FOR THOSE OF YOU WHO THINK the MASSACHUSETTS NEUROLOGIC ASSOCIATION, MASSACHUSETTS MEDICAL SOCIETY, the AMA AND ORGANIZED MEDICINE IN GENERAL HAVE NOT BEEN ADVOCATING ON BEHALF OF MEDICINE, A SAMPLE OF ACTIONS RECENTLY AT THE AMERICAN MEDICAL ASSOCIATION INFLUENCED BY MNA AND OTHER MASSACHUSETTS PHYSICIANS AND INSTITUTIONS is presented below.

 A Preamble:

As MNA Delegate to the MMS House of Delegates (HOD), I have proposed resolutions, a number of which were successfully passed, as an individual. I became a member of the Organized Medical Staff Section (OMSS) of MMS, coming into contact with other thoughtful activists and further leveraging my influence within the Society. Even more exciting, I was introduced to the OMSS of the AMA and became a delegate. This is one of six main subsections of AMA and resolutions passed there go immediately to the HOD of the AMA for consideration. I have been successful with resolutions at OMSS; the fate of those resolutions has been more meager at the AMA HOD for a few procedural reasons.

WHAT IS IMPORTANT TO RECOGNIZE IS THAT ANY PHYSICIAN IS ELIGIBLE TO JOIN THE AMA OMSS, PARTICULARLY IF a) A member of a medical staff and, (to vote), b) a member of AMA.

WE NEED MORE NEUROLOGISTS AT THE AMA OMSS AND HOPEFULLY AT THE AMA HOD, though the American Academy of Neurology also has a presence at AMA.

I urge each of you to consider becoming more active in advocacy, and the easiest and most leveraged way is via the OMSS of the AMA… (Contact me if you are interested or want more information: mdgold@massmed.org )

Below are results at the June, 2011 Annual meeting of the AMA as a result of actions originated in the OMSS. See also the accompanying listing of the White Paper of the AMA just published in respect to Preauthorization – an initiative also originating in OMSS! [The first three listed were mine; below that, other initiatives of Massachusetts OMSS and individual physicians.]

 PROCEEDINGS

OF THE AMERICAN MEDICAL ASSOCIATION

ORGANIZED MEDICAL STAFF SECTION ASSEMBLY

2011 ANNUAL MEETING

JUNE 16-18, 2011

CHICAGO, ILLINOIS

7. MEDICAL LIABILITY OF THIRD PARTIES

Introduced by Matthew Gold, MD

OMSS ACTION:

 ADOPTED AS FOLLOWS AND TRANSMITTED TO THE HOUSE OF DELEGATES FOR CONSIDERATION AT THE 2011 ANNUAL MEETING

RESOLVED, That our American Medical Association foster legislation at the national level in the 112th Congress (2011-2012) that changes federal law to prohibit the exemption from liability of managed care organizations, including ERISA plans, for damages resulting from their policies, procedures, or administrative actions taken in relation to patient care.

HOD ACTION: RESOLUTION 235 REFERRED FOR DECISION

8. REIMBURSEMENT FOR PREAUTHORIZATION WORK

Introduced by Matthew Gold, MD

OMSS ACTION:

 ADOPTED AS FOLLOWS AND TRANSMITTED TO THE HOUSE OF DELEGATES FOR CONSIDERATION AT THE 2011 ANNUAL MEETING

RESOLVED, That our AMA will foster, via regulatory or legislative means, creation of a

mechanism (beyond RBRVS) to receive payment for the professional time and office expense involved in each preauthorization encounter; and be it further

RESOLVED, That reimbursement for the professional time and office expense involved in each preauthorization encounter be mandated and proportionate to the physician’s value in face-to-face patient interactions (but not less than a quarter of an hour).

HOD ACTION: EXISTING AMA POLICY REAFFIRMED IN LIEU OF RESOLUTION 721.

9. REDIRECTING TORT REFORM

Introduced by Matthew Gold, MD

OMSS ACTION:

 REFERRED TO THE GOVERNING COUNCIL

RESOLVED, That our American Medical Association renew its efforts to advocate for tort reform by realigning its arguments to legislators, third party payers, and the public by advancing to a higher priority – and visibility - the following principles:

Tort reform efforts should acknowledge that considerations of cost to society is a legitimate factor in the design of the medical malpractice and tort system as it applies to medical delivery systems in general, in addition to the right of the individual citizen to seek redress of grievous wrongs.

Tort reform efforts should acknowledge the basic principle of a balance between privilege and responsibility; i.e., that practitioners cannot be held solely liable for outcomes under circumstances where they are not in full control of the implementation of medical management.

Tort reform should include the allowance of the factor of cost vs. probable benefit (or low probability thereof) of a test as a valid tort defense in actions claiming failure to diagnose, especially in instances of uncommon or clinically silent disorders.

Cost-containment systems (of any payer) should be held legally liable for the consequences of imposition of barriers to timely and medically appropriate testing and treatment.

Physicians can be allies, rather than adversaries, in the pursuit of a more efficient, yet still quality, healthcare delivery system by linking the concept of tort reform with the empowerment of physicians to use more clinical discretion in selection, or avoidance, of tests without fear of excessive liability (as well as cost containment micromanagement constraints).

10. IMPROVING COORDINATION OF CARE FOR PATIENTS

ENTERING AND LEAVING THE HOSPITAL

Introduced by the Massachusetts Medical Society Organized Medical Staff Section

OMSS ACTION: ADOPTED AS FOLLOWS AND TRANSMITTED TO THE HOUSE OF DELEGATES FOR CONSIDERATION AT THE 2011 ANNUAL MEETING

RESOLVED, That our American Medical Association (AMA) explore new mechanisms to facilitate and incentivize communication and transmission of data to the admitting hospitalist for timely coordination of care (via telephone, fax, e-mail, or face-to-face communication) and from the hospitalist to the outpatient doctor.

HOD ACTION: RESOLUTION 722 ADOPTED AS FOLLOWS

RESOLVED, That our American Medical Association explore new mechanisms to facilitate and incentivize communication and transmission of data for timely coordination of care (via telephone, fax, e-mail, or face-to-face communication) between the hospital-based physician and the primary physician.

11. REGIONAL HEALTH INFORMATION TECHNOLOGY AND

CLINICAL INTEGRATION OF INDEPENDENT PRACTICES

Introduced by Ronald Dunlap, MD,

and the Massachusetts Medical Society Organized Medical Staff Section

OMSS ACTION: REFERRED TO THE GOVERNING COUNCIL FOR DECISION

RESOLVED, That our American Medical Association assist smaller physician practices in assessing the legal and organizational issues involved in forming Regional Medical Corporations or Limited Liability Corporations (LLCs) required to implement interoperable and interconnected HIT systems.

12. BEST PRACTICE OF MEDICINE: THE CONSCIENCE CLAUSE

Introduced by Elizabeth Curtis, MD

OMSS ACTION: REFERRED TO THE GOVERNING COUNCIL FOR DECISION

RESOLVED, That our American Medical Association (AMA) reaffirm its support for a physician’s individual right to practice medicine in accordance with his or her code of ethics; and be it further

RESOLVED, That our AMA communicate its support for a physician’s individual right to practice medicine in accordance with his or her code of ethics in a formal letter to President Obama; and be it further

RESOLVED, That our AMA release statements for physicians to post in their offices acknowledging the AMA's support for allowing each physician to practice medicine in compliance with his or her code of ethics.

13. VIRTUAL ACCOUNTABLE CARE ORGANIZATIONS AND

CLINICAL INTEGRATION OF INDEPENDENT PRACTICES

Introduced by Ronald Dunlap, MD, and the Massachusetts Medical Society Organized Medical Staff Section

OMSS ACTION: REFERRED TO THE GOVERNING COUNCIL FOR DECISION

RESOLVED, That our American Medical Association investigate the structure and process of formation of “Virtual Accountable Care Organizations” (V-ACOs) that include:

1. A legal and organizational structure;

1.       An analysis of successful implementation and contracting done by V-ACOs;

2.       The development of a strategy for the structure and formation of interoperable and interconnected regional Health Information Technology systems for V-ACOs, independent practice associations, physician hospital organizations, etc.;

3.       Education of physician groups regarding this option;

4.       Assistance in the development of templates for performance standards, including quality metrics leveraging information from peer-review journals, local, national and specialty organizations, and other policy leaders involved in the process; and

5.       The analysis of regional differences in health care delivery as a part of tailoring such an organization to regional and/or community needs.

14. COMBATING ENHANCED LAWSUIT FUNDING

Introduced by Lee Ansel, MD

OMSS ACTION: ADOPTED AND TRANSMITTED TO THE HOUSE OF DELEGATES FOR CONSIDERATION AT THE 2011 ANNUAL MEETING

RESOLVED, That our American Medical Association (AMA) examine, state by state, laws addressing the financing of medical malpractice lawsuits by private equity sources and other lenders; and be it further

RESOLVED, That our AMA support those states where financing of medical malpractice lawsuits by private equity sources and other lenders is now illegal, and devise strategies to combat efforts in those states considering overturning such protections; and be it further

RESOLVED, That our AMA report back to the House of Delegates on this issue at the 2011 Interim Meeting.

HOD ACTION: RESOLUTION 236 ADOPTED