Attendees of the American Medical Association's annual House of Delegates meeting in Chicago will wrestle with an estimated 250 reports and resolutions addressing the hot problems affecting physicians in contemporary medicine, including medical malpractice, Medicare reimbursements, patient privacy, quality of care and healthcare information technology.
Paul Wertsch, M.D., past president of the Wisconsin Medical Society, will be leading the push from his state's delegation at the June 12-16 meeting to require the AMA to advocate for standards that would facilitate interoperability of clinical IT systems.
The Madison, Wis.-based family practitioner also will speak for a plan that would entail cost-sharing for IT among healthcare providers, insurers and the government.
Wertsch's 10-physician Wildwood Family Clinic has not yet purchased an electronic medical records system. Physicians there are still shopping, in part due to the uncertainty about data exchange between their group, other physicians and the hospitals, he said.
"I don't want to spend all my money buying a Betamax model and everybody else ending up with VHS," Wertsch said, recalling the dueling standards for home video technology of the 1980s. "I think it's going to be very important to the future of medicine to have electronic records, but I only want to switch over once."
On the back-office side of IT, one of several resolutions offered by the Medical Society of the State of New York deals with problems by physicians over claims handled by the giant clearinghouse WebMD. In April, the state society approved and made a "priority item" a resolution calling on the AMA to explore taking legal action against the Elmwood Park, N.J.-based IT company for claims-processing problems.
Problems with WebMD have not been isolated to New York. In January, the AMA, the American Academy of Family Physicians, the American College of Physicians and state medical societies in Arkansas, Colorado, Iowa, Kentucky and Texas signed on to a two-page letter of complaint to WebMD CEO Roger Holstein alleging physicians were suffering financial losses from botched electronic claims processing dating back to the September 2003. (See Claims problems plague groups working with WebMD, ModernPhysician.com, Jan. 28 -- purchase required.)
The problems were linked to WebMD's efforts to comply with data-transmission standards under the Health Insurance Portability and Accountability Act of 1996, which went into effect last year.
Nor do the problems appear to be settled, despite a February meeting between WebMD and AMA officials on the issue, a meeting that both sides referred to as positive and productive. According to an AMA source, the association continues to receive complaints about mishandled claims.
Franklin Zeplowitz, M.D., a general surgeon and former hospital vice president of medical affairs from Buffalo, N.Y., said he will deliver the two-part resolution because the New York society has "had complaints from physicians from all over the state. They're still having problems."
"The first half, we're asking the AMA to continue its efforts to solve the problem with WebMD," Zeplowitz said. In the second part, he said, "We're asking our House of Delegates to consult with legal counsel regarding legal action against WebMD" and see if it is possible to "hold WebMD liable for losses physicians have suffered from delayed claims."
"We are working closely with the AMA and state medical societies to address any issues and we take them seriously and believe we are making excellent progress," said Jennifer Meyer, vice president of corporate communications for WebMD. "Any specific issues we are made aware of we immediately resolve.
"Again, we take these issues very seriously," she said.
Richard Teer, M.D., vice president of the New York society and a surgeon from Buffalo, will carry a resolution asking the AMA to oppose any limitation on a physician's ability to prescribe medications for off-label uses. The resolution is particularly timely with the advent of Medicare prescription drug discount cards and the Medicare Part D drug benefit, Teer said.
"One of the fears is with the new Medicare drug discount card, some of the carriers won't reimburse the patients for those drugs when they're not used for an FDA-approved indication," Teer said.
For example, he said, diabetics and frostbite victims who suffer from the burning pain or numbness of peripheral neuropathy find relief from their symptoms in certain drugs that are approved by the Food and Drug Administration only for psychiatric indications.
"In practice, physicians out there in the trenches don't have a lot (else) to offer these patients," Teer said. "These drugs do help, and patients get benefit, but currently the FDA does not approve those drugs for some of those uses."
Another New York resolution calls for Medicare payment increases of 10.6% to match the federal payment increases given in the Medicare Prescription Drug, Improvement and Modernization Act of 2003 to insurance companies with Medicare managed-care programs.
"It's fairness, that's all," said William Rosenblatt, M.D., a Manhattan plastic surgeon and the state society's president. "They're throwing them (the payers) such a bone, why are doctors going to get the short end of it? We've had to go to Congress and beg and plead just to stay even. Your malpractice premiums go up at a much higher rate than overall inflation. We're just trying to keep our heads above water."
Other resolutions call for the AMA to support:
- Tax credits for physicians who provide services to the uninsured (Oklahoma)
- Reimportation of prescription drugs (District of Columbia)
- Federal legislation requiring pharmacy benefit managers to disclose their rebates from pharmaceutical manufacturers (Illinois)
- Patient surcharges to cover soaring medical malpractice costs (D.C.)