Don’t be surprised if the members of the American Medical Association (AMA) House of Delegates leave their annual meeting next week talking with a Texas drawl. No doubt they’ll have heard it a-plenty during their five days in Chicago.
Not only is Fort Worth allergist Sue Bailey, MD, (above) likely to be picked as the next AMA president; not only are Texans represented at almost every level of AMA leadership; not only is there a special reception honoring Louis J. Goodman, PhD, who is retiring as CEO of the Texas Medical Association; there’s also this little matter of 11 policy proposals the Texas delegation has submitted for the AMA house to consider.
Nine of the 11 are natural-born Texans, written by Texas physicians or medical students or by TMA councils or committees, and approved last month by the TMA House of Delegates with instructions to take them to Chicago. The Texans adopted the other two, cosponsoring them with other delegations.
Here’s a synopsis.
Quality
Resolution 243 grows out of TMA’s critical review of the shortcomings of the Centers for Medicare & Medicaid Services (CMS) report on the first-year of the Quality Payment Program (QPP). The resolution, adopted unanimously by the TMA house, lays out a detailed case for what’s missing in that report – and why it poses a danger if it’s accepted as a definitive portrayal of the QPP’s first year.
It directs AMA to:
- “Strongly advocate” that Congress make QPP participation “completely voluntary” for physicians;
- “Strongly advocate” for Congress to change the QPP so all Medicare bonuses for high performers are no longer paid for by penalties and cuts to physicians who don’t score as well;
- Call on CMS to publish a “transparent, accurate, and complete” annual report on the QPP; and
- Push CMS to increase the number or dollar amount of Medicare services a physician must provide before being required to participate in the QPP.
Maternal Health
Resolution 221 asks AMA to “support and actively work toward enactment” of state and federal legislation that would extend a new mother’s Medicaid coverage from the current 60 days to a full 12 months postpartum. TMA signed on to this resolution, originally submitted by the American College of Obstetricians and Gynecologists. TMA supports this change because so many maternal deaths take place between two and 12 months postpartum. Several TMA-backed bills to extend Medicaid coverage to 12 months died during the recently completed session of the Texas Legislature.
Payment
Resolution 131. Physician payments under Medicare – and, in turn, many commercial plans – depend on the RVUs in the CPT (the relative value units associated with the appropriate Current Procedural Terminology code). The RVUs are based on the resource-based relative value scale (RBRVS), which includes components for the physician work involved, practice expense, and professional liability insurance costs. CMS hasn’t updated the practice expense component since 2007. From electronic health records to quality reporting systems to basic overhead, 2019 isn’t your father’s medical practice expense. Spurred by the Harris County Medical Society, Resolution 131 directs AMA to push CMS to update the practice expense component “so it accurately reflects current physician practice costs.”
Resolution 716 addresses what physicians might call “artificial bad intelligence” on the part of health insurance companies. Developed by the TMA Council on Socioeconomics, this resolution targets health plans’ increasing use of software to analyze and audit, approve or not approve, and pay or not pay claims based just on the diagnosis code, CPT codes, and modifier codes on the claim form. It asks AMA to “vigorously oppose” the plans’ exclusive use of such software, with no review of the patient’s medical record, in deciding whether to pay or deny a claim.
Resolution 715, also from Harris County Medical Society, points out that when patients on Medicare Advantage don’t choose their own primary care physician, the health plan does it for them. Sometimes those randomly assigned patients seem to drop off the face of the earth, but their new doctors’ Medicare Advantage payments take a hit because they haven’t provided those missing patients with required services. Resolution 715 asks AMA to advocate for primary care physicians to be able to remove from their Medicare Advantage panels patients with whom they have been “unable to establish a patient-physician relationship, despite multiple documented attempts.”
Scope of Practice
Resolution 228, by the American Society of Anesthesiologists and cosponsored by TMA, takes aim at the “misappropriation of medical specialties’ titles” by nonphysicians. It directs AMA to work with state medical societies to “authorize only the use of titles and descriptors that align with the nonphysician providers’ state issued licenses and national board certification.”
Public Health
Resolution 023 stems from the Lubbock County Medical Society’s hard work to stop human trafficking. It begins with this gut-punch statement: “Human trafficking is slavery.” It points out that clinics, emergency departments, and other medical settings are prime spots for trafficking victims to seek help. And it asks the AMA to adopt as policy “that readily visible signs, notices, posters, placards, and other readily available educational materials providing information about reporting human trafficking activities or providing assistance to victims and survivors be permitted” in those locations.
Resolution 024 is a product of the TMA Medical Student Section. It advocates that AMA recommend that physicians use the term “intellectual disability” instead of “mental retardation” in clinical settings. The resolution points out that self-advocates began the campaign to “eliminate the pejorative and dehumanizing word ‘retarded’ from the public vernacular.” The term “intellectual disability,” the students say, better reflects an affected individual’s condition.
Telemedicine
Resolution 323 was the brainchild of three different TMA committees. It calls on AMA to promote awareness of and remove barriers to the use of Project ECHO (Extension for Community Healthcare Outcomes) and similar programs that bring specialists’ expertise to distant primary care physicians in underserved areas.
Pharmaceuticals
Resolution 129, also written by the Texas medical students, notes that current AMA policy on importing prescription drugs focuses solely on Canada even though huge numbers of Americans buy medications in Mexico each year. The resolution directs AMA to “study the implications of prescription drug importation for personal use and wholesale prescription drug purchase across our southern and northern borders.”
Resolution 130, devised by the Harris County Medical Society, focuses on the frequent changing of sources for generic medications on various formularies, and the clinical differences that can accompany that change. It calls on AMA to lobby for federal legislation requiring patients be notified of any change in the manufacturer of their generic drugs.