January 2001 • Volume 7 Number 1
From carve-outs to restructuring, AMA house takes action
The AMA House of Delegates, during its interim meeting Dec. 3-6 in Orlando, Fla., acted on topics including the following:
Carve-outs. The AMA pledged to try to eliminate mental health carve-outs, including drug rehabilitation carve-outs. The carve-outs separate mental health services and financing from other care and funding. AAFP delegates spoke against the carve-outs both in a reference committee and on the house floor.
Student delegates. The AMA house voted to have 18 student delegates in the house, with the students selected from various regions of the country according to the proportion of student members in the regions.
Provisional credentialing. The AMA house asked HCFA to allow provisional credentialing of new physicians by Medicare, Medicaid and managed care organizations, letting the physicians be paid for their services while completing lengthy credentialing processes. The house also encouraged expeditious credentialing of established physicians who move or change their practices.
Screening standards/preventive services. The AMA house voted to have a council study AMA's process for endorsing screening standards and recommend a process for dealing with resolutions on evaluating screening standards. AAFP delegates said the process should be evidence-based, as is the process used by the U.S. Preventive Services Task Force.
When the AMA house considered asking for increased Medicare coverage of preventive services, Academy representatives said an evidence-based process should guide Medicare's coverage of those services.
In the past, the AMA has sometimes taken stances at odds with evidence-based studies. For example, studies indicate the need for routine mammography screening for women beginning at age 50. But in an earlier meeting, the AMA endorsed routine mammography screening every two or three years beginning at age 40.
"The AMA house's acceptance of the Commission on Unity report was AMA's first official recognition there has to be systemic change. We can no longer just tinker around the edges."
Neil Brooks, M.D.
Restructuring the house of medicine. The Commission on Unity proposed a unified model for state and national medical organizations, all of which would automatically pay dues for all their members to belong to the national federation. The commission, including AAFP Past President Neil Brooks, M.D., of Vernon, Conn., met over a two-year period to explore ways to restructure and strengthen the house of medicine in the United States. Academy delegates testified in favor of the commission's overall report but did not support its one unified model.
The Advisory Committee on Membership proposed many models for membership, of which the AAFP supported an "organization of organizations" and a hybrid model allowing individual physician members. The committee will continue developing several models.
The AMA Board of Trustees will appoint a committee to continue the Commission on Unity's work, and the Academy expects to participate in that committee.
"The commission's charge was to look at more than the AMA, to study ways to increase the effectiveness of all of organized medicine and improve ways it represents physicians," says Brooks. "There's too much redundancy and wastefulness. Often, different organizations do not coordinate their efforts on subjects such as managed care. Multiple groups work on issues we're all interested in, including evaluation and management codes and Medicare fraud and abuse initiatives. The current system will continue to be dysfunctional; it won't work as we move into the future. The AMA house's acceptance of the commission report was AMA's first official recognition there has to be systemic change. We can no longer just tinker around the edges."
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