DISCLAIMER
The following is a preliminary report of actions taken by the House of Delegates at
its 2003 Interim Meeting and should not be considered final. Only the Official
Proceedings of the House of Delegates reflect official policy of the Association.
AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES (I-03)
Report of Reference Committee K
Ruth M. Covell, MD, Chair
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In keeping with Resolution 601 (A-96), the Reference Committee recommends the
following consent calendar for acceptance:
RECOMMENDED FOR ADOPTION
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Board of Trustees Report 3 – AMA Opposition to Securitization of Tobacco
Settlement Payments (Resolutions 431 and 440, A-03)
Board of Trustees Report 6 – Surge Capacity for Mass Casualty Care
Resolution 820 – Improving Regional Terrorism and Disaster Preparedness and
Response
Council on Scientific Affairs Report 1 – AMA National Disaster Life Support
Program
Resolution 844 – Visa Complications for IMGs in GME
Resolution 814 – Appropriations for Increasing the Number of Primary Care
Physicians
Council on Medical Education Report 3 – Strategies to Combat Mid-year and
Retroactive Tuition Increases
Resolution 848 – Long Term Solutions to Medical Student Debt
Resolution 849 – Financing Federal Consolidation Loans
Resolution 850 – Immediate Legislative Solutions to Medical Student Debt
Resolution 817 – Audit Equity
Resolution 818 – Medical and Dental Care for People with Developmental
Disabilities
Council on Medical Service Report 4 – Limiting Financial Incentives to Withhold
Appropriate Care (Resolution 915, I-02)
Resolution 842 – Provision for Conflict Resolution in Joint Commission
Standards
Resolution 843 – AMA Support for Physician Surveyors Consistent with AMA
Policy
RECOMMENDED FOR ADOPTION AS AMENDED OR SUBSTITUTED
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Board of Trustees Report 7 – Annual Tobacco Report 2003
Council on Medical Education Report 1 – Parity for International Medical
Graduates for Clinical Skills Assessment (Substitute Resolution 821, I-02 and
Resolution 305, A-03)
Reference Committee K (I-03)
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Council on Medical Education Report 2 – Proposed Revisions to AMA Policy on
the Physician Workforce
Resolution 807 – US Physician Shortage
Resolution 851 – Blue Cross of California Quality of Care Allegations
Resolution 847 – State and Local Advocacy on Medical Student Debt
Resolution 809 – Reimbursement Denial Based Solely on Specialty
Resolution 812 – Translating Biomedical Research to the Bedside
Resolution 835 – Principles for Incident-Based Peer Review
Council on Medical Service Report 3 – Health Reimbursement Arrangements
RECOMMENDED FOR REAFFIRMATION
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Resolution 803 – State Tobacco Tax Increases and Responsible Use of
Resulting Funds
Resolution 806 – Physician Credentials and the Tort System
RECOMMENDED FOR REFERRAL
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Resolution 834 – Cutting Prescription Drug Prices
RECOMMENDED FOR REFERRAL FOR DECISION
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Resolution 838 – Preservation of the National Resident Matching Program
(NRMP)
RECOMMENDED FOR NOT ADOPTION
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Resolution 829 – Guidelines to Avoid Inappropriate Insurer Kickbacks
Reference Committee K (I-03)
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(1)
BOARD OF TRUSTEE REPORT 3 - AMA OPPOSITION
TO SECURITIZATION TO TOBACCO SETTLEMENT
PAYMENTS (RESOLUTIONS 431 AND 440, A-03)
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Board of Trustees
Report 3 be adopted and the remainder of the report be
filed.
HOD ACTION: Recommendations contained in Board of
Trustees Report 3 adopted, remainder of report filed.
Board of Trustee Report 3 recommends that the AMA strongly oppose the use of
tobacco settlement funds for projects unrelated to tobacco use prevention and control,
tobacco-related health research, treatment of smoking-related diseases, or increased
access to medical services; and calls for the AMA to work with state medical societies to
protect the settlement funds, including issuing statements condemning the use of
settlement funds as a way to remedy state budget crises.
Your Reference Committee heard limited testimony, all in support of the report. One
witness noted the important implication of the Master Settlement Agreement (MSA) that
state governments are now among the greatest stakeholders in the tobacco industry.
While noting that securitization may also, in some states, be used as a way to protect
the flow of MSA revenues to health programs, your Reference Committee also notes
that the general trend has been for securitized funds to result in a lessening of both the
absolute amount and share of MSA funds available to finance antitobacco programs.
Your Reference Committee concurs with the testimony it heard as well as with both the
content and recommendations of the report, and so recommends that Board of Trustees
Report 3 be adopted.
(2)
BOARD OF TRUSTEE REPORT 6 - SURGE CAPACITY
FOR MASS CASUALTY CARE
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that the recommendation contained in Board of Trustees
Report 6 be adopted and that the remainder of the report
be filed.
HOD ACTION: Recommendation contained in Board of
Trustees Report 6 adopted, remainder of report filed.
Board of Trustee Report 6 recommends that AMA Directive D-130.992, regarding
medical preparedness for disasters, be amended by specifying that all state and local
medical societies and medical specialty societies should take a leadership role in
planning for and assuring adequate surge capacity in their state and community to
respond to mass casualties resulting from a disaster or other public health emergency.
Reference Committee K (I-03)
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Testimony heard by your Reference Committee commended Board of Trustees Report
6. An editorial correction in the body of the report was noted regarding the population of
Houston. Page 4, line 43 of the report indicates that Houston is home to 400 million
people, whereas its actual population is 4 million. The Committee concurs with the
support for this important report and applauds the Board.
(3)
RESOLUTION 820 - IMPROVING REGIONAL
TERRORISM AND DISASTER PREPAREDNESS AND
RESPONSE
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 820 be adopted.
HOD ACTION: Resolution 820 adopted.
Resolution 820 calls for our AMA to: 1) call on the Department of Homeland Security and
the Department of Health and Human Services (HHS) to assure a multi-state
coordinating capacity that would provide for more effective local, state, and interstate
response to terrorist incidents, including planning, mass casualty care, and risk
communication efforts; 2) call on the HHS and the United States Public Health Service to
expand the Medical Reserve Corps, a branch of the Citizen Corps, to include regional
and nationwide organization of volunteer health care professionals to provide additional
personnel surge capacity in a national level medical response, including organizational
requirements, educational and training needs, and credentialing and liability issues; 3)
call on federal and state agencies to develop a common credentialing standard with
liability protection mechanisms to rapidly credential health care providers from other
states to facilitate a regional or national level response; and 4) send letters to the
President, Secretary of Homeland Security, Secretary of HHS, Surgeon General, and
appropriate members of Congress urging such action.
Testimony regarding Resolution 820 was largely supportive. There was a suggestion to
amend the resolution with a request that the AMA should develop the common
credentialing standards referred to in the third Resolve. Your Reference Committee
concurs with the testimony of a member of the Board of Trustees, which indicated that
the development of such standards would be very expensive. The Committee believes
Resolution 820 proactively augments AMA policy on this critical issue.
(4)
COUNCIL ON SCIENTIFIC AFFAIRS REPORT 1 - AMA
NATIONAL DISASTER LIFE SUPPORT PROGRAM
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Council on
Scientific Affairs Report 1 be adopted and the remainder of
the report be filed.
Reference Committee K (I-03)
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HOD ACTION: Recommendations contained in Council on
Scientific Affairs Report 1 adopted, remainder of report
filed.
Council on Scientific Affairs Report 1 describes AMA involvement in developing a
National Disaster Life Support (NDLS) program for the purpose of providing the basic
knowledge and skills set that all health and safety workers need to competently respond
to an intended or naturally occurring public health emergency. The report recommends
modification of policy H-130.946 to authorize collaboration with the Federation and to
further specify program content related principally to public health activity and ethical
and legal issues pertaining to disaster response.
Testimony on Council on Scientific Report 1 was limited and highly supportive of the
proactive recommendations. Your Reference Committee lauds the Council for its
excellent report.
(5)
RESOLUTION 844 - VISA COMPLICATIONS FOR IMGS
IN GME
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 844 be adopted.
HOD ACTION: Resolution 844 adopted.
Resolution 844 calls for our AMA to: 1) work with the ECFMG to minimize delays in the
visa process for International Medical Graduates (IMGs) applying for visas to enter the
US for postgraduate medical training and/or medical practice; 2) promote regular
communication between the Department of Homeland Security and AMA IMG
representatives to address and discuss existing and evolving issues related to the
immigration and registration process required for IMGs; 3) work through the appropriate
channels to assist residency program directors, as a group or individually, to establish
effective contacts with the State Department and the Department of Homeland Security,
in order to prioritize and expedite the necessary procedures for qualified residency
applicants to reduce the uncertainty associated with considering a non-citizen or
permanent resident IMG for a residency position.
Testimony on Resolution 844 was limited and highly supportive. The Council on Medical
Education testified that it is currently tracking how long it takes from the time an
applicant matches to the time the applicant receives a visa, and expressed its intention
to publish the findings of its study in the near future. Your Reference Committee
commends the International Medical Graduates Section for highlighting this important
issue.
Reference Committee K (I-03)
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(6)
RESOLUTION 814 - APPROPRIATIONS FOR
INCREASING NUMBER OF PRIMARY CARE
PHYSICIANS
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 814 be adopted.
HOD ACTION: Resolution 814 adopted.
Resolution 814 calls for the AMA to: 1) support continued funding of Public Health
Service Act, Title VII, Section 747; and 2) encourage members to communicate with
their US Senators and Representatives to support Public Health Service Act, Title VII,
Section 747.
Your Reference Committee heard several witnesses testify strongly in support of the
resolution and heard no dissenting views. Your Reference Committee therefore
recommends that Resolution 814 be adopted.
(7)
COUNCIL ON MEDICAL EDUCATION REPORT 3 STRATEGIES TO COMBAT MID-YEAR AND
RETROACTIVE TUITION INCREASES
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Council on Medical
Service Report 3 be adopted and that the remainder of the
report be filed.
HOD ACTION: Recommendations contained in Council on
Medical Service Report 3 adopted, remainder of report
filed.
Council on Medical Education Report 3 investigates legal standing of mid-year and
retroactive tuition increases at public and private medical schools and explores
strategies to overturn or mitigate the effects of these increases, including legal challenge
based on contract law, federal legislation limiting increases, and/or medical school
programs for tuition offsets and increased fund-raising activity. The report recommends
our AMA disseminate the findings of its review, assist state medical societies in
opposing these tuition increases, and study the funding of medical education, and
reaffirm AMA opposition to mid-year and retroactive tuition increases.
Testimony on Council on Medical Education Report 3 was largely supportive, including
strong support from the Medical Student Section. A suggestion was made to have the
AMA contact the medical school tuition rate-setting bodies regarding the adverse effects
of mid-year tuition increases for students. Your Reference Committee concurs with the
testimony that such an amendment is likely to involve a complex directive and that the
recommendations of the report are thorough and appropriate.
Reference Committee K (I-03)
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(8)
RESOLUTION 848 – LONG TERM SOLUTIONS TO
MEDICAL STUDENT DEBT
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 848 be adopted.
HOD ACTION: Resolution 848 adopted.
Resolution 848 calls for our AMA to: 1) explore membership in the American Council on
Education and/or the Committee for Education Financing, in order to build our ties to the
higher education community and report back by the 2004 Annual Meeting; 2) more
aggressively publicize existing work done through the Coalition for Student Loan
Fairness; 3) study and report back at the 2004 Interim Meeting on potential new sources
of Graduate Medical Education funding and ways to increase resident salaries; 4) study
and report back at the 2004 Interim Meeting on feasible strategies for creating new
and/or expanded loan programs specifically for the health professions; 5) study and
report back at the 2005 Annual Meeting on the feasibility of earmarking federal funds to
undergraduate medical education for the purpose of reducing medical school tuition at
public and private universities; 6) study and report back at the 2004 Interim Meeting on
the need for non-primary-care physicians in underserved areas, with a focus on showing
how the National Health Service Corps and similar loan repayment programs could
feasibly be expanded to cover specialties beyond primary care; and 7) study and report
back at the 2005 Annual Meeting on appropriate methods for calculating the value of the
clinical work performed by medical students and taking such calculations into account
when determining the cost of educating a medical student.
Testimony on Resolution 848 was limited to support. The Council on Medical Education
indicated that it is conducting its systemic review of medical school financing and
welcomed the resolutions to help direct the Council’s effort. Your Reference Committee
commends the Medical Student Section for its extraordinary effort to address the issue
of medical student debt.
(9)
RESOLUTION 849 - FINANCING FEDERAL
CONSOLIDATION LOANS
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 849 be adopted.
HOD ACTION: Resolution 849 adopted.
Resolution 849 calls for our AMA to: 1) support the refinancing of Federal Consolidation
Loans; and 2) actively advocate for modification of pending and future legislation which
provides the opportunity to refinance Federal Consolidation Loans.
Reference Committee K (I-03)
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Testimony on was limited and supportive. Your Reference Committee agrees that the
resolution merits adoption.
(10)
RESOLUTION 850 - IMMEDIATE LEGISLATIVE
SOLUTIONS TO MEDICAL STUDENT DEBT
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 850 be adopted.
HOD ACTION: Resolution 850 adopted.
Resolution 850 calls for our AMA to: 1) endorse and actively lobby for the
Reauthorization of the Higher Education Act, (including elimination of the “single-holder”
rule, continuation of the consolidation loan program and a consolidator’s ability to lock in
a fixed interest rate, expansion of the deferment period for loan repayment to cover the
entire duration of residency and fellowship, broadening of the definition of economic
hardship as used to determine eligibility for student loan deferment, retention of the
option of loan forbearance for residents who are ineligible for student loan deferment,
inclusion of dependent care expenses in the definition of “cost of attendance”); and 2)
lobby for passage of legislation that would eliminate the cap on the student loan interest
deduction, increase the income limits for taking the interest deduction, include room and
board expenses in the definition of tax-exempt scholarship income, and make
permanent the education tax incentives that our AMA successfully lobbied for as part of
Economic Growth and Tax Relief Reconciliation Act of 2001.
Testimony on Resolution 850 was supportive and your Reference Committee
recommends its adoption.
(11)
RESOLUTION 817 - AUDIT EQUITY
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 817 be adopted.
HOD ACTION: Resolution 817 adopted.
Resolution 817 calls for the AMA to seek relief from insurance inequity through
legislation which instructs insurers to balance or refund for under-coding against any
discovered over-coding during the course of an audit and not through extrapolation.
Your Reference Committee heard limited testimony in support of the resolution, and
none opposed, and therefore recommends that Resolution 817 be adopted.
Reference Committee K (I-03)
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(12)
RESOLUTION 818 - MEDICAL AND DENTAL CARE FOR
PERSONS WHO ARE DEVELOPMENTALLY DISABLED
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that Resolution 818 be adopted.
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that the title of Resolution 818 be changed to read as
follows:
MEDICAL AND DENTAL CARE FOR PEOPLE WITH
DEVELOPMENTAL DISABILITIES
HOD ACTION: Resolution 818 adopted with change in title.
Resolution 818 calls for our AMA to entreat health care professionals, parents and
others participating in decision-making to be guided by the following principles: 1) all
people with developmental disabilities, regardless of the degree of their disability, should
have access to appropriate and affordable medical and dental care throughout their
lives; and 2) an individual’s medical condition and welfare must be the basis of any
medical decision.
Testimony was limited and supportive. It was suggested that the proposed title more
accurately describes those with disabilities as they would describe themselves.
(13)
COUNCIL ON MEDICAL SERVICE REPORT 4 - LIMITING
FINANCIAL INCENTIVES TO WITHHOLD APPROPRIATE
CARE (RESOLUTION 915, I-02)
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Council on Medical
Service Report 4 be adopted and the remainder of the
report be filed.
HOD ACTION: Recommendations contained in Council on
Medical Service Report 4 adopted, remainder of report
filed.
Council on Medical Service Report 4 recommends that the AMA advise state medical
associations that language suggested by OMSS and excerpted from Sect. 10 of Ch.
141 of Mass. Acts of 2000 is appropriate for model managed care contracts. In
response to Resolution 915 (I-02), which calls for AMA to (1) discourage certain types of
risk contracts, (2) identify inherently unfair managed care contract provisions, and (3)
fund a study of the impact of financial incentives on outcomes, the report recommends
Reference Committee K (I-03)
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as an alternative that physicians make use of existing AMA resources that are already
responsive, especially the AMA Model Managed Care Contract.
Your Reference Committee heard considerable testimony in favor of the report. The
Committee noted testimony from one witness calling for the AMA to enforce the
provisions of the proposed model managed care contract legislation, but finds such
activity may be outside the scope of the AMA’s authority.
Your Reference Committee also heard testimony in support of the AMA conducting
outcomes studies that may be effective in providing physicians leverage in their
negotiations with managed care plans. While affirming the importance of such studies,
your Reference Committee believes these are far better left to those independent
agencies which already possess the expertise and financial resources to conduct such
research.
Your Reference Committee concurs with the testimony calling for AMA support of statelevel advocacy in favor of adoption of the model legislation, and finds the first
recommendation of the report entirely consistent with this aim. In consideration of the
extreme importance of these issues, your Reference Committee strongly recommends
adoption of Council on Medical Service Report 4.
(14)
RESOLUTION 842 – PROVISION FOR CONFLICT
RESOLUTION IN JOINT COMMISSION STANDARDS
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 842 be adopted.
HOD ACTION: Resolution 842 adopted.
Resolution 842 calls for the AMA to work vigorously to immediately restore and expand
the requirement in the Joint Commission on Accreditation of Healthcare Organizations’
Hospital Accreditation Standards that the governing body or authority, and the medical
staff, provide for an impartial mechanism for conflict resolution that is satisfactory to both
parties.
Your Reference Committee heard limited testimony in support of Resolution 842 and
therefore recommends that it be adopted.
(15)
RESOLUTION 843 – AMA SUPPORT FOR PHYSICIAN
SURVEYORS CONSISTENT WITH AMA POLICY
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 843 be adopted.
HOD ACTION: Resolution 843 adopted.
Reference Committee K (I-03)
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Resolution 843 calls for the AMA, as per Directive D-220.984, to require AMA
Commissioners on the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) to: 1) commit to require surveyors to include practicing physicians wherever
possible; and 2) assure that JCAHO enters into agreements with those state medical
association independent subsidiaries that are qualified to participate in the surveys of
medical staff related standards in those states which have the will and resources to do
so. The resolution also calls on the AMA to instruct its AMA Commissioners that it is
their duty to advocate for positions with the JCAHO that are consistent with AMA policy.
Your Reference Committee heard limited testimony in support of Resolution 843 and
therefore recommends that it be adopted.
(16)
BOARD OF TRUSTEE REPORT 7 – ANNUAL TOBACCO
REPORT 2003
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Board of Trustees
Report 7 be amended by addition of the following
recommendation:
That the AMA will continue to produce the Annual Tobacco
Report.
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that Board of Trustees Report 7 be adopted as amended.
HOD ACTION: Recommendations contained in Board of
Trustees Report 7 adopted as amended, remainder of
report filed.
Board of Trustee Report 7 is a compendium of journal articles, news reports, and
activities by the health community and the tobacco industry in the ongoing task of
dealing with “the nation’s number one public health issue,” according to C. Everett
Koop, MD. The information ranges from research and clinically useful material to public
health policy and legal issues.
Your Reference Committee heard testimony in strong support of Board of Trustees
Report 7. One witness indicated that no alternative source provides any similarly
comprehensive collection of information. Testimony was so uniformly favorable that the
only reason offered for extraction of this report was the desire that it be continued on an
annual basis. Your Reference Committee strongly concurs with this sentiment and
recommends the report be adopted as amended.
Reference Committee K (I-03)
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(17)
COUNCIL ON MEDICAL EDUCATION REPORT 1 PARITY FOR INTERNATIONAL MEDICAL GRADUATES
FOR CLINICAL SKILLS ASSESSMENT (SUBSTITUTE
RESOLUTION 821, I-02 AND RESOLUTION 305, A-03)
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Council on Medical
Education Report 1 be amended by deletion and insertion
on page 3, lines 17-18, to read as follows:
2. That our AMA reaffirm Policy H-275.956,
“Demonstration of Clinical Competence.” (Reaffirm HOD
Policy)
2. That our AMA amend Policy H-275.956(3),
“Demonstration of Clinical Competence,” to read as
follows: It is the Policy of the AMA to:…(3) recognize that
clinical skills assessment is best performed using a
rigorous and consistent examination administered by
medical schools and should not be used for licensure of
graduates of Liaison Committee on Medical Education
(LCME)- and American Osteopathic Association (AOA)accredited medical schools or of Educational Commission
for Foreign Medical Graduates (ECFMG)-certified
physicians.
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Council on Medical
Education Report 1 be adopted as amended and the
remainder of the report be filed.
HOD ACTION: Recommendations contained in Council on
Medical Education Report 1 adopted as amended,
remainder of report filed.
Council on Medical Education Report 1 recommends reaffirmation of AMA policy
H-275.956(3), which states that clinical skills assessment is best performed by medical
schools and should not be used for licensure of graduates of medical schools accredited
by LCME and AOA. The report examines the merits of changing the policy to include
international medical graduates in the exemption from clinical skills assessment as a
part of licensure requirements.
Your Reference Committee heard extensive opposition from the International Medical
Graduate (IMG) Section regarding the recommendation to reaffirm Policy H-275.956.
Specifically, there was considerable discussion as to the perceived conflict between
Policy H-275.956 and Policy H-255.983. Policy H-255.983 states the following:
Reference Committee K (I-03)
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The AMA continues to support the policy that all physicians and medical students
should be evaluated for purposes of entry into graduate medical education
programs, licensure, and hospital medical staff privileges on the basis of their
individual qualifications, skills, and character.
Your Reference Committee concurs with the Council on Medical Education that no
conflict exists. As stated by a member of the IMG Section, the ECFMG has very
rigorous standards. The proposed amendment, offered by the Council on Medical
Education, provides assurance that all medical graduates (domestic or foreign) are
covered by Policy H-275.956.
(18)
COUNCIL ON MEDICAL EDUCATION REPORT 2 PROPOSED REVISIONS TO AMA POLICY ON THE
PHYSICIAN WORKFORCE
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that Council on Medical Education Report 2 be amended
by deletion and addition on page 9, lines 1-3, to read as
follows:
11.
That our AMA, through its Councils, and Sections,
Minority Affairs Consortium, and other organizations,
develop strategies to implement its workforce policy,
through research, advocacy, and other relevant means.
(Directive to Take Action)
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Council on Medical
Education Report 2 be adopted as amended and the
remainder of the report be filed.
HOD ACTION: Recommendations contained in Council on
Medical Education Report 2 adopted as amended,
remainder of report filed.
Council on Medical Education Report 2 updates the 21 separate AMA policies related to
physician workforce issues, principally by rescinding parts or all of 20 of those policies,
amending one other, and replacing the parts of the rescinded policies that are current,
consistent, and relevant, with seven new policies that generally include their content and
group it by subject matter according to the seven new policies. The report also
recommends that the AMA develop strategy to implement AMA workforce policy, and
collaboration with state and specialty societies on the development of a “national
consensus on physician workforce policy.”
Reference Committee K (I-03)
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Your Reference Committee heard considerable testimony, nearly unanimous in support
of Council on Medical Education Report 2. The few concerns expressed by witnesses
included concern that allied health professionals may come to supplant physicians in
those areas where the supply of physicians does not meet demand for physician
services. While your Reference Committee is also concerned about this issue, it is more
closely related to the context of policies dealing with scope of practice issues than it is to
those dealing with broader physician workforce issues. Another issue of concern was
that strategies for the implementation of AMA workforce policy should be conducted
through the auspices of a broader constituency than the AMA’s Councils and Sections
alone. Your Reference Committee therefore recommends that CME 2 be adopted as
amended.
(19)
RESOLUTION 807 - US PHYSICIAN SHORTAGE
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that Resolution 807 be amended on lines 23-37 by addition
and deletion to read as follows:
RESOLVED, That our American Medical Association
revoke all previous policy that implies a surplus of
physicians in the U.S., and be it further
RESOVLED, That our American Medical Association
explicitly recognize the existing shortage of physicians in
many specialties and areas of in the U.S., and be it further
RESOLVED, That our American Medical Association
support efforts to quantify the geographic maldistribution
and physician shortage in many specialties; and be it
further
RESOLVED, That our American Medical Association
support current programs to increase the number alleviate
the shortages in many specialties and the maldistribution
of physicians in the U.S., and be it further
RESOLVED, That our American Medical Association direct
the Council of Medical Advisors to draft a report outlining
policy options to address the U.S, physician supply.
shortage.
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that Resolution 807 be adopted as amended.
HOD ACTION: Resolution 807 adopted as amended.
Reference Committee K (I-03)
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Resolution 807 calls for the AMA to: 1) direct the Council on Medical Education and the
Council on Medical Service to draft a report outlining policy options to address the US
physician supply shortage; 2) revoke all previous policy that implies a surplus of
physicians in the US; 3) explicitly recognize the existing shortage of physicians in the
US; 4) support efforts to quantify the physician shortage; and 5) support federal policy to
increase the number of physicians in the US.
Your Reference Committee heard lengthy testimony in support of Resolution 807. While
your Committee noted concern with respect to the sensitivity of workforce models to
their underlying assumptions and the need to account for other related factors in
assessing the output of such models. The Committee views the proposed amendments
to the Resolves of 807 as due reflection of those concerns and also the importance of
restricting the federal role in workforce issues to the continued administration of the
current and beneficial public health service Title VII programs such as support of primary
care initiatives and workforce data collection. Your Reference Committee therefore
recommends adoption of Resolution 807 as amended.
(20)
RESOLUTION 851 – BLUE CROSS OF CALIFORNIA
QUALITY OF CARE ALLEGATIONS
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that the third Resolve of Resolution 851 be amended by
deletion to read as follows:
RESOLVED, That our AMA support a position stating that
all future peer review and quality of care issues between
insurance companies and medical staffs be brought to an
objective and neutral peer review body with standing of the
AMA, state medical societies, specialty societies or other
qualified neutral entity.
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that Resolution 851 be adopted as amended.
HOD ACTION: Resolution 851 adopted as amended.
Resolution 851 calls for the AMA to 1) reiterate that medical staffs shall not be impugned
and quality of care issues not be imposed between insurance plans and hospitals as a
means of addressing economic or contractual issues; 2) insist that all insurance plan
inquiries regarding quality of care and peer review issues be evaluated through objective
due process and peer review; and 3) support a position that all future peer review and
quality of care issues between insurance companies and medical staffs be brought to an
objective and neutral peer review body with standing of the AMA, state medical
societies, specialty societies, or other qualified neutral entity.
Reference Committee K (I-03)
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Your Reference Committee heard very limited testimony, all in support of the resolution.
The Committee notes that the AMA does not conduct determinations of standing, and
therefore recommends that Resolution 851 be adopted as amended.
(21)
RESOLUTION 847 - STATE AND LOCAL ADVOCACY ON
MEDICAL STUDENT DEBT
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that Resolution 847 be amended by deletion and insertion
on page 2, lines 5-6 to read as follows:
RESOLVED, That our AMA urge state medical societies to
advocate for study the merits of an annual tuition cap
(adjusted for inflation) at public and private medical
schools within their states. (Directive to Take Action)
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that Resolution 847 be adopted as amended.
HOD ACTION: Resolution 847 adopted as amended.
Resolution 847 calls for our AMA to: 1) support and encourage our state medical
societies to support further expansion of state loan repayment programs, and in
particular expansion of those programs to cover physicians in non-primary care
specialties; 2) urge state medical societies to actively solicit funds (either directly or
through their Foundations) for the establishment and expansion of medical student
scholarships, and that our AMA develop a set of guidelines and suggestions to assist
states in carrying out such initiatives; 3) oppose the charging of broad and ill-defined
student fees by medical schools, such as but not limited to professional fees,
encouraging in their place fees that are earmarked for specific and well-defined
purposes; 4) encourage medical schools to use their collective purchasing power to
obtain discounts for their students on necessary medical equipment, textbooks, and
other educational supplies; 5) encourage medical schools to cooperate with
undergraduate institutions to establish collaborative debt counseling for entering firstyear medical students; and 6) urge state medical societies to advocate for an annual
tuition cap (adjusted for inflation) at public and private medical schools within their
states.
Testimony on Resolution was largely supportive, although there was opposition to
supporting a tuition cap as called for in Resolution 847 and your Reference Committee
shares this concern. In particular, the Committee notes that medical school expenses
are not necessarily linked to cost-of-living expenses and believes it is unrealistic to
expect that a cap on tuition would not impact other budget areas. In addition, the
Committee noted that some schools charge tuition that is considerably less than what is
charged at other schools. While some students may be helped by a tuition cap, others
may be harmed. Due to the complexity of the issue, your Committee recommends study
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of the merits of a tuition cap.
remainder of Resolution 847.
(22)
The Committee concurs with testimony favoring the
RESOLUTION 809 - REIMBURSEMENT DENIAL BASED
SOLELY ON SPECIALTY
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that the following Substitute Resolution 809 be adopted:
RESOLVED, That our American Medical Association
actively support appropriate actions at both the state and
federal levels to ban insurers from denying or reducing
payment for services performed by physicians (MD and
DO) based solely on their specialty (Directive to Take
Action); and be it further
RESOLVED, That our AMA actively discourage insurance
companies from restricting professional fee payment to
MDs and Dos based on type of specialty. (Directive to
Take Action)
HOD ACTION: Substitute Resolution 809 adopted as
amended.
Resolution 809 calls for our AMA to: 1) actively support appropriate actions at the state
level to ban insurers from denying payment to physicians for procedures performed
within the purview of their practice based solely on their type of specialty; 2) actively
discourage insurance companies from restricting professional fee payment based on
their type of specialty; and 3) pursue through appropriate means at the federal level a
ban on insurers from denying payment to physicians for procedures performed within the
purview of their practice based solely on their type of specialty.
Your Reference Committee heard extensive testimony regarding Resolution 809.
Testimony indicated a concern with the language in the first and third Resolves. In
particular, it was suggested that the wording may inadvertently advocate that allied
health professionals should be paid on par with physicians. It was also suggested that
the directive should apply to payments that are reduced as well as denied and that the
term “procedures” should be replaced with “services.”
Your Reference Committee noted that the original third Resolve was largely repetitive of
the first Resolve and developed Substitute Resolution 809 to combine their disparate
intents (state versus federal advocacy) into a single recommendation and to respond to
the concerns raised during testimony. The original second Resolve of Resolution 809,
regarding private sector advocacy, was modified only to reflect a minor editorial change.
Reference Committee K (I-03)
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(23)
RESOLUTION 812 - TRANSLATING BIOMEDICAL
RESEARCH TO THE BEDSIDE
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that the second Resolve of Resolution 812 be amended by
deletion on line 19 to read as follows:
RESOLVED, That our AMA advocate for higher funding for
and the elimination of unreasonable barriers to bedside
care using new research (Directive to Take Action); and be
it further
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that Resolution 812 be amended by insertion on line 21 of
the following new Resolve:
RESOLVED, That our AMA work with specialty societies,
the American Association for the Advancement of Science,
the Institute of Medicine’s Clinical Research Roundtable,
appropriate federal agencies, and other organizations to
develop practical measures to expedite the incorporation
of scientific advances into medical practice; and be it
further
RECOMMENDATION C:
Madam Speaker, your Reference Committee recommends
that the third Resolve of Resolution 812 be amended by
insertion on lines 22-24 to read as follows:
RESOLVED, that our AMA alert the President and
Congress about regarding the major health problems
presented by the not adequately addressed due to lack of
support for fast-tracking clinical research to bedside
applications. (Directive to Take Action)
RECOMMENDATION D:
Madam Speaker, your Reference Committee recommends
that Resolution 812 be adopted as amended.
HOD ACTION: Resolution 812 adopted as amended with new
resolve to read as follows:
.
RESOLVED, That a report on actions taken to implement this
resolution be provided at A-04.
Reference Committee K (I-03)
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Resolution 812 calls for the AMA to: 1) give high priority to bringing promising biomedical
research to the bedside; 2) advocate for higher funding for and the elimination of
unreasonable barriers to bedside care using new research; and 3) alert the President
and Congress about the major health problem presented by the lack of support for fasttracking clinical research to bedside applications.
Your Reference Committee heard limited testimony all favorable to Resolution 812 and
recommends that it be adopted as amended. Your Reference Committee supports the
insertion of the new Resolve as suggested during testimony.
(24)
RESOLUTION 835 - PRINCIPLES FOR INCIDENTBASED PEER REVIEW
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that the first Resolve of Resolution 835 be amended by
deletion and insertion on line 24 to read as follows:
RESOLVED, That our American Medical Association
Board of Trustees study and report back at the 2004
Annual Meeting the feasibility advisability of adopting the
Massachusetts Medical Society Model Principles for
Incident-Based Physician Peer Review and Disciplining at
Health Care Facilities (Directive to Take Action); and be it
further
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that Resolution 835 be adopted as amended.
HOD ACTION: Resolution 835 adopted as amended.
Resolution 835 calls for our AMA to: 1) report back at the 2004 Annual Meeting the
feasibility of adopting the Massachusetts Medical Society Model Principles for IncidentBased Physician Peer Review and Disciplining at Health Care Facilities; and 2) send the
Model Principles to all state medical societies and all medical staffs in the US and be
prominently posted on the AMA’s web site should they be adopted by our AMA..
Testimony was largely supportive of the first Resolve and provided the suggested word
change in the Reference Committee’s amendment. There was also concern that the
second Resolve is premature given that the requested study has not yet been
accomplished. However, the Committee notes that the second Resolve specifically
states that the promulgation of the model principles is dependent upon their adoption by
the AMA. The Committee, therefore, supports the second Resolve as it appears in
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Council on Medical Service Report 3 finds that Health Reimbursement Arrangements
(HRAs) are effectively consistent with MSAs in several, but not all, important respects
and recommends AMA support of HRAs as an additional mechanism for consumerdirected health care finance. The report also recommends several improvements to
HRAs including employee ownership of accounts and mandatory rollover (or return to
employee upon termination of employment) of any unspent balance.
(25)
835
in
addition
to
the
amendment
to
the
first
Resolve.
COUNCIL ON MEDICAL SERVICE REPORT 3 - HEALTH
REIMBURSEMENT ARRANGEMENTS
RECOMMENDATION A:
Madam Speaker, your Reference Committee recommends
that Council on Medical Service Report 3 be amended on
page 4, line 32 by deletion and addition to read as follows:
That it is the policy of the AMA that: (a) Health
Reimbursement Arrangements (HRAs) be made into real
(rather than notional) accounts belonging to with
ownership by the individual employee; (b) employers be
required to rollover all unspent HRA balances annually;
and (c) employers be required to make unspent HRA
balances available to employees upon their retirement or
departure from the company. (New HOD Policy)
RECOMMENDATION B:
Madam Speaker, your Reference Committee recommends
that Council on Medical Service Report 3 be amended by
addition on page 4 of a new Recommendation 4 to read as
follows:
4. That our AMA report to the House
implementation of Health Savings Accounts.
on
the
RECOMMENDATION C:
Madam Speaker, your Reference Committee recommends
that the recommendations contained in Council on Medical
Service Report 3 be adopted as amended and the
remainder of the report be filed.
HOD ACTION: Recommendations contained in Council on
Medical Service Report 3 adopted as amended, remainder
of report filed.
Testimony on Council on Medical Service Report 3 was highly supportive. There was a
suggestion that the report be amended to support policy that calls for HRAs to be
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funded by employers, employees or both, but the Committee notes this flexibility
appears to have been accomplished with the creation of Health Savings Accounts
(HSAs). The Council on Medical Service testified that a future report on the newly
created HSAs would be warranted as they are defined and implemented. The
Committee supported an editorial suggestion as well as the recommendation to present
a future report on HSAs and commends the Council for this report.
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The AMA will work for and encourage other interested groups to support efforts
to pass increased excise taxes on tobacco products, with the proceeds used to
support educational and counter-advertising efforts.
(26)
RESOLUTION 803 - STATE TOBACCO TAX INCREASES
AND RESPONSIBLE USE OF RESULTING FUNDS
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Policy H-490.948 be reaffirmed in lieu of Resolution
803.
HOD ACTION: Resolution 803 referred.
Resolution 803 calls for the AMA to support increases in the taxation of tobacco
products with revenue from any such tax increases appropriated exclusively for the
following uses: 1) educational, counter-advertising, and cessation programs designed to
decrease the prevalence or the adverse effects of tobacco use, and 2) health related
costs associated with tobacco use.
Your Reference Committee heard testimony that was mixed and generally favorable to
the resolution. Witnesses expressed concerns including fear that the political
unfeasibility of raising excise taxes on tobacco when those tax increases are contingent
on the explicit allocations of the resulting incremental tax revenues to anti-tobacco
programs. Doing so will reduce the political prospects of raising tobacco product taxes.
Your Reference Committee also heard testimony expressing the opposite concern that
revenues from increases in tobacco taxes would not be directed to anti-tobacco
programs. Your Reference Committee finds that the language of the Resolve is clear on
the point, which links any and all revenue from such tax increases to their expenditure
on anti-tobacco programs.
However, your Reference Committee also finds that Resolution 803 is fully consistent
with policy H-490.948, which reads as follows:
Your Reference Committee, therefore, concurs with the recommendation of the
Convention Committee on Rules and Credentials that H-490.948 be reaffirmed in lieu of
Resolution 803.
Reference Committee K (I-03)
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(27)
RESOLUTION 806 - PHYSICIAN CREDENTIALS AND
THE TORT SYSTEM
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Resolution 834 calls for our AMA to support legislation to create a negotiated price
reduction program with pharmaceutical companies that lowers prescription drug prices in
order to make drugs affordable.
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Policy H-435.963 be reaffirmed in lieu of Resolution
806.
HOD ACTION: Policy H-435.963 reaffirmed in lieu of
Resolution 806.
Resolution 806 calls for our AMA to urge all medical staffs, hospitals, health plans,
health insurers and all other organizations that credential physicians to modify clauses in
their credentials applications to place a time limit of not greater than three years on the
reporting by physicians of unsuccessful claims of professional negligence against them.
Testimony on Resolution 806, which was extracted from the Reaffirmation Consent
Calendar, was limited. Your Reference Committee heard concern with regard to the term
“unsuccessful claims” and notes that Policy H-435.963 addresses the issue raised in
Resolution 806. Policy H-435.963 reads as follows:
The AMA opposes the need for reporting on medical staff and other nonlicensing board applications, including insurance company credentialing
applications, (excepting professional liability insurance applications) any
threatened, pending, or closed professional liability claims where the claim did
not result in payment on behalf of that physician.
The Committee concurs with the Convention Committee on Rules and Credentials that
Policy H-435.963 should be reaffirmed in lieu of the resolution.
(28)
RESOLUTION 834 - CUTTING PRESCRIPTION DRUG
PRICES
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 834 be referred to the Board of Trustees.
HOD ACTION: Resolution 834 referred to the Board of
Trustees.
Testimony regarding Resolution 834 was largely unsupportive and there were several
suggestions for referral. Opposition noted that the resolution runs contrary to the AMA’s
support for market-based solutions. It was also suggested that the resolution should
address the issue of pharmaceutical research. Your Reference Committee notes that
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prescription drug prices remain a critical issue, but nevertheless concurs that further
study is warranted.
(29)
RESOLUTION 838 - PRESERVATION OF THE
NATIONAL RESIDENT MATCHING PROGRAM (NRMP)
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 838 be referred to the Board of Trustees
for decision.
HOD ACTION: Resolution 838 referred to the Board of
Trustees for decision.
Resolution 838 calls for our AMA to: 1) recognize that the National Resident Matching
Program (NRMP) is important to the conduct of residency training programs and should
take as a highest priority the preservation and protection of the NRMP; 2) support the
NRMP; and 3) work with the Association of American Medical Colleges, and state and
specialty societies to encourage Congress to enact legislation that protects the match to
eliminate costly and protracted litigation and the risk of a verdict that would destroy the
integrity of the fair and effective match program and the graduate medical education
system.
The limited testimony on Resolution 838 fully supported its intent, although the concern
was raised that its adoption may complicate the AMA’s defense in the litigation regarding
the NRMP. For this reason, your Reference Committee concurs with the suggestion that
Resolution 838 should be referred for decision.
(30)
RESOLUTION 829 - GUIDELINES TO AVOID
INAPPROPRIATE INSURER KICKBACKS
RECOMMENDATION:
Madam Speaker, your Reference Committee recommends
that Resolution 829 not be adopted.
HOD ACTION: Resolution 829 not adopted.
Resolution 829 calls for our AMA to develop: 1) guidelines as to the timeliness and
permissible interval, if any, between payment by and request for repayment to insurers;
and 2) guidance to define when, if ever, it is appropriate to enter into arrangements with
insurers for repayment to the insurers of payments made to practitioners
Your Reference Committee heard no testimony on Resolution 829. Absent information
as to whether in fact such kickbacks occur, the Committee recommends the resolution
not be adopted.
Reference Committee K (I-03)
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Madam Speaker, this concludes the report of Reference Committee K. I would like to
thank Richard F. Ambur, MD, David W. Avery, MD, Kenneth W. Crabb, MD, Dennis
Galinsky, MD, Jennifer M. La Plante, Donald J. Swikert, MD, and all those who testified
before the Committee.
Richard F. Ambur, MD
Washington
Dennis Galinsky, MD
American College of Radiation
Oncology
David W. Avery, MD
American Academy of Family
Physicians
Jennifer M. La Plante (Alternate)
Florida
Kenneth W. Crabb, MD
Minnesota
Donald J. Swikert, MD
Kentucky
Ruth M. Covell, MD
Medical School Section
Chair