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AMA to Joint Commission We are the head of the medical household

AMA to Joint Commission: We're the head of the medical household

By Andis Robeznieks
Posted: June 10, 2014 - 7:45 am ET

The American Medical Association House of Delegates lashed out at the Joint Commission for suggesting that someone besides a physician could lead a patient-centered medical home healthcare team. But the delegates backed off a previous call to initiate a study comparing the cost and quality of care of nurse- and physician-led practices.

Delegates spent about an hour carefully choosing the words they would use in a policy resolution to express their anger at the Joint Commission for restating its long-held position that nurse-led care teams could qualify for its primary care medical home certification. The restatement was included on a frequently-asked-questions page posted on the Joint Commission website June 3.

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While the Joint Commission was originally singled out in the resolution, delegates broadened the language to register AMA opposition to any interpretation by any entity that the patient-centered medical home can be anything other than physician-led.

The Joint Commission, which has certified 1,138 practice sites as primary-care medical homes, is not the only entity that doesn't include physician leadership as a requirement for medical home recognition.

The National Committee for Quality Assurance, which has the most popular program, having recognized 7,525 practices as medical homes since May 2008, doesn't require physician leadership. Neither do the Accreditation Association for Ambulatory Health Care and URAC. All say an organization can provide the attributes of a medical home—such as care coordination and enhanced patient communication—without a doctor being in charge.

Delegates deleted from the original resolution a call to conduct a study on comparing physician-led and nonphysician-led medical homes in terms of quality of care, per-patient expenditures, total healthcare costs, access to care and patient outcomes.

Dr. Michael Greene, former president of the Medical Association of Georgia and a family physician from Macon, said he wasn't concerned about being compared to nonphysicians. But Greene said a quality comparison would probably consist mainly of who checked certain boxes on a form. Another doctor warned that the criteria used in any quality comparison would probably have as much value as the government's “meaningless-use” requirements for health information technology.

Former AMA Board Chairwoman Dr. Rebecca Patchin, who was a nurse before becoming an anesthesiologist, now chairs the Joint Commission board. She told delegates she was confident that the offending words would be removed from the Joint Commission website and that a root-cause analysis was being conducted to see how they got there in the first place.

Patchin is one of seven AMA appointees on the Joint Commission's 32-person board.

After the measure was approved via voice vote, Dr. Michael Simon, the immediate past president of the New York State Society of Anesthesiologists, encouraged delegates to “take a moment to applaud those seven people in that board room.”

“That was probably very much out of order, but very much appreciated,” said House of Delegates Speaker Dr. Andrew Gurman, who serves as the meeting's parliamentarian.

Delegates also approved without debate a report produced by the AMA Council on Medical Service on defining guidelines for a physician-led healthcare team.

The report called for patient- and family-centered care to be prioritized by the healthcare team and approved by the team's physician leader. The report also recommended that a relationship be established at the onset of care and that the role of each team member be explained to the patient.

"Teamwork in a healthcare setting between physicians and nonphysician practitioners is important as the medical community works to better coordinate care to ensure patients get the best possible care," Dr. Ardis Hoven, AMA president, said in a news release. "The policy passed today will help physicians transition to new care models by promoting flexibility to develop practice designs based on physician needs, the populations they serve, relevant state laws, and protection from the burdens that would come from a one-size-fits-all approach."

The American Association of Nurse Practitioners had its own take on the report: A patient's needs should determine who leads a team and leadership should not be “defined by a profession.”

“The American Association of Nurse Practitioners disagrees with the Council on Medical Service's overarching premise that physicians are best suited to lead healthcare teams,” Angela Golden, co-president of the AANP, said in a prepared statement. “Instead, we believe that team-based care is best thought of as a multidisciplinary, non-hierarchical collaborative centered around a patient's needs.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks

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