Consistent with past practice, the American Medical Association lobbed another few salvos across the bow of the managed-care industry at its meeting in Chicago last week.
The House of Delegates called on the AMA to publish data on managed-care companies, specifically: premiums col-lected; administrative costs, including top salaried positions and bonuses; dividends to the shareholders; retained earnings; and the premiums actually expended on medical care for patients (medical-loss ratio).
The doctors also want to "publicize inappropriate diversion of healthcare dollars" by HMOs. To that end, the AMA will push legislation to require managed-care plans to publish financial information every year.
The National Committee for Quality Assurance, an accreditation group for HMOs, also came in for criticism. The NCQA, one doctor said, "is going to become progressively more of a problem for us." Another doctor said he had endured "the indignity of having my office reviewed for quality by the NCQA." He added, "Their quality standards are not physician-friendly."
A third said, "If there's going to be an office review, we should be involved in setting the standards for that."
At the meeting, the House approved model guidelines for nurse practition-ers, emphasizing their subordinate role to the physician.
"In an integrated practice with a nurse practitioner," the guidelines state, "the physician is responsible for supervising and coordinating care and, with the appropriate input of the nurse practitioner, ensuring the quality of healthcare provided to patients."
The AMA also will lobby states and localities to prevent laws that allow advanced-practice nurses to provide medical care without a doctor's supervision.
The American Nurses Association called the policy "Neanderthal," serving "only to protect physicians' turf and maintain their generous incomes," President Virginia Trotter Betts said.
Increased access to primary care "cannot be achieved unless a sufficient number of qualified providers is available to meet the needs of all citizens in all geographic locations," Betts said.
Many in the AMA, however, think there are too many doctors. Delegates discussed at length a resolution to reduce Medicare funding of residencies for foreign medical graduates.
The situation is dire, one doctor claimed: "In this country, at this time, there are hospitals that exploit their house staff as almost slave labor.
"If we don't do something to stem the tide of the uncontrolled expansion of the physician manpower in this country, we shall all be harmed."