The American Medical Association's support for physician ownership of specialty hospitals threatens to alienate a large section of the organization's core membership -- family physicians.
Six months after the Chicago-based doctors' group threw its considerable political weight behind specialty hospitals, the 94,000-member American Academy of Family Physicians may protest the policy when the AMA gathers in Chicago beginning June 18 for the annual meeting of its 543-member House of Delegates.
The outlook for the coming year is uncertain. The American Hospital Association and the Federation of American Hospitals jointly said recently that there's "sufficient breathing room to approve legislation" by the end of the year. Still, the Government Accountability Office reported last week that as many as 37 new specialty hospitals could open in the next year or so even if Congress extends the moratorium on physician referral to these niche facilities.
The AAFP, whose 16 representatives on the AMA's House of Delegates rank it No. 1 with specialty groups, supports an extension of the federal moratorium on physician referrals to niche hospitals in which those doctors hold a financial interest. The moratorium officially ended June 8. Officials with the family doctors' organization, taking sides with the American Hospital Association over their colleagues in the AMA on this divisive issue, believe that specialty facilities may threaten community hospitals.
"We think the moratorium should be continued," said Michael Fleming, a Shreveport, La., physician who chairs the AAFP's board of directors. "We feel very strongly on this issue. It's very contentious, particularly in states like Kansas and South Dakota, where community hospitals have had a real issue because of the impact of specialty hospitals."
The debate over specialty hospitals is one of several hot topics expected to be addressed at the AMA's five-day annual meeting. Others include pay-for-performance, liability surcharges in physician offices and a discussion about how the AMA should address concerns over a looming physician shortage.
The AAFP, with about 14,500 members in the AMA, is the only big specialty group to publicly oppose the AMA's official position on a controversial issue that has divided the two key sectors of the industry -- doctors and hospitals. The nation's biggest specialty society -- the American College of Physicians, with about 116,000 members -- has remained officially neutral on the issue. Like the AMA, the ACP represents a wide mix of doctors ranging from internists to cardiologists who often hold diametrically different viewpoints on the issue. "We don't really have a position, so we really can't comment" on the AMA's policy, said one ACP spokesman, quoting Robert Doherty, senior vice president of government affairs and public policy.
AMA officials, meanwhile, said they have received widespread support among the rank-and-file membership for the new policy on specialty hospitals, which was adopted in December 2004. William Plested, a physician who is a member of the AMA's board of trustees, welcomed the end of the ban, saying, "Patients can now continue to benefit from the increased choice and competition that results from specialty hospitals."
While some in Congress are seeking a permanent ban, there appears to be considerable opposition to further limits on competition other than plans to alter the payment system to address differences in case severity that will make it tougher for niche facilities to treat only the most profitable patients. CMS officials said they will delay certification of any new specialty hospital for the rest of this year, a move that amounts to a de facto moratorium and gives Congress time to address community hospitals' concerns.
The AAFP's policy, adopted in January, calls for continuing the moratorium "until such time that the (organization) is convinced by evidence of (surgical hospitals') benefit on the health and well-being of our communities." Fleming said the AAFP wants more concrete information on the impact of niche hospitals before it reassesses its policy.