2006 AMA ANNUAL REPORT

                                     By Barry B. Sheppard, M.D. AMA Alternate Delegate

_{Advance Health Care Directives to Medicare Enrollees: Adopted as amended a California resolution calling for the AMA to work with the Centers for Medicare and Medicaid Services to use the Medicare enrollment process as an opportunity for patients to receive information about advance health care directives.(Res. 8)}

_{No American Child Left Uninsured: Referred a California resolution asking the AMA to (1) support federal legislation and funding to ensure the availability of health care coverage for all American children by (a) requiring all parents to provide proof of insurance of each child (through employer-based, individual, or government-sponsored coverage) with their federal tax returns, upon penalty of losing the tax exemption for that child; (b) allowing all parents the option to purchase coverage for their children through the SCHIP program (Healthy Families, in California) at actuarially-adjusted, revenue-neutral cost, without regard to pre-existing conditions; (c) incentivizing states to expand SCHIP coverage to families up to 300 percent of federal poverty line; and (d) ensuring adequate physician reimbursement levels for the SCHIP program and eliminating barriers to enrollment; and (2) use all of its best efforts to bring about the passage of such legislation.(Res. 113)}

_{Tobacco Use/Exposure in Medical Research: Referred for study and report back a California resolution asking the AMA to work to increase inclusion of smoking status, smoking history, and exposure to tobacco smoke pollution as a routinely observed variable in clinical research protocols.(Res. 424)}

_{AMA and Public Health in Developing Countries: Referred a California resolution asking the AMA to dedicate enhanced and serious effort toward supporting the control and eradication of infectious diseases such as malaria, TB, and HIV/AIDS in developing countries.(Res. 427)}

_{Medical Utilization Review by Out-of-State Physicians: Reaffirmed existing policy in lieu of a California resolution that called for the AMA to seek to ensure that (1) physicians performing utilization review for insurers be licensed in the state where the patient is being treated; (2) physician performing the utilization review has comparable training, competence, experience with the treating physician in the medical condition for which the review is being performed.(Res. 718)}

_{OTHER KEY ACTIONS:}

_{Recovery Audit Contractors: Adopted a resolution asking the AMA to work Congress to seek to overturn the mandate for the Centers for Medicare and Medicaid Services to continue the services of the Recovery Audit Contractors’ pilot projects in Florida, New York, and California.(Res. 214)}

_{Comprehensive Health System Reform: Adopted as amended a resolution that calls for comprehensive health system reform, which achieves access to quality health care for all Americans while improving the physician practice environment, be of the highest priority of the AMA.(Res. 613)}

_{Medicare Evaluation & Management (E&M) Medical Decision Making Guidelines : Referred for decision a resolution asking the AMA to (1) formally request the Centers for Medicare and Medicaid Services to apply a uniform set of E&M guidelines with uniform interpretation; (2) advocate that CMS seek input from the AMA regarding any uniform set of E&M guidelines to be applied currently and in the future; and (3) request that CMS mandate Medicare Part B carriers to submit any such auditing decisions through the Medicare Carrier Advisory Committee process.(Res. 712)}

_{Palliative Care and End-of-Life Care: Adopted as amended Board of Trustees Report 5, with the remainder of the report filed. BOT Report 5 asks that the (1) AMA establish policy that recognizes the importance of providing interdisciplinary palliative care as a means of relieving patients’ suffering and improving their quality of life; (2) Council on Medical Education’s support of palliative medicine as a medical subspecialty recognized by the American Board of Medical Specialties be reaffirmed and that the inclusion of palliative medicine in the undergraduate and graduate curriculum be encouraged; (3) AMA encourage the training of physicians and allied health workers in palliative care and interdisciplinary care; (4) AMA encourage all physicians to become skilled in palliative medicine and familiar with coding for reimbursements of hospice and palliative care services; (5) AMA advocate for reimbursement of E&M codes reflecting prolonged time spent on patient care beyond face-to-face encounters; (6) AMA promote research in the field of palliative medicine; (7) AMA continue efforts in developing CME activities on pain management and end-of-life care issues; and (8) AMA encourage physicians to be knowledgeable of patient eligibility criteria for hospice benefits.}

_{Modes of Participation in Medicare and Their Impact on the Patient, the Physician, and the U.S. Congress: Adopted as amended the recommendations of Board of Trustees Report 16, with the remainder of the report filed. The report recommends that the AMA (1) continue working to identify politically viable modifications to the statutory language on private contracting that will make opting out a more reasonable choice for practicing physicians; and (2) educate physicians on the different options for participating in the Medicare program and provide its members with the tools and information necessary to analyze the impact on their patients, their practice, and the U.S. Congress, of their choice of the three modes of relating to the Medicare program by: A. Opting out of Medicare or,}

_{B. Caring for Medicare patients in a fee-for-service relationship, making the decision to "accept assignment" on the basis of mutual needs of the patient and the physician or, C. Continuing as a "participating physician" in the Medicare program understanding that the physician is subject to the continued anticipated reductions in direct reimbursement and the ultimate inability to directly negotiate any fees on behalf of their practice. This may give Congress the wrong impression that there is no problem with continued fee reductions.(BOT Report 16)}

_{Individual Responsibility to Obtain Health Insurance: Adopted as amended the recommendations of Council on Medical Service Report 3, with the remainder of the report filed. The report recommends that (1) the AMA support a requirement that individuals and families earning greater than 500 percent of the federal poverty level obtain, at a minimum, coverage for catastrophic health care and evidence-based preventive health care, using the tax structure to achieve compliance; (2) upon implementation of a system of refundable tax credits or other subsidies to obtain health care coverage, the AMA support a requirement that individuals and families earning less than 500 percent of the federal poverty level obtain, at a minimum, coverage for catastrophic health care and evidence-based preventive health care, using the tax structure to achieve compliance; and (3) the AMA rescind Policy H-165.920[13] that "supports the use of tax incentives, and other non-compulsory measures, rather than a mandate requiring individuals to purchase health insurance coverage." (CMS Report 3)}