AMA Clarifies Position on Health System Reform & Public Plan Option
The presentation by President Obama to the AMA House of Delegates one week ago continues to generate discussion and debate. As does the announcement by the Senate Finance Committee last week that it would not be likely to successfully mark up a bill on health system reform until after the July recess. The CBO ten year cost estimates (>$ 1 trillion) also is problematical. No one ever said this was going to be easy...
The national health care reform debate and President Obama's speech on Monday at the AMA's 158th Annual Meeting in Chicago continue to be at the forefront of the news. In a statement released on Wednesday, June 17th, the AMA stated that the organization will "support health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients."
"The AMA is committed to health reform this year, and we are focused on ending our nation's uninsured crisis," said AMA Immediate-Past President Nancy H. Nielsen, M.D. "We will stay engaged with Congress and the administration to ensure that health reform proposals meet the AMA's criteria so that health reform makes a positive difference in the lives of our patients."
"We welcome and will thoughtfully consider all proposals consistent with AMA principles to provide Americans with affordable, high-quality health coverage," said Dr. Nielsen. "We look forward to the day when all Americans have health care coverage."
You can find materials related to the recent AMA meeting, including the President's speech on the web at: http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates/2009-annual-meeting/speeches.shtml.
The AMA has developed the following documents on national health care reform following the annual meeting.
AMA FRAMEWORK FOR HEALTH SYSTEM REFORM
AFFORDABLE COVERAGE FOR ALL
We want all patients to have health insurance, with subsidies (in the form of tax credits or vouchers) for those who can't afford it.
We want patients to be in the driver's seat rather than government or employers.
We want families and individuals to be able to choose from a variety of affordable health insurance options.
We want those choices to be more affordable than they are now, and insurance market reforms are needed to make that happen.
Patients must retain the ability to choose their own doctor and be permitted to enter into private contracting arrangements with their physicians.
Medical decisions should be made by patients and their doctors, using the best possible information.
No one should be denied health insurance because of pre-existing conditions.
Ideally, we want patients to own their health insurance even if it's financed through their employer, so if they leave that job, the insurance isn't lost, just paid for differently.
PREVENTION AND PERSONAL RESPONSIBILITY
We want greater investment in prevention and wellness, so that preventable diseases attributed to obesity and smoking are avoided, thereby lowering future costs.
We want everyone to take responsibility for their own health, insurance protection for their family, and choosing a personal physician.
We want everyone to make and carefully document their wishes about end of life care - even those who are now young and healthy.
Through the AMA convened Physician Consortium for Performance Improvement (PCPI), the medical professionl will continue and intensify efforts to develop evidence-based guidance for quality improvement.
Providing physicians and patients with real time data for decision-making at the point of care should be the driving force for quality improvement.
We support efforts to improve care coordination and management of chronic disease, including the patient-centered medical home and greater support for primary care.
Current antitrust policy must be modified to enable small physician practices to pursue quality improvement, care coordination and health information technology initiatives to achieve greater clinical integration in the delivery system.
The AMA has pledged to do its part to help reduce the rate of growth in health care spending. The AMA convened PCPI is developing measures to reduce unnecessary utilization by focusing on services, treatments and conditions that entail high variation, high volume, and high cost, and have the potential for improving quality and efficiency of care.
We are also working with policymakers and other health stakeholder organizations to streamline the insurance claims processing system, reduce time and resources devoted to paperwork and lower costs for patients, physicians and payers.
Medical liability reforms will reduce costs by reducing the practice of defensive medicine. We urge policymakers to authorize health courts, administrative compensation systems, early offer models, and "safe harbors" for physicians who follow best practice guidelines, and to adopt other proven medical liability reforms.
FISCAL RESPONSIBILITY AND SUSTAINABILITY
Health system reform must be achieved in a fiscally responsible manner in order to maintain a sustainable health care delivery system.
KEY HEALTH SYSTEM REFORM ACTIONS TAKEN
AT THE 2009 ANNUAL MEETING OF THE AMA HOUSE OF DELEGATES
HEALTH SYSTEM REFORM PRINCIPLES
Adopted policy supporting health system reform alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.
MEDICARE PHYSICIAN PAYMENT REFORM
Adopted a set of principles that should be upheld in the development of any Medicare physician payment reform efforts, including ensuring that reform efforts:
- promote improved patient access to care;
- are designed with input by the physician community;
- ensure payment rates that cover the full cost of sustainable medical practice;
- include participation options for all physicians; and
- ensure an appropriate level of physician decision-making authority over any shared-savings distributions.
PATIENT-CENTERED MEDICAL HOME
Clarified AMA support for the patient-centered medical home as a model for providing care to patients without restricting access to specialty care, and will urge the Centers for Medicare & Medicaid Services to work with the AMA and specialty societies t design incentives to increase care coordination among all physicians.
RIGHT TO PRIVATELY CONTRACT
Included in the AMA's top advocacy priorities in 2009: the right of patients to privately contract with physicians; and the ability of physicians to collectively negotiate with health plans.
MEDICAL LIABILITY REFORM
Adopted policy to press for effective medical liability reforms as part of comprehensive health reform legislation.
ELIMINATING RESTRICTIONS ON PRE-EXISTING CONDITIONS
Adopted policy to support health insurance coverage of pre-existing conditions with guaranteed issue in the context of an individual mandate.
INCENTIVES RATHER THAN PENALTIES FOR HIT ADOPTION
Adopted policy cautioning policy makers on the high costs of adopting health information technology (HIT) and advocating for greater adoption of HIT through incentives to e-prescribe and implement and maintain electronic medical records (EMR), without penalty for non-adoption of these systems.
Adopted policy that enhancements to bolster the physician workforce must be part of any comprehensive federal health system reform, including advocating for expanded funding for entry and continued training positions in specialties and geographic regions with documented medical workforce shortages.
MEDICAL STUDENT DEBT RELIEF
Adopted policy advocating for student debt relief through 100% tax deductibility of student loan interest.
FOLLOW ON BIOLOGICS
Adopted policy to make follow on biologics more available to patients and physicians (as a lower-cost alternative), while protecting patient safety and allowing a reasonable timeframe for FDA exclusivity and patent expiration.
HEALTH INSURANCE UNDERWRITING POLICIES
Adopted policy that urges insurance companies to make underwriting decisions based only on the presence of conditions that are valid predictors of morbidity and mortality.
PREVENTION AND PERSONAL RESPONSIBILITY
Adopted policy to improve health and preventive care efforts by advocating for increased physical activity, proper diet and personal responsibility, and working with concerned organizations to achieve this goal.
PRINCIPLES FOR PUBLIC RELEASE OF PHYSICIAN DATA
Adopted a series of principles addressing the public release and accurate use of physician data, including patient privacy safeguards, data accuracy and security safeguards, transparency requirements, review and appeal requirements, physician profiling requirements, quality measurement requirements, and patient satisfaction measurement requirements.