American Medical Association (AMA)

Case study: How TN physicians are changing their practice

Anne Zieger — Tue, 22 Jul 2008 15:07:20 -0400

With Medicare cuts looming, many physicians vowed that they'd stop accepting Medicare patients entirely if and when the cuts went through. The thing is, even though Medicare cuts have been held off, large numbers of physicians are dropping out anyway. One example of this comes in Tennessee, where doctors are increasingly dropping out of the program. Not only are many refusing new Medicare patients, some are thinking about dropping current Medicare patients too. That's because in some cases, doctors aren't even getting paid enough to cover their expenses, they say.

The steady drop in Medicare physicians is putting a painful squeeze on the state's health system, which already includes an above-average number of Medicare beneficiaries and a below-average number of doctors who are willing to accept them. Given the current conditions, patients there may need to make dozens of calls--and wait months to be seen--to be cared for by a physician who takes Medicare.

Ultimately, Medicare will have to adjust its payment formula, physicians say. But that won't happen without intervention from Congress, which set the current system in place in 1997. (Perhaps our new president will make some changes next year?)

To learn more about this trend:
- read this piece in The Tennessean

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CA bill gives state extra power to fine insurers who don't pay providers

Anne Zieger — Tue, 15 Jul 2008 09:25:40 -0400

In what is sure to be a cliffhanger, a bill has gone to California governor Arnold Schwarzenegger (R) for his signature, which would give the state beefed up power to fine HMOs and PPOs that don't pay providers. The bill was passed by the California Assembly with reasonable margins in both houses.

The measure is vigorously supported by the American Medical Association, which argues that physician underpayment is a national problem--and calculates that doctors' costs for collecting from insurers are about $200 million per year. While the agency arguably has such powers already, it would give the state's Department of Managed Health Care more legal cover for fining health plans that underpay or fail to pay providers.

On the other hand, it's opposed by HMOs, which are asking Schwarzenegger to issue a veto. They contend that the bill is unnecessary, given that DMHC already has substantial regulatory powers. Perhaps more significantly, the measure is also opposed by the DMHC itself, whose attorneys believe that the new rules could force the agency to become "a bill collector for providers."

To learn more about the bill:
- read this Los Angeles Times piece

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AMA apologizes for past racist policies

Anne Zieger — Fri, 11 Jul 2008 09:12:04 -0400

The American Medical Association has issued a formal apology for racist actions in its past, including a policy that barred black physicians from its ranks for decades. In a commentary appearing in the July 16 Journal of the American Medical Association, AMA immediate past president Ronald Davis admitted that the group had not only excluded black doctors, but it had also failed to speak out during struggles over legislation designed to end racial discrimination.

In writing the JAMA column, Davis was following up on the work of a committee of experts convened by the AMA to examine the black-white tensions in U.S. medicine. The panel noted that the AMA had excluded black doctors from state and local associations, listed black doctors as "colored" in its national physician directory, failed to participate in debates over the Civil Rights Act of 1964, and for some years, refused to join efforts that would force hospitals built with federal funds not to engage in racial discrimination.

To learn more about the AMA's position:
- read this Washington Post article

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SPOTLIGHT: AMA says CMS 'no-pay' list is unrealistic

Anne Zieger — Mon, 30 Jun 2008 21:43:21 -0400

At its annual convention this year, the American Medical Association raised some serious objections to Medicare's new plan to stop paying for a list of up to 17 hospital-acquired conditions. Delegates at the convention said that the conditions on CMS's list aren't necessarily preventable, even if physicians are following evidence-based guidelines. They argue that CMS rules threaten to increase the practice of defense medicine and will ultimately expose physicians to additional lawsuits. Article

FDA to notify doctors of drug, device issues via Internet

Anne Zieger — Wed, 18 Jun 2008 11:21:15 -0400

Hoping to speed up the process by which doctors learn that a drug or device may pose a danger to patients, the Food and Drug Administration has started working with the AMA, physician specialty groups, drug and device manufacturers and liability insurers to promote an Internet-based warning system. Traditionally, doctors have received notifications via standard paper mail when the FDA learns that there's a threat involved with a drug or device. However, professionals hope that the new Health Care Notification Network will speed up the notification process dramatically. More than 100,000 doctors already have signed up for the HCNN, which should launch in July.

The service, which is free to physicians, is being funded by drug and device-makers. Network developer Medem Inc. estimates that using the HCNN, doctors should get notified of drug and device issues within a day or two, rather than the three to four weeks it now takes for drug and device-makers to draft a letter, get FDA approval, print and mail it out. The AMA, which is one of seven medical societies behind Medem, is encouraging its members to enroll.

To learn more about the network:
- read this AMNews article

AMA medical tourism policy emphasizes care quality

Anne Zieger — Wed, 18 Jun 2008 08:53:12 -0400

As part of its annual conference, the American Medical Association has taken its first official stand on the principles it believes should govern the provision of care for medical tourists. In the principles, members seem focused on making sure employers and payers don't force patients to get substandard care or care that doesn't include adequate follow-up. (To date, we here at FierceHealthcare haven't seen any evidence that patients are being forced to go overseas or, if they choose to go, are being forced to accept inadequate care, but I suppose the AMA wants to stay ahead of the issue.)

In its new policy statement, the AMA addressed not only patient care, but also the financing of that care. First and foremost, it's advocating that employers, insurance companies and other middlemen in the medical tourism process follow several voluntary guidelines. Among other things, it's advocating that medical care outside of the U.S. is voluntary, that financial incentives to seek care outside the U.S. should not limit care alternatives and that patients should only be referred to providers accredited by international accrediting bodies like the Joint Commission International. It's also advocating that prior to any medical travel, patients should be able to arrange and establish financing for local follow-up care when they come back to make sure continuity of care is maintained.

To learn more about the AMA's new policy:
- read this AMA statement (.pdf)

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AMA issues first health insurer report card

Anne Zieger — Tue, 17 Jun 2008 12:28:49 -0400

Increasingly, providers and their vendors have begun to rate insurance companies. This comes in part as a means of turning the tables on the insurers who, some say, have become far too focused on rating and ranking providers. The latest to enter the "rate your insurer" sweepstakes is now the American Medical Association, which issued its first health insurance report card yesterday at the group's annual meeting. The report card, which purports to be an attempt to cut the cost of claims processing for doctors, compares payment rates for Medicare and seven national commercial health plans on how quickly and accurately they pay claims. The report card is based on a random sample taken from 3 million claims.

According to the report card, UnitedHealthcare has the lowest rate of contract compliance, with about 62 percent of medical services billed paid by UHC at the contracted rate, compared with 98 percent for Medicare and 71 percent for Aetna. Medicare actually performed better than private insurers in most areas, in part because it isn't obliged to constantly prove to employer customers that it's being tough on costs, observers noted.

To learn more about the report card:
- read this Associated Press piece

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AMA debates ethics of hospital 'mystery shoppers'

Anne Zieger — Mon, 16 Jun 2008 11:20:00 -0400

These days, it's far from unusual for hospitals and clinics to send undercover patients in to check out how the staff treats them. Administrators say such phantom patients--better known as "mystery shoppers" in the retail world--can help them get a realistic picture of the experience real patients have when they visit their facility. However, to date such practices haven't had the official approval of organized medicine--and some doctors actually have suggested that such patients can crowd out 'real' patients from getting the timely care they may need.

At this year's American Medical Association, the ethics council is going to take an official vote as to whether the trade group should endorse the use of mystery shoppers. The AMA's proposal doesn't offer blanket approval for the practice. Still, the ethics group will include recommendations that mystery shoppers don't interfere with the treatment of real ones, that doctors are warned that undercover patients may be coming through, and that doctors aren't punished if they get bad reviews.

To learn more about the discussion:
- read this Associated Press article

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FTC slams IL physicians' retail clinic rules

Anne Zieger — Mon, 16 Jun 2008 09:13:53 -0400

In a move that could set back national physician efforts to control the evolution of retail clinics, the Federal Trade Commission has labeled retail clinic regs backed by Illinois doctors as anti-competitive and bad for consumers. The FTC letter criticizes a bill pending in the Illinois state legislature that would require permits for the facilities, limit their capacity for advertising and mandate greater physician involvement in their operations. It issued the critique at the request of a state legislator who asked for the agency's input on the pending bill.

The FTC, in short, said it didn't like what it saw. "Because several of the bill's requirements would pertain only to retail clinics--and not other health-care facilities offering the same services or staffing--those requirements could put retail clinics at a competitive disadvantage without offering countervailing consumer benefits," the agency said.

Even this critique may not stop the Illinois State Medical Society, which has been a vocal opponent of retail clinic models. However, the FTC's input has shaped how regulations have evolved in other states, such as Massachusetts, where state health officials dropped proposals to regulate retail clinic ads on FTC advice.

To learn more about the FTC's position:
- read this Chicago Tribune piece

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Study: Patients don't typically use online ratings

Anne Zieger — Mon, 16 Jun 2008 01:02:08 -0400

Though physicians fear that their business will be adversely affected by off-the-cuff online ratings, few patients actually make use of such ratings, according to new research. A Harris Interactive poll commissioned by the California HealthCare Foundation concluded that while more than 80 percent of the state's adults use the web for health information, less than one-quarter have made use of physician ratings sites. More significantly, only 2 percent of those surveyed had changed doctors based on ratings-site information. Even fewer (1 percent) changed hospitals or health plans based on data from ratings sites. All that being said, more people are looking at physician ratings sites than they were three years ago. Harris found that the number of people who looked at physician ratings sites climbed from 14 percent in 2004 to 22 percent in 2007.

Even though consumers aren't heavily influenced by web ratings today, medical groups are well aware that things can change. For that reason, the AMA continues to monitor the practice of physicians ratings online, and has occasionally taken action to oppose such schemes.

To learn more about the study:
- read this AMNews article