AMA
The American Medical Association helps doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues.
AMA Interim Meeting 2011
The Western Mountain States Caucus (WMSC) comprises the AMA state delegates from Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming. Much like our own state of Colorado, there is a broad spread of political philosophy within the Conference. However, as an influence on the debates within the House of Delegates of the AMA -- and, therefore, within the House of Medicine-- it often serves as a wise and moderating contributor.
The process of the AMA HOD is similar to other medical organizations: issues that come before the HOD comprise Board and Council reports as well as submitted resolutions. These are all discussed and vetted in Reference Committees and the HOD votes on the final compilation from those committees. WMSC reviews those reference committee reports prior to voting in order to address any areas that people feel may need additional work or have had sufficient conflicting testimony that a unified statement from the Conference may inform that debate.
From the 2011 AMA Interim Meeting in New Orleans, the following had Conference support:
COUNCIL ON ETHICAL AND JUDICIAL AFFAIRS REPORT 1- PHYSICIAN STEWARDSHIP OF HEALTHCARE RESOURCES
This report provides guidance to support physicians in making fair, prudent, cost-conscious decisions for care that meet the needs of individual patients and help to ensure availability of health care for others.
Support for this report was unanimous within WMSC. However, the Reference Committee, because of concerns, recommended referral over the difficulty of making cost-conscious decisions.
RESOLUTION 1- EQUAL ACCESS TO ORGAN TRANSPLANTATION FOR MEDICAID BENEFICIARIES
This resolution asked our AMA to urge the Centers for Medicare and Medicaid Services to designate organ transplantation as a mandatory benefit under Medicaid such that coverage across the United States will be uniform and predictable.
WMSC supported referral: while the issue of need for treatment was recognized, WMSC also felt that states should make their own determination of how use limited resources and mandatory benefits could decrease access for other services. The proponents of this resolution used the example of Arizona’s Governor’s denial of transplantation for Medicaid beneficiaries. However, the Delegate from Arizona gave eloquent testimony, requesting referral, indicating that none of the patients were harmed by the action and mandates would favor expensive procedures --often for patients who had limited potential for benefit-- at the cost of treating other conditions due to limited funding.
The resolution was referred.
COUNCIL ON MEDICAL SERVICE REPORT 5 - MEDICAID WAIVERS: BLOCK GRANTS AND MAINTENANCE OF EFFORT REQUIREMENTS
There was consensus in support of changing the title by removing “block grants” to read:
MEDICAID WAIVERS AND MAINTENANCE OF EFFORT REQUIREMENTS
RESOLUTION 810
RESOLVED, That our American Medical Association advocates that state governments be given the freedom to develop and test different models for covering the insured, provided that their proposed alternatives a) meet or exceed the projected percentage of individuals covered under an individual responsibility requirement while maintaining or improving upon established levels of quality of care, b) ensure and maximize patient choice of physician and private health plan, and c) include reforms that eliminate denials for pre- existing conditions. (New HOD Policy)
This was initially a resolution that asked for AMA to support flexibility in covering the uninsured, including opting out of the individual mandate. The Reference Committee report amended the resolution to support freedom to develop and test different models but not specify any mechanism.
WMSC supported the amended resolution on the condition that guaranteed issue was added to the requirements in (c)
The HOD accepted the addition.
WMSC, similar to CMS-5 (above) supported state flexibility in financing but also wanted the patient protections of both prohibition of pre-existing exclusions and provision of guaranteed issue.
COUNCIL ON MEDICAL SERVICE REPORT 7 - PATIENT NAVIGATOR PROGRAMS
This council report provided guidelines for patient navigator and patient advocacy services. As defined, these services facilitate improved access to care and help patients manage difficult and complex aspects of the health care system. Although the report speaks primarily to clinical navigators who help manage access to complex treatment needs such as cancer care, it could apply equally to services provided through a state insurance exchange.
The guidelines included:
- The primary role of a patient navigator should be to foster patient empowerment b) Patient navigator programs should establish procedures to ensure direct communication between the navigator and the patient’s medical team. c) Patient navigators should refrain from any activity that could be construed as clinical in nature. d) Patient navigators should fully disclose relevant training, experience, and credentials. e) Patient navigators should fully disclose potential conflicts of interest, including employment arrangements,
WMSC supported adding clinical primacy of the physician and consideration of cost to the system in assessing navigator programs.
RESOLUTION 206 - CMS AUDITS OF ELECTRONIC HEALTH RECORDS
This was a resolution that recommended guidelines for Medicare and Medicaid auditors with respect to decisions made on content of electronic medical records. The resolution attempted to address decisions of incorrect coding based on the use of “pull forward technology” such as auto-population, templates, cloning, etc.
WMSC supported opposition to this resolution if it was extracted from the consent calendar. Although the reference committee recommendations were not unreasonable, WMSC felt that physicians need more information and education on appropriate use of timesaving technology.
A modified 206 passed.
The CMS delegation was unfortunately unsuccessful in adding an amendment to have the profession set guidelines for documentations in EMRs for the federal auditors to follow.
For instance, decision support, checklists and other types of information that improve quality and reliability are distinct from copy-and-paste activities. While much of the discussion was certainly “down in the weeds”, these are important issues for physicians, especially as we transition to newer technologies.
Other news...
The HOD Voted to mandate that the AMA stop implementation of ICD-10, if possible.
Overall, WMSC shows a consistent ability to come together in support of exploring new approaches that will improve the care of patients and help physicians navigate a continually changing landscape. We have good neighbors.
CMS Delegation to the AMA