Report from the AMA Interim Meeting

When the AMA interim meeting convened in Hawaii on Nov. 9, the Colorado delegation arrived with a four-part strategy - to pass two resolutions; increase the visibility of Brigitta Robinson, MD, candidate for the prestigious AMA Council on Medical Education; and to enhance relationships with the delegations from state medical and specialty societies across the country.

The two resolutions - Resolution 812 and Resolution 811 - both successfully passed and direct AMA to step up its efforts on administrative simplification and patient engagement. With a deep concern over Colorado physician burnout tied to the administrative complexities of the practice environment and the recognition that patients need to be more engaged in their own care, the CMS delegation crafted these two important resolutions in September. Both tie directly to initiatives already underway in Colorado.

Also in this issue: Delegates demand elimination of ICD-10 and AMA adopts principles for physician employment.

Shared Decision Making (SDM) is a more robust form of informed consent and is actualized through the use of evidence-based tools called patient decision aides (PDA). PDAs make the options, benefits and risks of medical decisions clearer to the patient. These tools provide patients with unbiased, complete, accurate and understandable information about care choices.

The concept was included in the federal Affordable Care Act, including grant making for Shared Decision Making (SDM) pilots, but Congress has yet to fund the pilots. Colorado Resolution 812 directs the AMA to lobby Congress to secure the funding.

Funding for SDM pilots is significant for numerous reasons. First, there are recent studies demonstrating that patients have elected to avoid many elective surgeries, saving dollars in the system. Second, an SDM pilot is already underway for employees of the San Luis Valley Regional Medical Center, with an evaluation underway and publication of results anticipated. Third, the Washington State legislature passed an SDM statute in 2007 providing physicians with additional liability protections when approved tools are utilized.

Bottom line, SDM represents an innovation that engages patients in their own care, potentially reduces cost, is evidenced-based and provides an opportunity for enhanced liability protections for physicians. The CMS Workgroup on Patient Safety and Professional Accountability will take action on a recommendation that CMS immediately promote liability protections for physicians who use SDM if the Colorado pilot proves successful.

CMS alternate delegate and past president Dave Downs, MD, led CMS efforts to pass the resolution. A practicing physician with the Colorado Permanente Medical Group, Dr. Downs is leading the clinical side of Colorado's SDM pilot, which is funded by grants from the state department of Health Care Policy and Finance and the Robert Wood Johnson Foundation.

Colorado senior delegate M. Ray Painter, MD, testified on Colorado Resolution 811 on administrative simplification, using a poignant metaphor to illustrate that addressing the administrative complexities are both daunting and ubiquitous. The rationale for Resolution 811 is evidence-based and urgently needed.

Studies show that:

• U.S. physicians spend 66 percent more than other benchmark countries on administrative-related costs.
• A minimum of $55 billion is wasted annually in unnecessary administrative costs.
• Colorado physicians and physicians across the country measure alarming levels of career-threatening burnout as a consequence of pervasive "hassle factors" in the practice environment in which they work.
• There is a link to excessive administrative burdens with increased care redundancy, as well as preventable errors.
• Administratively simple and transparent care delivery systems enhance care efficiency, value and outcomes.

CMS has already approved numerous initiatives to address administrative complexities supported by AMA, such as a national effort to standardize claims edits and prior authorization, among others. CMS believes strongly that the pervasive nature of hassle factors must be addressed across the spectrum and in a manner coordinated throughout organized medicine.

Resolution 811 directs AMA to:

• Continue its strong leadership role in automating, standardizing and simplifying all administrative actions required for transactions between payers and providers.
• Continue its strong leadership role in automating, standardizing and simplifying the claims revenue cycle for physicians in all specialties and modes of practice with all their trading partners, including, but not limited to, public and private payers, vendors and clearinghouses.
• Prioritize efforts to automate, standardize and simplify the process for physicians to estimate patient and payer financial responsibility before the service is provided, and determine patient and payer financial responsibility at the point of care.
• Continue to use its strong leadership role to support state initiatives to simplify administrative functions, such as the Colorado Clean Claims Taskforce.
• Expand the AMA Heal the Claims process™ campaign as necessary to ensure that physicians are aware of the value of automating their claims cycle.

CMS should stop its planned use of the new diagnosis coding set ICD-10, delegates said. A policy adopted at the meeting instructs the AMA to immediately reiterate to CMS that the physician reporting burdens imposed by ICD-10 will force many small practices out of business. This message will be sent to all in Congress and displayed prominently on the AMA website.

CMS requires that ICD-10 be the new standard to use for billing Medicare physician services starting Oct. 1, 2014. The coding set contains 68,000 codes; the current standard ICD-9 has roughly 13,000.

The AMA must continue to communicate to CMS about the burdens that ICD-10 implementation places on doctors, said W. Jeff Terry, MD, a delegate for the Medical Association of the State of Alabama and a urologist in Mobile.

"If we lose this fight, the doctors need to know we went to battle for them," he said.

AMA adopted new principles for physicians entering into employment and contractual arrangements, acknowledging the "unique challenges to professionalism" arising from the trend toward physician employment. An AMA press release reports that one-third of final-year residents list hospital employment as their first choice of practice setting.

The principles address six potentially problematic aspects of the employer-employee relationship: conflicts of interest, advocacy, contracting, hospital-medical staff relations, peer review and performance evaluations, and payment agreement.

View the press release here and access the PDF of the principles here.