The American Medical Association's decisionmaking processes "began to reel out of control" last year when top officers entered talks with U.S. congressional leaders on legislation cracking down on "partial birth" abortions, says a report to the AMA's leadership.
The report said it was unlikely that AMA officials discussed a quid pro quo with Republican congressional leaders, asking for favorable Medicare legislation in exchange for support on the abortion ban. Yet it said both the AMA and the GOP were "keenly aware" of Congress' ability to help or hurt the AMA's membership through changes in Medicare payment policy.
The consulting firm Booz-Allen & Hamilton prepared the report, which was commissioned by an ad hoc AMA committee appointed by the AMA's House of Delegates at a December 1997 meeting.
In lending its support to the ban on partial-birth abortions in May 1997, the AMA reversed its stance, angering many of its members and the pro-choice community.
It notified Congress of its ban endorsement on the same day that it submitted a list of its priorities on Medicare payment policies; at the time, Congress was preparing to draft the Balanced Budget Act of 1997 (May 26, 1997, p. 3).
The report said the AMA board of trustees' decision to designate its members to negotiate with the Republican leadership put the group at "significant risk."
The report will be formally presented to the AMA's House of Delegates at its December meeting.
Audrey Nelson, M.D., chairman of the ad hoc committee, said the report was drafted with the aim of improving AMA governance to better serve members and the public.
The report concludes that the AMA's culture is "one of power and control, where political considerations often take precedence over the profession's needs."
It also said the AMA's governing bodies-the board, the House of Delegates and numerous councils-operate independently and often have overlapping roles.
An instance of that came during the AMA's negotiations on partial-birth abortions, when the board circumvented the AMA's normal policymaking body, the House of Delegates, the report said.
The board took its actions in May 1997 because the U.S. Senate was likely to vote on the issue before the House of Delegates could meet in June 1997, according to the report. Yet no evidence shows how the board decided the matter was urgent enough for it to bypass the House, the report said.
Specifically on Medicare, the AMA had asked that some payment cuts for surgeons be delayed until 2000 and that physician payment spending targets be set at 2 percentage points above the gross domestic product. Neither request happened, but the AMA did win a delay in resource-based practice expense implementation.
Congress passed the ban on partial-birth abortions, but it was vetoed by President Clinton.
In appointing trustees to negotiate with bill sponsors, the AMA put itself in the hands of unskilled negotiators who were "ill-prepared," the report said.
"In the process, the AMA risked its reputation and emerged from this decisionmaking process appearing to its stakeholders and the public as a poorly managed organization on the wrong side of the issue," the report said.