AMA House Tackles Scope Challenges, Payment Problems
By Steve Levine

Fueled by a historically rare consensus on major issues, the American Medical Association House of Delegates took swift action to address many of the difficulties that frustrate physicians these days.

"Texas physicians should be quite pleased by what the AMA House accomplished at this meeting," said David Henkes, MD, of San Antonio, chair of the Texas Delegation. "The new policies enacted and the directives for action given to AMA leaders will make a real difference in our day-to-day practices."

About 100 Texas physicians and medical students representing the Texas Medical Association, various sections, and national specialty societies took part in the Nov. 11-14 interim meeting in Honolulu. Former TMA President Sue Bailey, MD, of Fort Worth, presided over her fifth session as speaker of the house. The sole resolution TMA brought to Hawaii won unanimous approval.

Texans Share Lessons of Harvey

From staffing shelters, to providing “mental health first aid,” to helping physicians rebuild flooded practices, organized medicine was a critical piece of the response to Hurricane Harvey, a panel of Texas leaders said at a special forum on disaster medicine.

Lessons learned from hurricanes Katrina, Rita, Ike and others ensured that the Texas Gulf Coast was better prepared and in a better position to respond to the storm and the flooding it caused, explained AMA Board of Trustees member Russ Kridel, MD, who organized the forum, and trauma surgeon Ken Mattox, MD, a renowned expert on disaster readiness.

Evacuees at Houston’s two mega-shelters received help from a broad array of emergency, primary care, and specialty care physicians. “Many of them didn't want to leave [the shelter], they were getting such great service,” Harris County Medical Society CEO Greg Bernica quipped.”

Beaumont anesthesiologist Ray Callas, MD, explained that good working relationships among physicians and local, state, and national elected officials helped ensure that the government’s response met critical needs on the ground. 

Dallas psychiatrist Les Secrest, MD, discussed how storm victims and first-responders alike can benefit from a trained and friendly ear. “Just listen nonjudgmentally,” he said. “The conversation will lead from hopelessness to hopefulness.”

TMA President Carlos J. Cardenas, MD, thanked the AMA, the Physicians Foundation, and physicians and medical societies nationwide for helping TMA make more than $1 million available in disaster relief grants so practices could reopen their doors to patients. “When we have members in need, all of us come together to help our colleagues,” he said. “You never know when a hurricane may be coming to a home near you.”

Houston emergency physician Diana Fite, MD, and John Carlo, MD, of Dallas, a member of the AMA Council on Science and Public Health, also participated in the forum.

A “Consistent National Strategy” on Scope Incursions

The AMA house adopted a trio of resolutions to help protect patient safety and prevent inappropriate independent practice by nonphysician practitioners. The latest threats include the APRN (Advanced Practice Registered Nurses) Multistate Compact, the “doctor of medical science” degree pushed by physician assistants in some states, and the broad medical screening tests offered by nonphysician vendors.

A multi-specialty and multi-state coalition – including Texas – pushed delegates to adopt a resolution calling on AMA to convene a physician workgroup to create a “consistent national strategy,” a public relations plan, and legislative language to oppose the nationwide drive for nonphysicians’ independent practice. 

The APRN Compact, which three states already have adopted, would allow APRNs to practice without physician supervision or oversight. Medicine so far has been able to stop all attempts to pass “doctor of medical science” legislation.

The house also endorsed a six-part policy on nonphysician screening tests to protect patients and to ensure adequate follow-up. Texas delegate Michelle Berger, MD, of Austin, persuaded the delegates to adopt an amendment that would require screening test vendors to send copies of the results to the patient’s primary care physician.

Modifier 25 Pushback

The house reacted strongly to news that some commercial health insurance companies are reducing or disallowing payments for claims with modifier 25, which physicians use when a patient receives evaluation and management (E&M) services, and a procedure on the same day. Delegates directed AMA to use “any legal means possible” to ensure that health plans pay both fees at the full rate when physicians use modifier 25 appropriately.

“Health insurers that reduce or deny payment for E&M services associated with procedures performed on the same day are needlessly forcing patients into multiple visits and delaying the provision of necessary care,” said AMA President David O. Barbe, MD.

Burnout Needs More Than a Band-Aid

To address growing rates of physician burnout — and its associated impact on patient care — several medical groups asked AMA to help health systems and medical societies develop programs and services to help physicians cope. 

Others argued that AMA should focus instead on correcting the root causes — such as government overregulation, check-the-box demands from electronic health records, and insurer and hospital meddling in patient care. 

Sugarland internist Elizabeth Torres, MD, agreed with that approach. “I'm depressed because I want to focus on patient care, but I cannot,” she said. “Giving me an antidepressant isn't going to help.”

The Physicians Foundation 2016 Survey of American Physicians found physician morale to be the lowest in Texas, which also has the largest percentage of physicians working in solo or small practices that have the fewest resources to combat or comply with external demands.

Delegates referred the matter to the AMA Board of Trustees, which promised “an aggressive and comprehensive response in an expedited manner.”

Texans in Action

In addition to Dr. Bailey on the podium and Dr. Kridel on the AMA board, other Texans served at the meeting and won new leadership spots. Houston’s Arlo Weltge, MD, served on the Reference Committee on Amendments to Constitution and Bylaws, and Melissa Garretson, MD, of Stephenville, was a member of the Reference Committee on AMA Governance and Finance. Numerous Texas physicians continued their service on AMA councils and committees.

San Antonio surgery resident Michael Metzner, MD, was chosen alternate delegate to the AMA house from the Residents and Fellows Section. Texas medical students won these spots representing Region 3 in the house: 

  • Luis Seija, from the Texas A&M Health Science Center College of Medicine — regional delegate;
  • Sinan Bana, also from Texas A&M — alternate delegate;
  • Rouzbeh Kotaki, from The University of Texas Rio Grande Valley School of Medicine — alternate delegate; and
  • Aaron Wolbrueck, from the University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine — alternate delegate. 

The Texans bid a fond farewell to Clifford Moy, MD. The Frisco psychiatrist first joined the Texas delegation as a medical student in 1984. His tenure included a stint as chair of the AMA Council on Long Range Planning and Development.

Other Issues Merit Action

Delegates addressed various other economic, legislative, and public topics, including: 

  • Adopting a resolution originally written by the TMA Medical Student Section to oppose legislation or administrative actions that hurt access to federal child nutrition programs.
  • Continuing its push to hold national certifying boards’ feet to the fire by stating that fees for maintenance of certification (MOC) should reflect fairly the cost of developing and administering the tests.
  • Adopting new policies to encourage routine depression screening in pregnant and postpartum women, and directing AMA to advocate for legislation to establish maternal mortality review committees to analyze deaths that occur during pregnancy or within the first year after childbirth. 
  • Voting to oppose any further legalization of marijuana or cannabis for recreational or medicinal purposes, to encourage states to use cannabis tax revenue for public health purposes, and to support research to determine the medical consequences of long-term cannabis use.
  • Urging the federal government to help Puerto Rico and the U.S. Virgin Islands’ hurricane recovery by funding adequately their Medicaid programs. Dr. Kridel said the move would “provide support for the medical and public health needs of their residents, and help provide needed care and restore access to health care services.”
  • Asking for a recommendation, to be completed by June, for a payment policy to address the site-of-service differential — the difference between what Medicare pays for services provided in hospital-owned facilities vs. independent physician practices.
  • Adopting new policy providing guidance, consultation, and model legislation on peer review immunity and protection from retaliation.
  • Asking the AMA Board of Trustees to tackle unconscionable drug pricing and to push for transparency from pharmacy benefit managers. “Greater transparency among pharmaceutical manufacturers, pharmacy benefit managers and health plans will shed light on the rationale for drug price increases and why patients pay what they do for their medications,” said AMA President-elect Barbara L. McAneny, MD. 
  • Directing the AMA Board of Trustees to decide how to address the potential antitrust implications of a pharmacy or drug store chain buying a health insurance company.

Action, Dec. 1, 2017

Last Updated On

December 08, 2017

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Steve Levine

VP, Communication

(512) 370-1380
Steve Levine

A former statehouse reporter, political press secretary, and state agency spokesman, Steve Levine has directed the Communication Division at TMA since 1997. He oversees Texas Medicine, Texas Medicine Today, TMA's media and public relations activities, and the TMA Knowledge Center, website, and social media activities.

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