AMA House of Delegates Meetings in 2006

2006 Annual Meeting
Texans putting their boot print on AMA . Another Texan won a spot on the American Medical Association Board of Trustees and the 155th Annual Meeting of the AMA House of Delegates adopted numerous new policy positions that would further Texas Medical Association's Healthy Vision 2010 at the national level.

More than 100 Texas physicians, residents, and medical students representing TMA, various sections, and national specialty societies participated in the June 10-14 meeting in Chicago. The house adopted two of the four resolutions the Texas delegation carried to the meeting on behalf of the TMA House of Delegates, and Texans ascended to several AMA leadership positions.

House begins to get Healthy Vision . Delegates debated numerous issues that tie closely to Healthy Vision 2010, TMA's strategic blueprint to increase accountability, efficiency, and effectiveness in the Texas health care system. The agenda item that produced the longest discussion centered on a proposal recommending that Americans purchase basic health coverage.

At a minimum, delegates said, upper-middle class individuals and families should obtain coverage for catastrophic health care and evidence-based preventive health care. The policy would extend to the rest of the population when and if Congress adopts AMA's long-standing policy of providing refundable tax credits or other subsidies for health care coverage.

"This country is not going to abide the continued rise of the uninsured," Arlington general surgeon Bohn Allen, MD, a former TMA president, said in support of the proposal from the AMA Council on Medical Service. The house rejected a call to put off the new policy until after evaluating the first two years of results of the individual insurance mandate Massachusetts recently enacted.

TMA's Healthy Vision calls for Texas to "provide access to affordable health care and an appropriate medical home to all of our residents. We must focus our efforts on working poor families - the uninsured and underinsured."

The AMA delegates' healthy vision also covered these issues:

• Transparency: The house called on the health insurance industry to stop trying to conceal its pricing systems for medical services.
• Access to Quality Care: Delegates decided store-based health clinics need to have well-defined and limited scopes of services, and they must establish and follow appropriate, evidence-based patient care protocols.
• Prevention: To combat cardiovascular disease, the house called on the food industry and federal regulators to reduce the sodium content in processed and restaurant-served foods by 50 percent over the next decade. On the obesity front, delegates came up two votes short of recommending a "small" state and federal excise tax on sugar-sweetened soft drinks.
• Adequate Physician Workforce: The house called on the federal government not to cut Medicare graduate medical education payments for the time residents spend in didactic lectures.
• Scope of Practice: Delegates decided that "doctor nurses" better make sure they identify themselves to patients as nurses, and their nurse doctoral training programs better not misrepresent what they or their graduates can do.
• End-of-Life Care: The house directed AMA to better inform the public (through public and private health insurance systems and state driver's license agencies) and physicians about the importance of advance directives and better end-of-life care planning.

Dr. Annis wins . After days and weeks of one-on-one campaigning by the candidate and the full Texas Delegation to the AMA, Austin anesthesiologist Joseph P. Annis, MD, won election to the AMA Board of Trustees. "The AMA remains the most credible national voice for physicians and the patients who depend on us every day," Dr. Annis said. "It is my honor and privilege to join the Board of Trustees in the effort to keep this voice strong and America's patients safe."

Dr. Annis was one of six candidates, including three incumbents, seeking four seats on the board. He was the only non-incumbent to win. He joins Jim Rohack, MD, of Temple, a former TMA president, on the AMA board. Dr. Annis thanked his family, the Texas and New Hampshire delegations to the AMA, the American Society of Anesthesiologists, TMA staff, and his campaign manager: Carolyn Evans, MD, of Dallas. "It's a great day for American medicine and a great day for Texas," said Texas Delegation Chair Susan Rudd Bailey, MD, of Fort Worth.

In other election news:

• San Antonio pediatrician Rajam Ramamurthy, MD, became the first delegate to the AMA house from the American Association of Physicians of Indian Origin (AAPI). Dr. Ramamurthy took her seat shortly after delegates voted to grant AAPI formal representation in the house.
• Dawn Buckingham, MD, an Austin ophthalmologist, won election to the governing council of the AMA Young Physician Section.
• Andrew Brenner, MD, of San Antonio lost his bid for the resident/fellow position on the Council on Science and Public Health.

Two Texas resolutions advance . Physicians from the rest of the nation must think their Texas colleagues learned an important thing or two from Hurricanes Katrina and Rita last year. With a few minor improvements, the AMA House of Delegates unanimously adopted TMA's proposal to improve disaster preparedness and response. The Texas resolution focuses on educating physicians about licensure and medical liability issues during disasters, improving health care in mass evacuation shelters, and developing templates for private practice/office continuity plans.

The house incorporated another TMA proposal into a broad new set of recommendations to improve the distribution of influenza vaccine. Physicians caring for high-risk patients, not discount stores and grocers serving the general public, should receive the first shipments of influenza vaccine each year, the Texas resolution said.

Two other Texas resolutions were well-received, but the house decided they repeated existing AMA policy, which was reaffirmed in lieu of the Texas proposals. They asked AMA to:

• Support legislation to prohibit, with criminal penalties, the release of Drug Enforcement Administration license numbers for illegitimate purposes; and
• Take a lead role in reworking - and renaming - so-called "pay for performance" programs.

Immigration debate reaches AMA house . Legal immigrants to the U.S. would have needed health insurance cards along with their green cards under a proposal the house debated. Led by a South Texas physician, though, delegates decided the issue needs further study before it becomes AMA policy. "Is this the image American medicine wants to send: We're happy to have you in our country but only if you can pay for your own health care?" San Antonio pediatric neurologist Sheldon Gross, MD, asked the house. When his grandparents emigrated to America in the 1880s, Dr. Gross said, "they weren't carrying a card from Blue Cross-Blue Shield of Russia."

The house did, however, decide that the Border Patrol, Customs Office, Department of Homeland Security, or other federal agency should pay for the health care of undocumented foreign nationals in custody when they deliver them to U.S. physicians and hospitals for medical care. Delegates also called on AMA to lobby policymakers to take into account how new immigration laws and rules will affect physicians, hospitals, Medicare, and Medicaid.

A new generation of leaders . In addition to Dr. Annis, who moved from chair of the AMA Council on Medical Service to his new spot on the board, several other Texas physicians changed AMA leadership seats - either just for the Chicago meeting or for a longer term. Dr. Evans moved up to become chair of the Council on Long Range Planning and Development, while Houston psychiatrist Priscilla Ray, MD, finished her year as chair of the influential Council on Judicial and Ethical Affairs.

Four Texans served on reference committees for this session of the house. TMA Board of Trustees Chair C. Bruce Malone, MD, of Austin, chaired the reference committee on medical practice. John Zerwas, MD, of Richmond, who chaired the reference committee on legislation, may have more legislative committee work in his future. Dr. Zerwas is also the Republican nominee for Texas House of Representatives District 28, east of Houston. Mary Dale Peterson, MD, of Corpus Christi, served on the reference committee on amendments to constitution and bylaws. TMA Council on Socioeconomics Chair Susan Strate, MD, of Wichita Falls, worked on the reference committee on medical service.

William Plested, MD, a California thoracic and cardiovascular surgeon, was installed as AMA president and called on physicians to stand up and "seize the day" to overcome the nation's health care problems. "We are, I would contend, witnessing a combination of circumstances favorable for change," he said, "and we are the ones-we, America's physicians-to lead that change." Dr. Plested will be a featured speaker at TMA Fall Conference in Austin on Sept. 30.

Ronald Davis, MD, of Detroit, was chosen president-elect without opposition. When he takes office as president next year, he will become the first prevention medicine specialist to lead the AMA.

2007 Interim Meeting
Delegates struggle with Medicare cuts … again . Twin angst over then-pending cuts in Medicare payments coupled with the government's insistence on adding a pay-for-performance feature to the senior citizens' health care program dominated the hallway conversations and formal debate at the American Medical Association's House of Delegates.

More than 150 Texas physicians and medical students representing the Texas Medical Association and various sections and national specialty societies participated in the Nov. 11-14 meeting in Las Vegas, Nev. The house unanimously adopted both of the resolutions the Texans brought to the meeting

Enough is enough . The delegates gathered in Las Vegas just days after the Democrats recaptured control of the U.S. Senate and House of Representatives. The election results further clouded prospects that Congress would override the Medicare reimbursement cuts during the Republicans' waning days in power. The annual end-of-the-year showdown came about as physicians once again found themselves asking Congress to undo cuts required due to what many call the unsustainable Sustainable Growth Rate (SGR) formula.

AMA President William G. Plested III, MD, reminded the house that the Centers for Medicare and Medicaid Services (CMS) had already determined that the SGR mandated not only a 5-percent reimbursement cut in January 2007 but also reductions of at least 40 percent over the ensuing nine years. All the while, he said, physicians' operating costs continue to climb. 

"So, what is the message CMS and Congress is sending to the physicians of America?" Dr. Plested asked. "The answer is crystal clear. If seeing Medicare patients is a fiscally prudent decision for you today, we promise to cut reimbursements year after year until that is no longer the case. In other words, this entire SGR exercise may just be government's dare to find out just how low reimbursements will go before physicians are forced to say, 'Enough,' simply to protect their practices from bankruptcy. "In my opinion, it's time we called their bluff. I've had enough. You've had enough. And enough is enough."

While some delegates called for physicians to begin marching in the streets to protest the cuts, the house directed AMA to maintain its political full-court press against Congress. Tactics unveiled during the meeting included full-page ads in national newspapers and a mass call-in from the floor of the house to Congress on the opening day of its lame duck session.

What is quality ? U.S. Health and Human Services Secretary Michael Leavitt acknowledged physicians' worry over Medicare reimbursement and anxiety over the government's still-uncertain pay-for-performance program. Still, he called on AMA to continue to take the lead in devising clinically appropriate ways to measure quality care. "Cost and quality are going to be part of the equation" of any long-term changes in Medicare financing, he told the delegates. "If the MDs don't develop quality measures, the MBAs will."

After hours of emotional testimony and debate, delegates voted down a proposal for AMA to reject any Medicare payment plans that include pay-for-performance provisions. Instead, they directed AMA lobbyists to continue to look only at those quality-measuring plans that meet or exceed the pay-for-performance guidelines and standards the house adopted in 2004.

Health care leadership, Texas-style . Texas physicians brought their own concerns to the meeting, and the AMA house endorsed the Lone Star solutions without dissent. First, the Texas delegation called on AMA to use TMA's Healthy Vision 2010 and multi-party Health Care Summits as a model for devising a national health care policy agenda. Rather than fight medicine's numerous battles piecemeal, Texans argued that AMA should compile existing policy into a comprehensive national health care policy strategy that covers the most important issues affecting American physicians. The adopted resolution asks AMA to use that framework to drive the health care policy debate in the 2008 presidential campaigns.

"Who knows, perhaps America will adopt TMA's prescription for fixing the ailments in the today's health care system - a prescription calling for accountability, efficiency, and effectiveness," said TMA President Ladon W. Homer, MD.

The second resolution directs AMA to urge Congress to prevent managed care companies from hiding behind loopholes in the federal Employee Retirement Income Security Act of 1974 (ERISA). Some health insurers use ERISA as a shield from stricter state laws regulating health insurers and how they interact with physicians and patients. TMA believes the sole solution is for Congress and the courts to weigh in definitively.

"Without clear congressional or judicial direction, state regulators will not enforce current law," Arlington surgeon Bohn Allen, MD, told the house.

Several Texans played key roles in the AMA meeting. Stephen Brotherton, MD, an orthopedic surgeon from Fort Worth, served on the reference committee on private sector advocacy. Austin colon and rectal surgeon David Fleeger, MD, served on the reference committee on AMA finance and governance. Scott Chaiet, a medical student from Baylor College of Medicine, served on the reference committee on legislation. Also, Russell Kridel, MD, a plastic surgeon from Houston, announced he will seek a spot on the AMA Council on Science and Public Affairs at the June elections.

Other issues merit action . Delegates addressed various other economic, legislative, and organizational topics. The house:

• Rejected a plan to call on Congress and state governments to impose a small tax on the retail sale of soft drinks sweetened with sugar, with the tax revenues earmarked to prevent and treat obesity. Instead, the house called on AMA to be a national leader in finding ways to finance a comprehensive national program for the study, prevention, and treatment of obesity.
• Resolved to oppose health plans' development of tiered or narrow networks inappropriately driven by economic criteria.
• Adopted a new ethics policy on the use of placebos in clinical practice, emphasizing that physicians must maintain patients' trust by avoiding even the appearance of deception.
• Voted to urge the Food and Drug Administration to conduct surveys for purity and dosage accuracy of all compounded "bioidentical hormone" formulations and to create a registry of adverse events related to their use.
• Directed AMA to study and educate physicians on the practice of silent rental networks.

Harris County Medical Society Gets AMA Award for Katrina Efforts . Its response to the thousands of Hurricane Katrina victims evacuated to Houston last year earned the Harris County Medical Society (HCMS) the American Medical Association's Presidential Citation for Service to the Public. The award was presented at the AMA House of Delegates Interim Meeting in Las Vegas on Nov. 11.

The medical society mobilized more than 1,000 Houston-area physicians to treat almost 200,000 evacuees taken to Houston after the hurricane.

"It took a true team effort to provide the surge of Katrina victims with immediate medical care, particularly with Harris County's overcrowded emergency departments and sparse hospital beds," said HCMS President Diana L. Fite, MD. She said the award-winning relief effort would not have been possible without "the enormous effort of our medical community, especially the medical society staff, the Harris County Hospital District, and our two medical schools, Baylor College of Medicine and The University of Texas Medical School at Houston."

AMA President William G. Plested III, MD, called the relief efforts "inspiring and overwhelming." He said the award "is a small token of the tremendous respect the AMA has for the physicians who worked to provide care to hurricane victims under challenging and dangerous conditions, as well as those who continue to care for evacuees around the country."

The award is presented to a state medical association, county medical society, or national specialty society for significant contributions to the public good by fostering the involvement of physicians in community activities .

TMA House of Delegates: TexMed 2007