More news from the AMA's House of Delegates meeting last week:
Tobacco industry settlement. The AMA leadership came under fire for participation in a coalition that is seeking a settlement with the tobacco industry. Rejecting the recommendation of one of its committees, the House restated AMA opposition to "any civil immunity" for tobacco. But a proposal for the AMA to consider withdrawal from the Effective National Action to Control Tobacco (ENACT) Coalition failed to win approval. The proposal was made by the American College of Radiology and the American Society for Therapeutic Radiology and Oncology. Critics said ENACT's public health goals aim too low. AMA past President Lonnie Bristow, M.D., secretary of the Center for Tobacco-Free Kids, a coalition member, called the critics "zealots" who "want nothing less than the destroyed, bleeding body of the industry."
Medical marijuana. Delegates called for "free and unfettered exchange of information on treatment alternatives" without criminal penalties for physicians or patients. The vote followed emotional stories from physicians about relief provided by marijuana use. Delegates rejected a policy of blanket legal protections for medical marijuana, citing the need for well-controlled clinical studies. They urged the National Institutes of Health to facilitate grants for such studies.
Resident physician organizing. The AMA will urge the American Council for Graduate Medical Education to require teaching institutions to develop resident physician organizations with "substantive empowerment" to address issues of patient care and working conditions. Concerns included deficient support staff and equipment, workloads that compromise patient safety, unsuitable rest areas and unlit parking lots. Delegates opted against a resolution calling on staff to file an amicus brief in support of residents at Boston Medical Center who are seeking to unionize under the National Labor Relations Act. Instead, it urged the board of trustees to decide when and if to file a brief as a last resort. "We view this as a collaborative and collegial process," said C. Darren Duvall, chairman of the AMA's Resident Physicians Governing Council. "The best way to address these concerns is through requirements on hospitals imposed by the (ACGME) rather than through unions, which expose residents to the obligation to strike." During a committee hearing, there was no discussion of wage and hour issues. Speakers generally opposed unions, citing potential changes in student-faculty relationships. Some speakers, however, cited fruitful collective bargaining at teaching institutions in California, Illinois and Michigan.
Physician-hospital relations. The AMA will study the growing use of hospitalists, physicians who specialize in inpatient care, in response to a request by the California delegation. It also will look at how primary-care physicians who relinquish their hospital privileges to teams of hospitalists can maintain their skills, scope of practice and health plan participation. In a separate action, the AMA adopted the principle that hospitals should not limit medical staff privileges of physicians who are on staff at competing hospitals. In a third area of concern, physicians testified about problems related to medical practices contracting with hospital-run management services organizations for billing and collections. The board of trustees was directed to examine fraud and abuse liability, unpaid bills and other problems related to the growing use of MSOs.
Managed care. The AMA released a model managed-care contract on the heels of its public bashing of Aetna U.S. Healthcare for refusing to negotiate with individual physicians and medical groups. The AMA said it wanted delegates to take the contract home to fellow doctors, state legislators, consumer groups and health plans. Trustee William Mahood, M.D., called it a reasonable compromise rather than a physician wish list. "We have tried for years to get physicians to review these contracts with their lawyers, but that has not worked well because of the imbalance of power between the physicians and the plans," Mahood said. The American Association of Health Plans said it had not been consulted about the model contract and had not had an opportunity to review it as of late last week.
Milliman & Robertson guidelines. The AMA and the National Committee for Quality Assurance will seek to study health insurers' use of Milliman & Robertson guidelines to recommend lengths of hospital stays.