November 2007

ArMA's AMA delegation participated in the 2007 AMA Interim Annual House of Delegates, which reviewed reports and resolutions including:

In addition to ArMA's AMA Delegates: Drs. Jacque Chadwick, Delegation Chair, Bruce Bethancourt, Jr., Ronnie Dowling and William Mangold, Jr.; and Alternate Delegates: Drs. Gary Christensen, Leonard Ditmanson, and Philip Keen, Dr. Marilyn Laughead and several Arizona medical students participated in the AMA Interim House of Delegates, which reviewed reports and resolutions including:

RESOLUTION 715 - PATIENTS ADMITTED FOR OBSERVATION, INTRODUCED BY THE ARIZONA DELEGATION
Introduced by the Arizona Delegation, Resolution 715, asks that our AMA (1) study the scientific and clinical accuracy and merits of currently available criteria used to determine admission to hospitals under "observation" vs. "inpatient" status; (2) study the potential impact on clinical treatment and outcomes as well as financial consequences to patients, hospitals and physicians that may occur as a result of the strict application of clinical criteria to patients admitted for observation; and (3) promote the application of criteria that are established by scientific evidence, based on good clinical practice for admission to hospitals. Following extensive testimony regarding the need for guidelines that could be used by physicians and third party payers to assist in determining varying levels of observation or admission status, the House voted to refer the resolution for decision to allow the Board to assess the implementation of current AMA policies.

RESOLUTION 603 - PRESIDENTIAL CANDIDATES' VIEWS ON HEALTH SYSTEM REFORM
Resolution 603, which calls upon our American Medical Association (AMA) to host a US presidential candidate forum of all the candidates at the 2008 Annual Meeting, was referred for decision. Testimony was positive toward the resolution's goal - making the views of presidential candidates on health reform available to physicians with some concern about using the next House meeting as the specific vehicle. The decision to refer for decision enables the Board to investigate the legal issues associated with an organization such as our AMA hosting a presidential candidate forum and gives the Board opportunity to study the feasibility of organizing the event as proposed and allows the Board to start planning the event, if feasible.

RESOLUTION 701 - ONE FEE, ONE NUMBER
Resolution 701, which asked that our AMA work with the appropriate agencies to require only one federal DEA number that would be physician-specific rather than site-specific, was amended to include a request for a study of the impact of the elimination of multiple physician identifiers and was adopted.

RESOLUTION 704 - HEALTH CARE AS A FUNDAMENTAL SOCIETAL OBLIGATION
Resolution 704 calls for our AMA to: (1) formally recognize that every member of society deserves an adequate level of protection from illness and avoidable pain and suffering related to health problems and that this fundamental societal obligation is derived from the sum of the diverse ethical considerations of our values of equality of opportunity, justice and compassion; and (2) recognize that providing access to quality and affordable health care for all US citizens is a fundamental societal obligation, and that a letter advocating that societal obligation be sent from the AMA Board of Trustees within 90 days of the adjournment of the 2007 Interim Meeting to all official candidates for president of the United States for the upcoming 2008 presidential election and all elected members of the United States Senate and the United States House of Representatives. After evenly divided testimony including concerns that the notion of "societal obligation" implied an individual right to health care and testimony that the Council on Ethical and Judicial affairs is considering the issue, the resolution was referred with a report back in June 2008.

RESOLUTION 717 - SINGLE PAYER
Resolution 717, which asks that our AMA (1) reaffirm AMA policy in support of pluralism, freedom of enterprise and its strong opposition to a single payer system; (2) distribute our policy positions on health system reform to all declared candidates for the presidency of the United States of America and formally request their public support of those positions; and (3) undertake a media campaign designed to educate the American people about AMA policy on health system reform, emphasizing pluralism, individual ownership of health insurance and the insurance market reforms necessary to allow free market principals to function, was adopted as amended.

RESOLUTION 904 - IMPROVING AFFORDABILITY OF CHILDHOOD VACCINES
Resolution 904 asks that our American Medical Association actively encourage the US Congress to develop legislation aimed at allowing states to purchase vaccines at the Vaccines For Children rate even when private funding is included in the financing of a state's Universal Status Immunization Initiative. While recognizing the need to increase immunization rates for children by overcoming cost barriers, it was felt that further study is warranted due to various concerns expressed including those relating to funding, financial viability and whether the AMA should take a legislative approach given its current activity on this issue. Resolution 904 was referred for decision.

RESOLUTION 925 - BALANCE BILLING FOR ALL PHYSICIANS
Resolution 925, which asks (1) that our American Medical Association devote the necessary political and financial resources to introduce national legislation at the appropriate time to bring about implementation of Medicare balance billing and to end the budget neutral restrictions inherent to the current Medicare physician payment structure that interferes with patient access to care; (2) that this national legislation be designed to pre-empt state laws that prohibit balance billing and prohibit inappropriate inclusion of balance billing bans in insurance-physician contracts; (3) that our AMA develop model language for physicians to incorporate into any insurance contracts that attempt to restrict a physician's right to balance bill any insured patient; and (4) that our AMA Board of Trustees report back to the AMA House of Delegates, by e-mail or fax on a quarterly basis, their progress toward the completion of all of these goals. Was adopted as amended

ANTITRUST RELIEF
Following emphatic testimony on the need for our AMA to continue its efforts at seeking legislative relief from the antitrust constraints to which physicians are subjected, resolutions which ask that our American Medical Association redouble its efforts to make physician antitrust relief a top legislative priority, to provide the necessary foundation for fair contract negotiations designed to preserve clinical autonomy and patient interest, and to redirect medical decision-making to patients and physicians, were adopted. The AMA also affirmed its commitment to undertake all appropriate efforts to seek legislative and regulatory reform of state and federal law, including federal antitrust law, to enable physicians to negotiate effectively with health insurers.

COUNCIL ON MEDICAL SERVICE REPORT 3 - STATE EFFORTS TO EXPAND COVERAGE TO THE UNINSURED
The AMA adopted several principles to guide in the evaluation of state health system reform proposals: health insurance coverage for state residents should be universal, continuous and portable; coverage should be mandatory only if health insurance subsidies are available for those living below a defined poverty level; the health care system should emphasize patient choice of plans and health benefits, including mental health, which should be value-based. Existing federal guidelines regarding types of health insurance coverage should be used as references when considering if a given plan would provide meaningful coverage. The delivery system should ensure choice of health insurance and physician for patients, choice of participation and payment method for physicians, preserve the patient/physician relationship, focus on providing care that is safe, timely, efficient, effective, patient-centered and equitable. The administration and governance system should be simple, transparent, accountable, efficient and effective in order to reduce administrative costs and maximize funding for patient care. Health insurance coverage should be equitable, affordable and sustainable. The financing strategy should strive for simplicity, transparency and efficiency and it should emphasize personal responsibility as well as societal obligations.

• University of Arizona Medical Student Kendall Allred was elected by the Medical Student Section to the position of Student Trustee-elect, effective November 9, 2007, and will assume the Student Trustee seat on the AMA Board of Trustees in June 2008.
• The Delegation would like to recognize the contributions of Dr. Philip Keen, who is retiring as a member of the delegation.
• Further, we would like to extend our appreciation to Dr. Gary Smethers, Senior Vice President of Medical Affairs, and Blue Cross/Blue Shield of Arizona for its support.

Respectfully submitted,

Arizona's Delegation to the AMA