ACLM Delegate Meeting Report

AMA Interim Meeting 2014

ACLM Delegate Meeting Report

The 2014 Interim Meeting of the AMA House of Delegates (HOD) was held at the Hilton-Anatole in Dallas, Texas from Nov. 8-10. It was scheduled to go another half day, but finished early in an unusual show of unanimity of opinion.

Among the items of general interest were Ebola which was the subject of multiple resolutions and was reported upon at length bya CDC Expert,the high cost of some drugs and the unavailability of others, and Veterans Medical Care which was elucidated by the Secretary of Veterans Affairs.

Important concerns for practicing physicians were the impending implementation of ICD-10 which the AMA opposes because of the enormous expense and confusion of transitioning to a new coding for all of the various flavors of EHRs. This will increase the number of hospital based codes nearly 30 times with 87,000 new codes. Another is the need to repeal and replace SGR (Sustainable Growth Rate) Legislation in order to avert a potential 35%.reduction in Medicare fees. There was even hope that this could be done during the current “lame duck” session.

Of interest to those who practice in several states directly or through telemedicine ismodel legislation, the Interstate Compact for Medical Licensure,developed by the Federation of State Medical Boards (FSMB).In it, the practice of medicine is defined as taking place where the patient receives care, requiring the physician to be licensed in that state and under the jurisdiction of that state’s medical board. Regulatory authority will remain with the participating state medical boards, rather than being delegated to the new commission which will administer the compact. In effect it will be a form of regularized reciprocity. Participation in the Compact is voluntary for both physicians and state boards of medicine. So far, at least 10 Boards have adopted this legislation.

The AMA Code of Ethics is complex having been put together at many different times. The Council on Ethics and Judicial Affairs (CEJA) has been trying to rewrite it since 2008to make it coherent and more understandable. . It was examined with concern by delegates from states such as Ohio where the Code is written into the State law and violations of the AMA Code may be considered crimes. CEJA’s first effort was scrutinized by the HOD at length and then sent back for more work. Meanwhile, it is online on the AMA Website and open for comment until the end of the year.

The Stark Law is being used by some employers as a reason to limit physician compensation. A resolution calling for its repeal was referred to the Board of Trustees (BOT) to deal with because the law’s primary purpose was to limit fraud and abuse, with which purpose the HOD agrees. One speaker expressed the belief that Representative Stark himself wanted repeal of the part of the law used to limit employed physician pay. The shift in medical care to large hospital chain dominated systems with employed physicians is leading to a call for study of possible physician unionization under Federal labor law.

The Maintenance of Certification (MOC) initiativeby some ABMS Members, especially the Board of Medicine (ABIM),to label the holders of “life-long” Certificatesas notkeeping up with medical progress was attacked as being primarily just a way to force more of the doctors who currently have themto take the overpriced programs of the boards, since a currently valid Certificate is usually a requirement for medical staff privileges. The AMA does not believe that MOC should be a mandated requirement for licensure, credentialing or reimbursement (Res 920).

Litigation: The status of litigation by the AMA and constituent societies was the subject of a seminar. One of the major casesin which the AMA is amicus isin a case regarding the Florida legislation promoted by the NRA,Title XLVI 790.338, limiting the right of physicians to ask about firearms in the home. This law is contested in Wollschlaeger, et.al. v. Scott, et. al. The plaintiff, a general practitioner,is suing the Florida Governor on First Amendment grounds. The case may go to the US Supreme Court after a divided verdict of an 11th Circuit panel. Another is North Carolina State Board of Dental Examiners v. FTC, U.S. No 13-534 with oral arguments before the Supreme Court on Oct 14. This is regarding the FTC contention that the Board of Dental Examiners are just representing a monopoly which seeks to prevent competitors from entering the business of whitening teeth versus the position that this is a state body, with state immunity, regulating for the benefit of preserving quality in dentistry.

Suits involving malpractice cases included a Colorado Supreme Court Case: Kelly v. Haralampopoulos No 11SC889 about hearsay evidence of cocaine use in a sudden cardiac arrest during anesthesia. In Washington the plaintiffs want to sue the hospital when they can’t identify the responsible physician for a “compartment” syndrome. Tort reform itself has the AMA helping in cases in New Mexico, California (3), Florida, Montana, and Utah

Other subjects of AMA involvement in suits included several against insurance companies for understating calculations of “usual, customary and reasonable” charges in Connecticut, New York and California and one in North Carolina involving a faulty state Medicaid payment computer system.

Another major subject is medical staff Issues with suits in Minnesota and Arkansas. Scope of practice suits are AMA supported in Colorado, Texas, and South Carolina.

A 2nd Circuit case addresses the problem of payment for Medicare patients who stay in the hospital for more than a day but are not “admitted” just “observed” because CMS decides retroactively that they were not hospitalized and, therefore, not eligible for Part A Medicare payment.

Peer Review Confidentiality is the issue in Michigan (2), Utah, and Kentucky cases.

Respectfully submitted,

Richard S. Wilbur MD JD FCLM

AMA Delegate