The American Medical Association, which long has proclaimed itself the foremost patient advocate among provider and insurer groups, is waffling on its support of proposed patient protection bills on Capitol Hill.
Critics say the AMA is putting physicians' competitive interests above those of the patients they serve. AMA executives, though, say they're just waiting for the right patient protection bill to come along.
Last week, a top AMA official confirmed that the nation's largest physician organization is not supporting the most prominent patient protection bill floated to date because a provision in the bill would force health plans to contract with limited license practitioners.
Such practitioners, including nurse anesthetists and chiropractors, could compete with physicians for certain services.
The sponsor of the bill, Rep. Charles Norwood (R-Ga.), is a dentist.
Still, Norwood's bill, dubbed the Patient Access to Responsible Care Act, or PARCA, has drawn support from more than 200 members from both political parties in the House.
Fearing that the bill's regulatory provisions would drive up their operating costs, the health insurance industry opposes the bill, as does the business community, which would be hit with any subsequent premium increases.
The lone provider group to go on record against the bill is the Premier hospital alliance, whose members want to get into the Medicare provider-sponsored organization insurance business (Feb. 16, p. 6).
While not taking quite the public stand that Premier has, the AMA doesn't support the bill either.
The anti-discrimination language would tie up the courts for years with practitioners claiming that their services are equal to those of physicians and that they deserve inclusion on provider panels and equal compensation, said Richard Deem, the AMA's vice president of federal affairs and coalitions.
Deem said the organization of 293,500 physicians considers patient protection to be a "priority issue." But Deem said the AMA has not come out in favor of any patient protection legislation, including the Norwood bill, because it wants to wait until more legislation has been developed. For example, there still may be a bill from Republican leadership or a revision of PARCA.
But at least one organized medicine group, the Massachusetts Medical Society, believes the AMA should back Norwood.
"This is a major opportunity for organized medicine to fulfill its mission to be the No. 1 advocate for patients," said Allan Goroll, M.D., president of the state group. "It may require accepting some minor parts of the bill that are economically disadvantageous to physicians in return for fundamental reforms in patient access, patient choice, fundamental professionalism and overall consumer protection."
Many observers attribute the AMA's reluctance to support the legislation to its close ties to GOP leadership, which has characterized Norwood's bill and other managed-care reform measures as backdoor attempts to implement regulation-heavy national healthcare reform like the Clinton plan that failed four years ago.
"It does seem like they've backed off that PARCA-like stance," said one healthcare lobbyist, who asked not to be identified. "It's not a Republican thing to do, and I think their members figured that out."
Other observers speculated that the AMA may not want to anger the leadership at a time when the AMA also wants Congress to pass legislation allowing physicians to contract privately -- and without restriction -- with Med-icare beneficiaries for Medicare-covered services.