts are rebuilding relationships with those who were displeased with our actions in the past and who have decided to give us another chance.

Medical school chapter recruitment set new records again in 1999, and we are anticipating strong gains for 2000. We are particularly pleased with the great response to our new pilot, the Student to Resident Pilot, also referred to as the 4+1-membership program for graduating medical students. This program rewards medical students with their free first year of AMA-Resident and Fellow Section membership because of their past four-year commitment to the AMA. The first year of this program assisted an additional 3,658 graduating students with transitioning their student membership to resident membership.

To build on the success of thanking members for their long-term relationship with the AMA, and to create an opportunity for them to show their commitment to the AMA, we have developed a new membership category called Lifetime Membership. Visit the AMA Outreach booth and learn more about this innovative five-year pilot.

A key driving force to our recent successes is the implementation of our first membership business plan. We are now in its second year and while we have experienced some unexpected challenges, we are confident that we can continue to carry out our initiatives so that we can reach our goals for the year.

Two of our major initiatives involve developing an internationally renowned service center and encouraging peer-to-peer acquisition and retention. Developing an internationally renowned service center is a multi-step process, but one in which we have already taken the first few steps. The AMA Unified Service Center consolidates several service units within the AMA so that we can provide knowledgeable, prompt and courteous service that exceeds member expectations. In other words, we will be providing one-stop shopping to build and sustain loyal relationships with members and potential members.

Revitalizing the Member Outreach Program is another initiative for this year. Identifying and developing streamlined methods of communication, while providing the tools and support for peer-to-peer acquisition and retention, are key to the program’s success. Please visit the Member Outreach Booth and complete a survey that will assist us in tailoring the program to your needs.

In addition to these initiatives, we are continually reviewing all our membership activities – enhancing those that work, creating activities that have potential, and eliminating ones that do not. We are confident that with our efforts, and the strong support of our Federation partners, we will sustain our membership growth.

Internet and Database Services

The first half of 2000 saw many enhancements and improvements to the AMA Web site. The rollout of StoryServer (our content management solution) encourages content providers to update their sites more frequently. Sites such as “News from the AMA” show that StoryServer allows the AMA to provide more timely and therefore more compelling content to the AMA Web site.

The Members-Only homepage also has been personalized allowing users to identify content areas in which they are interested. The homepage built for that specific user from Members-Only will serve up those content areas selected by the user.

The AMA’s Online Oversight Panel (OOP) continues to play an active role in the AMA’s Internet strategy and directions. Meetings are held via conference calls and in person during the Annual, Interim and NLDC meetings. The OOP is briefed on all new Internet projects and developments. Their input has been invaluable to the many ongoing projects.

Started in 1999, the AMA/Intel Internet Health Road Show teaches physicians how to utilize the Web for patient care and education as well as professional enhancements. The curriculum offers attendees the hands-on opportunity to explore the Web via laptops linked to the Internet. Attendees earn 7.5 category 1 CME units while learning about the latest Internet technologies in medicine today. Seven courses have been held so far this year with a total of 845 physician attendees. Another five courses are scheduled for the latter half of 2000. Funding for this project primarily has come through corporate sponsors in the form of unrestricted educational grants.

Staff continues to improve the quality of the AMA Physician Masterfile. We have explored the possibility of obtaining licensure data on a more frequent basis. Shortly, we will be collecting licensure data from most of the 67 licensing boards on a monthly basis rather than twice a year.

This year, we are conducting the Graduate Medical Education survey of residency training programs with the Association of American Medical Colleges. Data now will be collected primarily using GME Track: a survey instrument provided on the Internet. We expect to continue to get a 96-98 percent response rate.

We also have moved our physician profile service (now called E-Profiles) to the Internet. Now hospitals and CVOs, for example, can pay and receive from the Internet a biographic and practice record of a physician, thereby eliminating staff intervention. This also will be used as an opportunity to update data. When an order is taken, the requestor has to give us the physician’s current office address and phone number. Physician contact information also will be enhanced as a result of the digital certificate project. As part of the verification, we expect to update approximately 50,000 physician office telephone numbers and addresses this year.

A video was e-mailed to 8,000 physicians with a message from AMA Trustee Donald J. Palmisano, MD, encouraging physicians to update their AMA data using the Online Data Collection Center. Since this experiment resulted in four times the normal number of submits during a week, we plan on sending this message to a wider audience later this year.

Medem, Inc.

The AMA, along with the American Academy of Ophthalmology; American College of Obstetricians and Gynecologists; American Society of Allergy, Asthma and Immunology; American Society of Plastic and Reconstructive Surgeons; American Psychiatric Association and the American Academy of Pediatrics, formed Medem, Inc. in late 1999. Medem has moved from concept to action in 2000. In May, Your Practice Online was launched, and the consumer content site launch is scheduled for July 2000. Your Practice Online allows AMA members to build their practice Web sites without cost. This tool is being offered to AMA members, as well as members of the partnering societies, as a member benefit.

Medem editorial staff is transferring quality information from the AMA’s vast resource of medical information to the Medem site. Currently, Medem will be using information from the AMA’s scientific publications, Consumer Health Web site and science and books areas to help populate content on the Medem consumer health site.

Medem is continuing discussions with interested specialty and state medical societies. In April, two specialty associations, the American Association of Neurological Surgeons and the American College of Occupational and Environmental Medicine, joined the Medem partnership. Additionally, Medem negotiated a $20 million investment from the Whitney Fund in March.

Medem will be working with the partner medical societies to exhibit and register physicians at the organizations’ annual meetings. Medem also will be working with the founding societies to enhance communications to their respective members including advertising in society publications and articles for use by the societies.

AMA/Intel Digital Certificate project

The AMA has entered into a business relationship with Intel Corporation to deploy a new form of electronic identification that will protect physician and patient privacy and confidentiality when physicians use the Internet to send and receive medical information. The AMA will issue digital certificates to physicians within the next few months. The digital certificate will uniquely identify individuals over the Internet, providing a more reliable authentication technique than passwords for secure Internet transactions. Digital certificates function in the online world in the same way drivers’ licenses, passports and other trusted documents function in the paper world.

The AMA and Intel believe that the potential for physicians to use the Internet to obtain data such as lab results, send prescriptions to pharmacies, or store and retrieve patient files makes it vitally important that systems are in place to ensure that the patient’s privacy and confidentiality are protected. Furthermore, by authenticating the identity of the physician, this system will allow a wide and growing variety of routine medical transactions to occur online. Ultimately, this development will enable better patient care and lessen the administrative burden on busy physicians and their staffs.

The decision to provide digital certificates is an outgrowth of the “Electronic Data Interchange Report” issued by the AMA Council on Medical Service in 1998. The council recommended that the AMA work to establish consensus for electronic storage and transmission of medical records as an important means of protecting patient privacy.

In addition, a 1998 AMA survey of physicians found that more than nine out of 10 physicians (93 percent) have access to a computer in their medical practice. Of the physicians who have access to a computer, 96 percent of those computers have modem capabilities and 78 percent have communications software.

In this business relationship, the AMA is responsible for providing up-to-date physician information and for communicating information about the product to physicians. Intel is responsible for developing and integrating technical solutions to deliver the certificates.

Publishing

CPT editorial and information services
We have continued to enhance the CPT process to work toward having CPT named as the procedure coding system of choice for the near term. To ensure CPT’s viability well into the future, for the past several years we have been building and planning for the next generation of CPT through the CPT-5 Work Groups and the Executive Project Advisory Group (PAG). This past November, the CPT Editorial Panel considered the final recommendations of the PAG. These changes have already begun in CPT 2000 and will culminate in CPT 2003.

Education and information about CPT has remained in focus. This year we published “Principles of CPT” a long awaited authoritative text on CPT coding. We’ve extended the text’s reach by offering additional information on our Web site.

As physicians and others look to the AMA to provide accurate and up-to-date information about CPT, we’ve made back issues of our “CPT Assistant” newsletter available on CD-ROM and have expanded our annual CPT Symposium. We’ve helped more than 9,000 members with their coding questions through our CPT Information Service.

Our Correct Coding Policy Committee has reviewed thousands of correcting coding edits, as well as thousands of “Black Box” edits. Through this process and AMA advocacy, we have revised thousands of incorrect code edits. HCFA also has promised to avoid the future use of “secret” proprietary code edits.

Additionally, we have continued to press HCFA for information about documentation guidelines. We have called on Congress to exercise its oversight of HCFA and to hold hearings on the myriad onerous regulations that physicians must follow.

Periodical publishing
Periodical publishing, which includes JAMA, AMNews, and the Archives Journals, will generate close to $80 million in 2000, an increase of $7 million over 1999. While JAMA remains the number one advertising revenue producer in the world, a strong advertising performance from the Archives Journals and another strong performance from Circulation & Content Marketing will fuel the growth in revenue for 2000.

Circulation & Content Marketing sells the contents of JAMA and the Archives Journals worldwide through paid print subscriptions, electronic licensing, and paid subscriptions to the new Web-based full-text online service.

In June, the full-text of JAMA and the Archives Journals will be available free to AMA members and paid subscribers. We expect this full-text online service, the Essential Medical Library, to generate more than $2 million this year alone.

AMNews also will benefit from our investment in Web-based publishing. Beginning in June, many members will start receiving AMNews online instead of print. Of course, all members can continue to receive AMNews in print just by requesting it. We expect more than 60,000 members to prefer the online version of AMNews, saving the AMA $2 million annually in just paper, printing and postage.

Clearly, our investment in the Web-based publishing products will yield even larger dividends in the future. An expanded classified advertising and career center, as well as a CME Center, are just two items on the drawing board.

AMA Press
AMA Press, the book publishing division of the AMA, is the same group of dedicated publishing professionals who have brought you dozens of valuable books and CDs on topics like CPT, reimbursement, ethics and practice management. We continue to be the leading authority on reimbursement, but now will be doing even more.

Our new name reflects a broadening of our publishing program to include virtually all aspects of the medical landscape. Moving into the 21st century, we will be expanding our list in all current areas, especially the professional clinical publishing area. The entry of AMA Press into the $300 million medical book market will stimulate the continued growth of the AMA book business.

Drawing upon the unparalleled content of our flagship publications, JAMA and the Archives Journals, we will be publishing titles in ophthalmology and internal medicine in the next year. During 2000, new editions and new products on disability evaluation, medical education, physician leadership, ethics and other topics will spotlight the AMA’s immense body of knowledge, research and insight into the medical profession. This adds up to more than $45 million in revenue. We are dedicated to ensuring that every new AMA Press title enhances physicians’ ability to fulfill the mission of improving the health of America.

AMA Business
Database Licensing and Credentialing had another record year, with revenue of $23.4 million, an increase in net margin of nearly $4 million. The growth is a result of strategic pricing, increased contract compliance, improved customer support and a strong direct-sales effort.

The wholly owned AMA subsidiaries, AMA Insurance Agency Inc. and AMA Solutions, Inc., had another good year in 1999 with revenues of $23.9 million and after-tax net income of $4.8 million. Emphasis continues to be placed upon development of new products and enhancement of existing products for both the AMA PersonaLink and AMA PracticeLink product portfolios, designed to meet, respectively, the individuals needs of physicians and their families and the needs of their practice.

AMA/CMA Leadership Training Institute Seminars
The AMA, in conjunction with the California Medical Association (CMA), has developed a Leadership Training Institute for physicians. The Leadership Training Institute provides leadership seminars for physicians focusing on business leadership skills development. The seminars, designed to assist physicians in developing leadership skills not taught in business schools or management training programs, provide physicians the tools to succeed in a changing marketplace. The workshops bring top-ranking national leadership experts and accomplished leaders to work with physicians who have a potential for future leadership positions.

We are also providing seminars on making a successful career transition that focus on creating opportunities and making a change in career. Elements of the leadership skills seminars are incorporated into these programs.

Health Law

Health Law Division as advisor
The Office of General Counsel’s Health Law Division provides legal advice to the policy and advocacy initiatives of the AMA, including those undertaken by the AMA’s public and private sector advocacy and professional standards areas. A key function of the division is to provide educational materials on health law issues to AMA members and the Federation. The division also advances AMA policy in the courts and before other legal and regulatory bodies, provides information and advice to the specialty sections, and monitors and analyzes the health law issues that affect the AMA, its members and their patients.

Health Law Division as advocate
Working closely with the advocacy area, the Health Law Division has intensified efforts to cause the fraud and abuse laws to be applied in a manner that supports the physicians of this country.

The Health Law Division prepared a letter that was submitted by the AMA to the Office of Inspector General (OIG) of the Department of Health and Human Services, requesting it to investigate the practice of “exclusive credentialing” by some hospitals across the country. The OIG has the authority to issue a fraud alert to all health care providers warning that such practices violate the federal fraud laws and could subject violators to sanctions.

This practice of “exclusive credentialing” has been cropping up around the country as competition for patients increases. “Exclusive credentialing” is a method by which hospitals grant medical staff membership/privileges to those practitioners who are on its staff only, and not on other hospital staffs. Another method is to prohibit physicians from holding office or leadership positions at the hospital if that physician is also a member of another hospital medical staff. The AMA believes these practices may deprive patients of choice for quality health care and limit a physician’s ability to provide the best care possible to their patients.

The OIG has indicated it will review our request, and we look forward to an opportunity to meet with OIG to share many specific instances of these practices that have been reported to us by physicians across the country.

The AMA also has participated in two court cases in which the constitutionality of the False Claims Act is being challenged. Each of these cases calls into question the ability of private individual “bounty hunters” to bring claims under the act. The Office of General Counsel, working with our advocacy area, intends to continue and expand its scrutiny of fraud enforcement activities, with particular attention to challenging instances of prosecutorial overzealousness.

The division and the advocacy area have been collaborating to formulate a position in connection with the OIG’s issuance of proposed corporate compliance guidelines for small group practices. Health Law has begun developing new educational compliance materials for use by physicians and their representatives. These materials will enhance written compliance materials, as well as the CITS fraud compliance Web site, already developed by the AMA.

Health Law Division as legal information source
Health Law has prepared a comprehensive, annotated Model Physician Employment Agreement. This model will serve as a helpful reference for both employee and employer physicians because it provides a checklist of important considerations for the physician and a compilation of legal issues and laws that affect both employee and employer. This agreement is a useful tool for physicians who are entering into employment arrangement with hospitals, private practice groups or other private or institutional healthcare providers. It also can be used as a template for employer physicians. It is available free to members and Federation representatives.

Health Law Litigation; Litigation Center
The AMA, both alone and with the Litigation Center, has advanced the cause of physicians through the nation’s court system. Some highlights include:

• Physician payment issues – The AMA, with the Litigation Center, filed two class-action lawsuits against three large insurance companies. We contended that one of these insurance companies, Aetna U.S. Healthcare, systematically violates the Georgia prompt payment law. We claimed that the other two insurance companies, Metropolitan Life and United Healthcare, use faulty data when paying physicians on a uniform, customary and reasonable basis. With AMA support, a number of anesthesiologists secured a favorable settlement against Blue Cross of Wisconsin on issues involving improper bundling and downcoding of payment claims. The AMA sued the U.S. Department of Health and Human Services for failure to calculate the Sustainable Growth Rate correctly under the Medicare laws. In addition, the AMA filed an amicus curiae brief before the U.S. Supreme Court to argue that physicians should not be considered ERISA fiduciaries when performing clinical work.

• Physician deselection from managed care panels – The AMA, with the Litigation Center and the California Medical Association, filed an amicus brief which contends that a physician is entitled to “fair procedure” under California law when the physician is terminated without cause from an insurance company’s physician networks. Potvin v. Metropolitan Life Insurance Co. The California Supreme Court decided in favor of the physician. As a result, in California, most insurance companies no longer have carte blanche to “deselect” a physician from its panel of physicians without allowing them some procedure of due process.

Corporate Law Division
The Corporate Law Division of the Office of General Counsel provides a broad range of support to all of the operating units within the AMA and its subsidiaries. The division’s business law services include the structuring, negotiation and documentation of publishing, data licensing, vendor, e-commerce and other commercial transactions. In addition, the division provides the full range of corporate legal services to the AMA relating to employment law, benefits, real estate, taxation, governance and intellectual property protection and licensing.
In the last six months, the division has provided substantial services to the AMA’s business development team in connection with new and proposed ventures such as Medem.com, Inc., the digital certificate project with Intel, and proposed ventures including a national physician identifier product, a joint venture for enhancement and distribution of the Physician Masterfile, and an Internet-based CME business. The division continues to provide extensive legal services to AMA Solutions in connection with its products and services.

The Corporate Law Division recently negotiated a favorable settlement of the PMIC litigation involving a challenge to the validity of the AMA’s copyright in its CPT products. This case was started six years ago by PMIC and produced an appeal to the Ninth Circuit Court of Appeals. The Ninth Circuit upheld the CPT copyright, but also found that the exclusivity provision in the AMA’s license to HCFA constituted copyright misuse. The AMA cured the misuse by deleting the exclusivity provision from the licensing agreement. While the details of the settlement are confidential, it may be reported that PMIC has formally acknowledged AMA’s CPT copyright and has entered into a long-term licensing agreement. The parties have resumed a normal business relationship on terms that will be financially beneficial to the AMA.

Recently, the U.S. Patent and Trademark Office give the AMA a complete victory in another six-year-old dispute involving CPT. In 1994, Blue Cross and Blue Shield Association filed an opposition to the AMA’s application to register “CPT” as a trademark. The PTO considered detailed testimony by the AMA business managers responsible for CPT and rejected the Blues’ opposition. The PTO should issue the trademark registration without further delay.

The Corporate Law Division continues to assist in the development and monitoring of the legal parameters that allow the AMA to use Web technology in new products and services. The attorneys were instrumental in the development of the Medem Web site, representing the AMA in the discussions with the medical societies that founded the Web site. Through Corporate Law’s participation, the parties clearly defined the information owned by the various medical societies that will be available on the Web site, and the processes by which it will be reviewed, revised and made available to the public. Corporate Law also took steps to ensure the Web site will be launched with safeguards in place, so that it will meet AMA’s standards for advertising and sponsorship. The division has been an active participant in the discussions with Medem.com regarding the use of AMA information, name and logo in Medem.com’s business. Corporate Law attorneys also played a significant role in negotiating the terms of the equity investment by Whitney Partners.

With the termination of the American Medical Accreditation Program (AMAP), the Corporate Law Division worked closely with remaining AMAP staff to exit the AMAP business without generating legal claims. We have effected the termination of dozens of contracts with CVO and EOC vendors, state medical society sponsors and partners, and software vendors. As of the date of this report, no legal claims have been filed against the AMA.

Corporate Law continues to provide assistance to advance health and medical education, focusing on using new technology to deliver information. The division provides legal advice for the expanding area of licensing of JAMA, the Archives Journals and AMNews over the Internet and through other electronic media. The division provided legal services to develop the Web site, allowing access to the full text of JAMA and the Archives Journals.

Circulation of international licensed editions of JAMA and the Archives Journals has reached 434,600. The Corporate Law Division has undertaken an aggressive initiative of registering the JAMA trademark in foreign countries and opposing competing registrations. The AMA now has registrations of JAMA trademark completed or in progress in 17 countries.

The division also is protecting vigorously the JAMA trademark domestically, notifying misusers to cease promptly and, when necessary, filing suit to stop the use of JAMA’s name in advertising. The attorneys have managed the litigation against American Suzuki Motor Corporation for its misuse of JAMA’s name in its advertising for a motor vehicle. Suzuki cancelled the ad campaign, and discussions with Suzuki and its ad agency regarding a monetary settlement are underway.

As noted above, Corporate Law supports the activities of CPT where book sales and licensing activity continue to promote the goal of uniform coding. Corporate Law is assisting management in meeting the federal mandate requiring CPT to be available in a low cost and efficient manner with a particular focus on Internet availability. This year, more than 100 CPT license 250 agreements have been finalized this year.

The division provides legal support for the “Guides to the Evaluation of Permanent Impairment,” including the licensing and electronic media. The 5th edition, the first new edition in five years, is scheduled to be available in the year 2000.

Corporate Law continues to provide legal assistance to the AMA’s subsidiaries, as they increase their scope of products and services for physicians. Several agreements have been negotiated with providers of financing and practice products. An agreement to offer a long-term care insurance product was finalized.

The Corporate Law Division played a leading role in developing improved contracting procedures to streamline the contracting process. The new process will make better use of purchase orders, standard form agreements and master services agreements. One of the objectives of the improvements is to reduce the volume of contracts requiring OGC approval so that the division’s lawyers can concentrate on delivering the highest value legal services to the AMA.

The Office of Finance has been focusing its efforts on the 2000 strategic repositioning and strengthening financial policies and procedures. Additional efforts have gone toward redesigning financial budgeting and reporting processes to provide more timely and useful information for senior management and the Board of Trustees.

In the first half of 2000, Human Resources played an integral role in the planning and implementation of the AMA’s “repositioning project.”

• HR, along with OGC and Finance, was involved in the evaluation of repositioning/ downsizing options, which were proposed by managers across the organization. Decisions regarding the separation of employees were individually scrutinized to assure fairness, equity and conformance with established HR policies and legal requirements.

• Managers were provided with an orientation on “How to Conduct a Separation Meeting.” HR staff worked closely with unit managers and separated employees throughout the process to ensure the transition was carried out efficiently, yet with fairness and sensitivity. Separated employees were provided benefits information and consultation.

• A Career Transition Center was set-up to provide employees with immediate access to outside assistance from outplacement services and the Employee Assistance Program.

• Two sets of workshops on the changing work environment were developed and delivered in-house. “Managing in a Changing Environment” was designed to assist managers in understanding the typical behaviors and emotions people display during a major change event and to prepare them to deal with the concerns of the current workforce related to the repositioning. 125 managers attended these workshops. “Adapting to a Changing Environment,” was designed for non-managers to help them process recent organizational changes and learn practical strategies for dealing with change in a proactive and productive manner. These workshops are in progress and to date, 145 employees have registered.

HR continues its partnership with AMA management in delivering workshops on cultural change to increase organizational effectiveness. To date, more than 600 employees have completed the workshop on “Seven Habits of Highly Effective People.”

New initiatives are being introduced and existing ones are being expanded to attract, retain and develop employees. Special emphasis is placed on such initiatives because the recent repositioning and staff downsizing have affected employee morale and made recruitment of new employees more difficult. In addition, these non-monetary incentives, along with the AMA’s strong benefits and compensation package, will better position the association to meet the challenges of an excellent economy and increased competition for quality employees.

The AMA continues to enhance its strategic planning process to expand its information base and to increase stakeholder input. In addition, our new planning process will focus more at the programmatic level. The revised planning process provides a framework for the organization to evaluate risks and benefits of actions, allowing the AMA to make decisions that are in the best interest of the association and its members.

Council on Long Range Planning and Development

At the Annual Meeting, the Council on Long Range Planning and Development will issue its 2000 Environmental Analysis: Trends, Impacts and Opportunities report. This report provides the information foundation for the AMA’s annual strategic planning process.

Commission on Unity

The Commission on Unity will submit a report to the HOD at the 2000 Annual Meeting outlining its preliminary design for transforming the Federation of medicine, and will be asking the House of Delegates for its feedback.

Clearly, the AMA has much to be proud of early in this 21st century. We emerged from the repositioning process far better prepared to address the complex challenges of today’s health care sector, and we brought with us a valuable lesson that can be applied to everything we do: Organizations that strive to persevere – in spite of the obstacles they face – become stronger for it in the long-run.

The AMA is stronger – and more committed than ever to do what’s right for America’s physicians and their patients. We will continue our aggressive advocacy efforts on Capitol Hill, striving for patients’ rights and a level playing field with health care plans. We will continue our fight to protect the patient-physician relationship and resist heavy-handed government intrusions into medicine. We will continue developing the necessary innovations to make health care transactions on the Internet safe and secure. We will continue to address professional standards and pursue public health initiatives. And we will spread the good news from the AMA so that every physician in the nation recognizes the benefits of membership.

The AMA is sowing the seeds today that will determine the course of medicine tomorrow. With physicians and their patients, with Congressional leaders, with the media, and with the public, the AMA’s voice is being heard.

Respectfully submitted,