Choosing their words with the utmost of care and leaving no nit unpicked, the American Medical Association's House of Delegates adopted a resolution calling for an end to government-imposed barriers to electronic prescribing during their annual meeting in Chicago Tuesday, and they managed to do it without being late for lunch.
They also rejected a proposal to insert a phrase calling for the privacy protection of patients' pharmacy data, with opponents arguing they were not opposed to the idea, but that it was not germane to the issue before them.
The original resolution, introduced by the AMA's Texas delegation, noted that "antiquated federal rules and regulations are one significant impediment to the widespread adoption of the e-prescribing of prescription drugs and controlled substances," and argued that "physicians' acceptance would significantly increase in the absence of federal administrative barriers."
It also called for the removal of all federal Medicare and state Medicaid requirements mandating the use of paper prescription forms for certain drugs, that the AMA initiate discussions with the federal Drug Enforcement Administration to allow e-prescribing of schedule 2 drugs, and that Medicare or Medicaid payments not be contingent upon adoption of e-prescribing.
The proposed resolution was brought before the House of Delegates' Reference Committee B, which handles legislative matters, and the physicians on the committee recommended that the House of Delegates pass the resolution in lieu of two other similar proposed resolutions.
They also recommended that the following phrase be added: "Resolved, that our AMA work with federal and private entities to ensure universal acceptance by pharmacies of electronically transmitted prescriptions."
But that was just the beginning of the amendment proposals.
Ronald Kirkland, a Jackson, Tenn.-based otolaryngologist serving as a delegate representing the American Medical Group Association, proposed removing the language advocating against Medicare or Medicaid payments being contingent upon adoption of e-prescribing, and replacing it with this phrase "that our AMA advocate for appropriate financial incentives to physicians to facilitate electronic-prescribing adoption."
Kirkland explained that the replacement would be "the same concept in a more positive way."
A delegate from Pennsylvania then spoke to support the AMGA proposal and the original language, explaining that it was important to specifically take a stand against any government e-prescribing mandates.
Alnoor Malick, a delegate from Texas representing the American College of Allergy, Asthma & Immunology, proposed removing the word "financial" from before the word "incentive" in the AMGA's proposed amendment.
"I don't think all incentives have to be financial," he said.
AMA Board Trustee Steven Stack, a Lexington, Ky.-based emergency physician, noted that the AMA has received some bad press that called the association a barrier to e-prescribing, but also said that there was another message "clearly out there."
"We do not support mandates, period," Stack said. "We absolutely do not support unfunded mandates, period."
Richard Corlin, the 2001-02 AMA president, expressed skepticism on any positive impact of the discussion, noting that some government official will take a look at the resolution and within a "millisecond" decide that one financial incentive would be to pay doctors less than they already are.
San Antonio neurologist Sheldon Gross, speaking for the Texas delegation, strongly objected to changing the original language that was against any CMS e-prescribing mandates, and he argued thatas writtenthe resolution seeks to ensure that physicians are not punished if they are "unable to participate" in e-prescribing.
Hugh Vincent, an anesthesiologist from Mill Valley, Calif., cited how the debate was now mainly "about potential minefields we might step in," and moved to have the matter referred to the AMA Board of Trustees for review at a later date.
His motion was seconded but loudly voted down by a voice vote.
A delegate from Pennsylvania called for a vote on whether to delete the clause pertaining to Medicare and Medicaid as the AMGA's Kirkland had proposed. This time the delegates voted electronically, and 73% opted to keep the anti-CMS language in the resolution.
Marcy Zwelling-Aamot, a Los Alamitos, Calif.-based internist, called for an amendment to safeguard patient privacy. She suggested the following be added: "Resolve that our AMA advocate for protection of our patients' privacy with respect to the sale of pharmacy data."
She added that, while the AMA could still advocate for the use of such data in scientific studies, it "must stand tall to protect the privacy of our patients."
Instead, Gross rose to oppose Zwelling-Aamot's motion. He noted that he was doing so not because he was against what she was saying, but that privacy and removing government barriers to e-prescribing were two separate issues.
His comments were followed by applause.
William Rosenblatt, a New York plastic surgeon, asked the presiding AMA officials to rule on whether Zwelling-Aamot's proposal was germane to the discussion. But Andrew Gurman, an Altoona, Pa.-based orthopedic hand surgeon serving as vice speaker of the House of Delegates, said it was up to delegates to decide if Zwelling-Aamot's proposal was germane. A voice vote was taken and the proposed privacy amendment was loudly voted down.
"We don't think it's germane," Gurman quipped.
American Gastroenterological Association alternate delegate Peter Kaufman, who acknowledged that he works for a company (DrFirst Corp.) that does e-prescribing, suggested that the resolution should be changed to say Medicare and Medicaid payment should "not be reduced" if physicians do not use e-prescribing as Congress may be leaning toward paying physicians who e-prescribe more than those who do not.
After this proposal was bandied about, American Academy of Neurology delegate Michael Williams suggested taking a break for lunch so the interested parties could "wordsmith."
Gross from Texas argued against tabling the discussion. But American Academy of Family Physicians delegate Colette Willins backed Williams.
"We need to get this verbiage right," she argued. "It's time for lunch."
A voice vote was ruled inconclusive despite the loud votes against tabling the discussion coming from the Texas delegation.
"Texas, this is the last time you sit in front of the room," Gurman said with a smirk, as he called for a vote using "the clickers."
The official tally had 277 votes or 57% voting against the motion to break for lunch, while 208 delegates or 43% voted to table.
"The irony is we have to break for lunch in a couple minutes anyway," Gurman said.
With that message received, a Minnesota delegate moved to call for an immediate vote, and his motion was loudly seconded.
The resolution was adopted via a very loud voice vote, and now the AMA can say it officially stands for removing government barriers to e-prescribing.
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