Physicians were in a combative mood at this week's American Medical Association annual House of Delegates meeting in Chicago, picking fights with other healthcare groups and with each other. Some even turned on the AMA for its failure to achieve Medicare physician-payment reform and other lobbying priorities this year. But their leaders urged unity to achieve organized medicine's goals.
Nevertheless, delegates took strong stands that are sure to anger some healthcare industry stakeholders. They reaffirmed their position that physicians should be the “captain of the ship” in team-based care, a position quickly criticized by nurse practitioners. They also restated the AMA's controversial position
that doctors providing care through telemedicine should be licensed in the states where their patients reside. The Federation of State Medical Boards recently took a similar stand and was criticized by technology companies and health systems seeking to expand their telehealth services.
Dr. Barbara McAneny
, reelected to the AMA board as its new board chair, summed up the delegates' mood by pointing to physician frustration and the “hassle factor” connected with the plethora of quality reports doctors are required to file. “I know what it means to physicians to feel like a data-entry clerk,” she said.
In an interview, new AMA president Dr. Robert Wah
acknowledged the tension among AMA doctors. “We're in a time of change and uncertainty, and certainly some people respond to change and uncertainty with unease and anxiety,” said Wah, the organization's first Chinese-American president. “I choose to see change as an opportunity.”
Delegates railed against the required switch to the ICD-10 coding system and federal meaningful-use requirements for health information technology. The House of Delegates also instructed the AMA to lobby Congress to raise the Physician Payments Sunshine Act threshold for reporting drug and devicemakers' “transfers of value” to physicians from $10 to $100. “It's insulting, debasing and just gets us very angry,” said Dr. Charles Moss, a vascular surgeon from Elizabeth, N.J.
Among other new targets of physician ire were the newly implemented maintenance-of-certification programs
from the American Board of Medical Specialties and the Federation of State Medical Boards. The ABMS program has created a process of continuous education and assessment, in contrast to the previous system of certifying physicians in their specialty for life, or requiring them to take an exam once every seven years to recertify.
Some delegates urged the AMA to call for a moratorium on maintenance of certification (MOC) until a study was conducted on whether it improves patient outcomes. Delegates ultimately voted to oppose mandatory participation in MOC as a condition of licensure. Delegates blasted the Joint Commission
for recently restating its policy of not requiring patient-centered medical home practices to be physician-led to qualify for certification. The American Association of Nurse Practitioners responded with a statement from its co-president Angela Golden, saying health team leadership should be determined by a patient's condition and not “defined by a profession.”
Congress was a frequent target for delegates and AMA leaders. In her address to the delegates
, outgoing AMA president Dr. Ardis Dee Hoven stressed how close Congress came to repealing and replacing the Medicare sustainable growth-rate formula, only to have a bipartisan, bicameral agreement unravel at the last moment. “I saw politicians on both sides of the aisle—in the Senate and the House—voice their approval for the legislation,” Hoven said. “And then, a few weeks later, I saw those same politicians vote that bill down.”Dr. James Madara
, the AMA's executive vice president and CEO, emphasized the importance of “a clear and unified voice” in advancing the AMA's agenda. That unity was threatened by a resolution from unhappy delegates calling for an independent review of AMA lobbying efforts
. The measure cited the AMA's inability to kill the Medicare sustainable growth rate payment formula and ICD-10 implementation as evidence that such a review was necessary.
Some delegates accused supporters of the resolution of using the Medicare SGR issue as a ploy to renew criticism of the AMA board for its support of many of the key features of the Patient Protection and Affordable Act. Ultimately, delegates nixed the idea of an independent review of AMA advocacy and voted to merely bolster the reporting that was already being done.
One delegate pushed doctors to be more transparent about their prices, Dr. Marcy Zwelling-Aamot, an alternate delegate from California. “This is probably the most important thing we can deal with at this conference,” Zwelling-Aamot said, noting that she's been posting the prices she charges at her Los Alamitos concierge practice. “Put your big-boy pants on and post your prices,” she said.
At the meeting, Dr. Steven Stack
was chosen president-elect, the first emergency medicine specialist ever elected to that position at the AMA. And in winning the board's youngest physician seat, Dr. Jesse Ehrenfeld
became the AMA board's first openly gay trustee.Follow Andis Robeznieks on Twitter: @MHARobeznieks