AMA House of Delegates Call for Elimination of Pay for Delay and ICD 10 – Plus Other Issues
In addition to the CME changes adopted at the American Medical Association (AMA) it’s Interim Meeting, the House of Delegates discussed, debated, and voted on several other important recommendations. For a full list of recommendations and other information about the Interim meeting can be found here.
The AMA voted to take on the drug industry's practice of "pay-for-delay" deals in which branded drug makers pay generics companies to hold off on flooding the market with cheaper generic versions of their medications. Several federal courts have addressed the effect these deals have on competition, and currently there is a “circuit split” among courts—some finding the deals valid for companies to protect their patents, with others deciding they are anti-competitive.
In addition, the house adopted policy directing the AMA to oppose cuts in federal funding for graduate medical education (GME) that would lead to the closure of residency programs or the dismissal of residents from current positions. “There’s a big concern that the government is not going to continue children’s hospital GME funding,” said Thomas McInerny, MD, a delegate for the American Academy of Pediatrics from Rochester, N.Y. “Children’s hospitals train the majority of pediatrics residents and fellows. So we’re very much in support of this resolution that we not dismiss residents and fellows from training.” Delegates also voted to expand the J-1 visa waiver program from 30 slots per state to 50 slots per state.
The House approved a Council on Medical Service report and recommendations that call for preserving traditional Medicare as an option for seniors, who also would have HMOs, PPOs and high-deductible plans paired with health savings accounts as coverage choices. The position builds on existing AMA policy, said Donna Sweet, MD, the council’s chair and an internist from Wichita, Kansas, told amednews.
According to the article, “The new policy says beneficiaries should have the ability to use a set federal subsidy to purchase coverage from competing health insurance plans. It also stipulates that health insurance coverage should be affordable for all beneficiaries by allowing annual updates to the defined contribution amount. Lower-income and sicker patients would receive larger subsidies to purchase insurance.”
Contribution amounts would be adjusted annually to reflect changes in health care costs and insurance fees. Current Medicare structure does not effectively protect patients against high out-of-pocket costs, the council report said. Nine of 10 beneficiaries have supplemental coverage.
Some physicians warned of the unintended consequences of moving to a defined-contribution system. Medicare currently is a defined-benefit program, but switching to defined contribution could interfere with the ability to engage with patients, said Glen Stream, MD, of Spokane, Wash., board chair of the American Academy of Family Physicians. “More patients will be more likely to choose high-deductible plans and less likely to avail themselves to necessary preventive and wellness services, as well as care for chronic conditions and illness,” Dr. Stream said in reference committee testimony Nov. 11.
Team-base care principles created
Delegates approved recommendations in a report addressing the need for interprofessional team-based care. The new policy defines what constitutes team-based care: A physician-led team works with each health professional on staff, along with patients and their families, to achieve coordinated and high-quality care. The principles for team-based care say physicians and other health professionals should make clear their team’s mission and values. The team also should be accountable for clinical care, quality improvement, efficiency of care and continuing education.
“The future of health care delivery is patient-centered and will require a team approach, and physicians and health care professionals need to be prepared to efficiently work together to provide quality patient care,” said Dr. Sirio. “The principles offered by this new policy can guide physician leaders of health care teams, helping to optimize patient-centered, coordinated, high-quality care.”
Autonomy protections articulated for employed physicians
Furthering the AMA’s previously stated goal to be “the lead association for employed physicians,” the house adopted policy outlining principles for physician employment that seek to protect doctors’ autonomy and put patient welfare ahead of employers’ interests. The adopted employment principles were contained in an AMA Board of Trustees report that spelled out guidelines on conflicts of interest, contracting, peer review and other matters affecting employed physicians.
One example of a conflict is when a health care organization requires or pressures its employed doctors to send referrals within the hospital or health system. The new policy says such practices should be disclosed to patients.
“We hope this will provide broad guidance for physicians and their employers as they strive to provide high-quality, cost-efficient care,” said William E. Kobler, MD, a member of the AMA Board of Trustees who presented the report in reference committee testimony. The house directed the AMA to disseminate the principles among graduating residents and fellows, and advocate for adoption of the guidelines by trade groups representing hospitals and medical groups.
AMA to study corporate practice of medicine
Delegates asked the AMA to study the evolving “corporate practice of medicine” — that is, when physicians are employed by nonphysician-run organizations — and see how it affects the patient-physician relationship, patient-centered care and related issues.
Second, delegates referred for study the question of whether the AMA should adopt the principle that doctors’ employment or contractual status should not affect their ability to hold medical staff leadership positions or participate in self-governance.
Automatic budget cuts targeted
The house directed the AMA to develop a fiscally responsible alternative that would prevent the automatic budget sequestration cuts that would reduce Medicare payment rates next year. Federal law mandates future budget deficits to be cut by roughly $1 trillion from 2013 to 2022. Congress and President Obama agreed to reduce spending across the board during 2011 negotiations to raise the federal debt ceiling. Medicaid and Social Security are protected from cuts, but Medicare payments are not, and pay would be lowered by 2% for physician services.
The sequestration of federal health programs is not just limited to Medicare, said Cranston, R.I., internist Yul D. Ejnes, MD, a delegate for the American College of Physicians. The budget mechanism will affect federal drug safety programs, physician work force growth initiatives and care to dependents of military personnel.
“Given the broad scope of sequestration and its impact on our patients and the work we do, we thought it was important to submit this resolution to get the message out in a timely manner to the Congress,” Dr. Ejnes said.
Delegates also adopted policy urging the Centers for Medicare & Medicaid Services to repay physicians for time and other costs associated with appealing an incorrect recovery audit contractor determination. Physicians get audited, but they have high rates of success when appealing demands for repayment.
Elimination of ICD-10 demanded
CMS should stop its planned use of the new diagnosis coding set ICD-10, delegates said. The policy states that the AMA immediately reiterate to CMS that the physician reporting burdens imposed by ICD-10 will force many small practices out of business. That message will be sent to all in Congress and displayed prominently on the AMA website.
CMS requires that ICD-10 will be the new standard to use for billing Medicare physician services starting Oct. 1, 2014. The coding set contains 68,000 codes, while the current standard ICD-9 has roughly 13,000. The AMA must continue to communicate to CMS about the burdens that ICD-10 implementation places on doctors, said W. Jeff Terry, MD, a delegate for the Medical Assn. of the State of Alabama and a urologist in Mobile.
“If we lose this fight, the doctors need to know we went to battle for them,” he said.
Immunization mandate approved
For the first time, the house backed an immunization mandate that applies to health professionals. Delegates voted to support mandatory, annual influenza vaccination for physicians and any other workers who have direct contact with patients in long-term-care settings. “Many health care organizations now have mandatory immunization,” said Eric Tangalos, MD, a delegate from Rochester, Minn., speaking on behalf of the American Medical Directors Assn., which proposed the policy. “It saves lives, saves money and keeps people on the job. And with regard to [this resolution], we’re talking about protecting the most frail, most vulnerable population of patients.”
Concerns about drug compounding
Delegates directed the AMA to monitor ongoing state and federal investigations of compounding pharmacies and encourage any new regulations needed to ensure patient safety.
Clinical Application of Next-Generation Genomic Sequencing
The house also adopted a Council on Science and Public Health Report on so-called next-generation genomic sequencing. An entire individual genome now can be sequenced within days, and the cost is expected to fall below $1,000 in the near future, the report said. Delegates adopted policy encouraging the development of standards for the appropriate clinical use of these genomic technologies and best practices for the laboratories performing the tests. The AMA also supported regulatory policy to enable physician use of next-generation sequencing, protect patient confidentiality, and enable physicians to access and use such diagnostic tools as clinically appropriate. The policy also calls on the AMA to inform and educate physicians and physicians-in-training on the clinical uses of these technologies.
Streamlining Prescription Refill Schedules
The AMA adopted policy encouraging relevant organizations to develop a plan to implement prescription refill schedule strategies so that patients requiring multiple prescription medications may reduce travel barriers to get their medications.
“Patients with chronic conditions often need multiple prescription medications to effectively manage their conditions, but some may not be able to easily go to the pharmacy multiple times in a month to pick up their various medications,” said AMA Board Member Monica C. Wehby, M.D. “By finding ways coordinate a patient’s medication refill schedules, we can make it easier for patients to successfully stick with their medication regimen.”
Supporting Medicaid Expansion
The Supreme Court’s decision on the Affordable Care Act determined that it is optional for states to expand Medicaid eligibility to 133 percent of the Federal Poverty Level (FPL). New policy adopted calls on the nation’s largest physician organization, at the invitation of state medical societies to advocate at the state level to expand Medicaid eligibility to 133 percent FPL. The new policy also calls on the AMA to advocate for an increase in Medicaid payments to physicians and improvements and innovations in Medicaid that will reduce administrative burdens and deliver healthcare services more efficiently, even as coverage is expanded.
Advocating for Hepatitis C Virus Education, Prevention, Screening and Treatment
New AMA policy adopted encourages the implementation of birth year-based screening practices for Hepatitis C in alignment with recent CDC recommendations. The policy also encourages the CDC and state Departments of Public Health to develop and coordinate Hepatitis C infection education and prevention efforts.
“If patients with Hepatitis C don’t realize they have the virus and don’t receive treatment, they are at risk for developing cirrhosis or liver cancer later in life,” said AMA Board Member Alexander Ding, M.D. “Millions don’t know they have this virus, but by encouraging the screening of patients born between 1945-1965, physicians can help their patients get the treatment they need to live longer, healthier lives.”
Improving Vaccination Coverage for Whooping Cough
The AMA also passed policy to urge Medicare to cover Tdap (Tetanus, Diptheria, Acellular Pertussis) vaccines under Medicare Part B. Tdap vaccinations are currently not reimbursed under Medicare Part B and rates of Pertussis, also known as whooping cough, are on the rise.
“The Tdap vaccination plays a critical role in preventing the spread of pertussis, also known as whooping cough,” said Dr. Harris. “It is important that Medicare Part B provide coverage for this vaccine to help protect patients from this serious illness.”
Eliminating Obstacles in Providing Care to Medicare and Medicaid Patients
Policy was adopted to seek federal legislation or regulatory changes to stop Medicare and Medicaid from decertifying physicians due to unpaid student loan debt. The current practice of decertifying physicians with outstanding loan debt stops them from accepting Medicare and Medicaid patients and undermines their ability to repay the student loans.
“Preventing a physician with outstanding student loan debt from participating in Medicare and Medicaid unnecessarily compromises access to care for patients,” said Dr. Harris. “Unpaid student loan debt should not stand in the way of physicians providing care to Medicare and Medicaid patients.”