When the 144th annual meeting of the American Medical Association House of Delegates convenes in Chicago this week, delegates will take up a number of proposed resolutions that reflect the diminished economic bargaining power of physicians.
The resolutions, submitted by state medical societies and reference committees, could become policy for the nation's largest doctors' organization if approved by the 432-member body.
Many of the resolutions and reports prepared for the meeting seek to put doctors on a stronger footing relative to other economic agents in the changing healthcare system, including insurance companies, HMOs, hospitals and the federal government. Some resolutions would restrict activities of those other groups.
Among other things, resolutions call for changes to:
Exempt physician office laboratories from compliance with the Clinical Laboratory Improvement Act, or repeal it, on the grounds that the act is burdensome and expensive while yielding few benefits to anybody. Another resolution would exempt physician offices from compliance with the Occupational Safety and Health Act, "since sound medical practice already addresses proper precautions for employees providing patient care."
Mandate that managed-care companies contribute toward care of the uninsured. AMA policy advises doctors to donate 10% of their time to indigent care; the Pennsylvania delegation wants to see this obligation shared by HMOs.
Relax antitrust laws to permit physicians to behave more like insurance companies and HMOs. A separate proposal would repeal the McCarran-Ferguson Act, which exempts the insurance industry from federal antitrust regulation.
Prohibit economic credentialing of physicians by managed-care companies and hospitals.
Advise states to regulate nurse practitioners very tightly.
Study clinics run by insurance companies to make sure doctors are able to maintain high standards and be patient advocates.
Dissolve the National Practitioner Data Bank, and keep it closed to the public.