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Team-Based Care, Principles for Employed Physicians Take Top Spots at AMA Interim Meeting
"We asked for, and the reference committee provided, some clarifying language in this report that says the health care team could be a solo physician working in a practice -- working with a nurse or a medical assistant to provide health care," said Stream in an interview with AAFP News Now.
The resolution itself encourages "independent physician practices and small group practices to consider opportunities to form health care teams, such as through independent practice associations, virtual networks or other networks of independent providers."
- Delegates at this year's AMA House of Delegates interim meeting in Honolulu officially designated physicians as the leaders of the health care team and approved a definition of team-based care that is nearly identical to the definition used by the AAFP.
- At the behest of the AAFP delegation, AMA delegates also recognized the role of solo and small practices in leading the health care team.
- AAFP Board Chair Glen Stream, M.D., M.B.I., testified in various reference committees, speaking out against a proposal to switch Medicare from a defined benefit program to a defined contribution program.
The definition also closely resembles the definition used in the AAFP's Primary Care for the 21st Century document, which makes an evidence-based argument for physician-led health care teams to improve quality and cost efficiency in the U.S. health care system, said Stream.
The AMA resolution calls for adopting principles to help guide physician leaders of the health care team, including incorporating a focus on patient and family-centered care; clarifying the team's mission, vision and values; and engaging with other team members in delivering patient care.
Principles for Employed Physicians
"Physicians are increasingly entering into employment and other contractual relationships with hospitals, group practices and other health care organizations and delivery systems," says the AMA report.
The report goes on to say, "The American Hospital Association estimates that physician employment by hospitals has increased by 32 percent over the last ten years. This trend toward employment is expected to continue, as indicated by a recent Merritt Hawkins survey that found that 32 percent of final-year residents preferred hospital employment over any other practice option."
The report argues that, although contractual relationships can benefit both physicians and patients, "employed physicians face a unique set of challenges as they seek to protect their professional, ethical and financial interests while maintaining the inviolability of the patient-physician relationship."
In response, AMA delegates adopted principles for physician employment in six key areas:
- conflicts of interest,
- advocacy for patients and the profession,
- hospital medical staff relations,
- peer review and performance evaluations, and
- payment agreements.
The principles also note that "employed physicians should be free to exercise their personal and professional judgment in voting, speaking and advocating on any matter regarding patient care interests, the profession, health care in the community and the independent exercise of medical judgment. Employed physicians should not be deemed in breach of their employment agreements, nor retaliated against by their employers for asserting these interests."
Medicare Defined Benefit Plan
During reference committee testimony on Nov. 13, Stream testified against turning Medicare into what he described as a voucher program, saying it would result in "unintended consequences." With a voucher program, Medicare beneficiaries likely would choose high-deductible plans that skirt wellness and prevention, hallmarks of primary care and family medicine, Stream said.
AMA delegates adopted a final report that calls for maintaining the traditional Medicare program while also allowing beneficiaries to use defined contributions to purchase Medicare coverage from private health plans. Stream described the outcome as "reasonable."
AMA House Tackles Medicare Financing Reform, Public Health Topics