2010 AMA Annual Meeting, Organized Medical Staff Section (OMSS)

Disposition of Actions

 The following actions were taken by the American Medical Association Organized Medical Staff

Section (AMA-OMSS) at its June 10-12, Annual Meeting. Also, where the AMA House of

Delegates (HOD) subsequently acted on the Section’s business it is also noted. If you would like

more information on any of the items listed below, please contact the Department of Organized

Medical Staff Services at (312) 464-5622, or e-mail omss@ama-assn.org.

Resolution 6 – Consistency of Pharmaceutical Therapy

 AMERICAN MEDICAL ASSOCIATION ORGANIZED MEDICAL STAFF SECTION

Resolution:  A10

Introduced by:      Matthew D. Gold, M.D.

Referred to:           Reference Committee      

Whereas, Improving health care quality, access, equity, and cost effectiveness as well as promoting a sound public health system are part of the AMA strategic priorities; and

Whereas, Due to the necessity to control health care costs, a number of new initiatives from industry and government have been proposed with little input from practicing physicians; and

Whereas, Certain disorders (e.g., epilepsy) require consistency of pharmaceutical product, specifically bioequivalence, from one manufactured batch to another, in order effectively to be controlled. (Bioavailability is a term that describes the rate and extent that a drug is absorbed, e.g., reaches the inferior vena cava or systemic circulation. Bioequivalence is the term for pharmaceutical equivalents that show similar bioavailability when studied under similar experimental conditions.  Blood levels for the generic and standard products should be very similar undefined the inference that equal blood levels of drug for both products result in equal therapeutic effects[1][1]; and

Whereas, In the opinion of many, mandated use of generic products results in prohibitive restrictions on access to, and costs for, consistently manufactured pharmaceuticals (usually in Branded form); and

Whereas, The difference, batch to batch, in bioequivalence of generic products may be as high as 40% (by existing FDA regulation: “Code of Federal Regulation: Bioavailability and Bioequivalence Requirements”, vol. 21, Part 320, U.S. Government Printing Office, Washington, DC 20000) relative to the reference listed (i.e., branded) drug [RLD]; and

Whereas, our AMA represents the position that the practice of medicine should be under the direction of those trained and experienced in that practice, and so licensed; therefore, be it

RESOLVED, That our AMA vigorously oppose any industry or government initiative or existing requirement, proclamation and/or legislation that  contradicts the assessment of qualified medical practitioners, and thereby constrains the use of consistently manufactured pharmaceutical products where medical evidence categorically supports that use.

OMSS ACTION: Resolution 6 adopted and transmitted to the HOD for the 2010 Annual

Meeting.

 RESOLVED, That our AMA vigorously oppose any industry or government initiative or

existing requirement, proclamation and/or legislation that contradicts the assessment of

qualified medical practitioners, and thereby constrains the use of consistently manufactured

pharmaceutical products where medical evidence categorically supports that use (New

HOD Policy).

 HOD Action: Policy H-125.984 Generic Drugs be reaffirmed in lieu of Resolution 525.

OMSS Resolution 9 – Pre-Authorization Abuse

 AMERICAN MEDICAL ASSOCIATION ORGANIZED MEDICAL STAFF SECTION

Resolution:  A10

Introduced by:      Matthew D. Gold, M.D.

Subject:                 Abuse of Preauthorization Procedures

Referred to:           Reference Committee      

Whereas, Improving health care quality, access, equity, and cost-effectiveness are AMA strategic priorities; and

Whereas, The practices of mandating preauthorization requirements for prescription medications; using excessively stringent criteria for certain widely performed tests and procedures; and using first-line reviewers unqualified to render competent judgment about clinical appropriateness appears to have escalated; and

Whereas, Numerous inefficiencies employed in the process of preauthorization serve no apparent purpose other than to discourage prescribing/ordering of medications and tests. (For example, automated telephone lines not specifying which choice should be made for preauthorization; repeated requests for basic data at each level of contact; delegated prescription management services who are once removed from the preauthorizing third party without specifying accurate directions where to contact; asking questions already present on the original script or requisition); and

Whereas, The proliferation of said preauthorization has increased to the point of interference in the efficient delivery of quality medical care as practiced by the vast majority of medical practitioners; and

Whereas, The cumulative effect of such preauthorization procedures is an intrusion into the practice of medicine to the point of constituting the practice of medicine itself by non-professionals, non-physicians, and/or non-treating physicians ? or those unqualified to understand the individual circumstances (e.g., allergies, co-morbidities, other patient-centered factors) of a given patient situation; and

Whereas, Emphasis on cost control over the specific medical knowledge and experience that the practitioner has already applied to the individual patient’s care is periodically counterproductive to the cost savings inherent in the care that has been properly provided; and

Whereas, The effect of a denial of payment inexorably leads to the reduction in the patient’s compliance and treatment; and

Whereas, The preauthorization process costs the physician and his/her staff time and the contribution of the physician’s expertise; therefore, be it