AMA House Acts on 'Blended' Payments, Other FP Hot-Button Issues

Blended payments and abusive economic profiling of physicians were just two of the issues affecting family physicians that were front and center at the AMA House of Delegates' interim meeting here Nov. 11-14. Other topics the AMA acted on included the future of emergency and trauma care and how to deal with conscientious objections by pharmacists.

Delegates directed the AMA to work with Congress "to make it illegal for insurance companies to unilaterally change payments by 'blending' levels." The decision was welcome news for FPs, who have struggled with insurance companies about the issue.

"Insurance companies blend rates when they see utilization of the higher (CPT) codes, which are actually appropriate, going up," said AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., an AAFP delegate to the AMA house, in an interview at the meeting. The Academy delegation strongly supported the house's action on blending because it "reaffirms the fact that family physicians and other physicians should be adequately paid for what they do," Fields said.

Through its private sector advocacy work, the AAFP "has beaten this issue down in certain areas, but it crops up with the same companies in other parts of the country," he added. "The fact that the AMA is willing to look at (making blending illegal) is an extremely positive step."

The AMA house also passed an amended resolution that directs the AMA to "explore the feasibility of participating in legal action designed to address arbitrary and abusive economic profiling of physicians." Many delegates burst into applause when the resolution passed.

"Economic profiling is what insurance companies use to try to save money," said Fields. "They try to direct patients to doctors who charge less. It has absolutely nothing to do with quality. It has everything to do with profit for the insurance company." That kind of action "is unconscionable and probably immoral, and it may take legal action to fix this," said Fields.

In a related action, delegates directed the AMA to seek legislation or regulation that would prohibit the formation of health plan networks based solely on economic criteria. Payers should disclose the criteria used to create tiered, narrow or restricted networks, the delegates decided, and, when new networks are established, physicians should be informed of participation criteria with enough lead time to enable them to meet those criteria.

Family physician delegates to the AMA stood up for the specialty when they testified about a report on the future of emergency and trauma care in reference committee. The report from the AMA Board of Trustees was based on deliberations of a work group composed mostly of surgical specialty representatives, without family medicine input --even though FPs provide much of the emergency and trauma care in rural America.

AAFP Director David Avery, M.D., of Vienna, W.Va., speaking for the AAFP delegation, called on the AMA to "expand the dialogue" to include family medicine. Speaking as an individual, Kentucky delegate and family physician Gregory Cooper, M.D., of Cynthiana called it "a mistake to overlook the role of family physicians in emergency medicine." AAFP Director Judith Chamberlain, M.D., of Brunswick, Maine, an AAFP delegate, urged inclusion of primary care in the work group, noting that family physicians "also follow up (with emergency and trauma patients) in our offices and are not compensated."

AMA Trustee Peter Carmel of Newark, N.J., the work group's convenor, acknowledged that "some specialties were not at the table" and urged adoption of the report, which called for continued dialogue. The reference committee recommended expansion -- not just continuation -- of the dialogue to involve other stakeholders. The house agreed and adopted an amended version of the report, which also calls for the AMA to advocate

The AMA board will report back to the house on the issue in a year.

The AMA house also took up the question of what should happen when a pharmacist conscientiously refuses to fill a legal prescription and refers the patient to an alternative dispensing pharmacy. A report from the AMA Board of Trustees recommended that the pharmacist tell the patient the reason for the referral. The AAFP delegation begged to differ.

In reference committee testimony, AAFP delegate Jun David, M.D., of Albany, N.Y., strongly opposed explaining the referral to the patient. "Our patients do not need a sermon or lecture from the pharmacist," David said. The pharmacist should immediately have another pharmacist fill the prescription or refer the patient to another pharmacy without confiscating the prescription, humiliating or harassing the patient, or breaching the patient's confidentiality, he added.

The majority of those testifying agreed with the AAFP's stance, and the reference committee recommended that the pharmacist should notify the prescribing physician instead of the patient and should return the prescription to the patient. The AMA house adopted the reference committee's recommendation.

"The physician needs to know if the patient is getting the prescribed treatment," said Dale Moquist, M.D., of Houston, chair of the AAFP delegation. The physician also can direct patients to another pharmacy if the same product is needed in the future, he said.

AMA delegates also decided the AMA should

Reference committee testimony on the last item was mixed; the AAFP spoke against the resolution. A resolved clause that asked the AMA to consider withdrawing support if the AQA failed to significantly improve was withdrawn by the resolution sponsor.

The AQA was convened two years ago by the AAFP, American College of Physicians, America's Health Insurance Plans, and Agency for Healthcare Research and Quality. Its mission is to improve health care quality and patient safety by bringing key stakeholders together to agree on a strategy for measuring, reporting and improving performance at the physician level.