The American Medical Association’s (AMA) House of Delegates has been working hard to achieve a unified voice for organized medicine. Its goal is to provide for the common good of all patients and physicians, promote trust and cooperation among members of the House, advance the image of the medical profession, and increase the overall efficiency of organized medicine for the benefit of its member physicians.
Composed of delegates from state and national medical organizations and appointed representatives from the AMA, the House of Delegates has aggressively advocated the views of organized neurosurgery on a wide range of issues. Following are some initiatives sponsored by the House of Delegates that have impacted neurosurgery.
Patient Bill of Rights. The AMA worked closely with the AANS and other medical specialty organizations to promote passage of the Norwood-Dingell bill (HR 2723), which allows medical decision making to be made by the patient’s physician and holds health plans accountable for limitations of care (more information on the bill).
Practice Expense. The AMA and Practice Expense Coalition continue to work with the Health Care Financing Administration (HCFA) so Medicare adequately pays for physician practice expenses. The AMA and the Coalition recently convinced Congress to force HCFA to abandon the implementation of a flawed payment scheme that would have reduced neurosurgeons’ income by 35 percent. This action prevented a loss of more than $100 million to neurosurgeons in 1998 alone. The AMA was instrumental in drafting and lobbying for the legislative language that led HCFA to adopt this top down methodology.
Campbell Bill. To promote the passage of federal legislation that will permit physicians to jointly negotiate with health insurance companies without being subject to antitrust liability, the AMA has established an “Antitrust Workgroup.” The group is a Washington-based lobbying coalition comprised of specialty societies that help push for anti-trust relief for physicians. The AMA has appointed Katie O. Orrico, JD, Director of the AANS/CNS Washington Office as Co-Chair of the Workgroup, and has developed joint talking points and a sign-on letter for all specialties.
Sustainable Growth Rates. The AMA is actively lobbying for corrections to the Medicare Sustainable Growth Rate (SGR) calculation, which impacts the Medicare conversion factor. The AANS is very supportive of this effort which will help ensure the conversion factor does not decline due to peculiarities in the current formula.
Scope of Practice Issues. Supporting the AANS, the AMA recently signed-on to the AANS/CNS coalition letter opposing HR 1046, the “Chiropractic Patients’ Freedom of Choice Act”. Introduced in March by Representative Wes Watkins (R-OK), this bill would inappropriately expand the scope of diagnostic and therapeutic services that chiropractors can perform under Medicare.
E&M Documentation Guidelines. The AMA CPT Editorial Panel has worked closely with the AANS and CNS to refine the Evaluation and Management Guidelines established by HCFA. In fact, the AMA CPT Editorial Panel adopted every AANS and CNS recommendation for neurological and musculoskeletal examinations. The recommendations for these exams were the product of a consensus process that included numerous medical specialties.
Surgical Specialty Representation. There has been a significant increase in surgical specialty representation in the AMA Board of Trustees. Members include Susan Adelman, MD (pediatric surgeon); Bill Plested, MD (thoracic surgeon); John Nelson, MD (obstetrician/gynecologist); Donald Palmisano, MD (vascular surgeon); and Ralph Smoak, MD (general surgeon), who was elected President-Elect this past meeting. New to the Board are Duane Cady, MD (general surgeon); and Joseph Riggs, MD (obstetrician/gynecologist). In addition, Bruce Scott, MD (otolaryngologist) serves as the young physician representative.
AANS Representation in AMA House of Delegates. Representing organized neurosurgery in the House are myself, George H. Koenig, MD (AANS alternate); Peter W. Carmel, MD (CNS delegate); and Philip W. Tally, MD (CNS alternate). Several neurosurgeons serve in the House from their state societies, including: Constantino Y. Amores, MD; Andrew G. Chenelle, MD; Haroon Choudhri, MD; Tanvir Choudhri, MD; Gary C. Dennis, MD; Calvin C. Kam, MD; Adam I. Lewis, MD; Philipp M. Lippe, MD; Howard A. Richter, MD; Francis X. Rockett, MD; Joseph S. Sadowski, MD; Andrew J.K. Smith, MD; Troy M. Tippett, MD; Gary D. Vander Ark, MD; and Roy W. Vandiver, MD. Your representatives, along with Katie O. Orrico, JD, were influential in getting neurosurgeon Samuel Hassenbusch, MD, appointed to the AMA CPT Editorial Panel. This appointment gives neurosurgery a strong voice on reimbursement issues.
Clearly the AMA is committed to providing a unified voice for organized medicine, and it is to neurosurgery’s advantage to have a strong voice in this group. The AMA can help deflect the forces challenging us and our healthcare delivery system. To join the AMA call (800) AMA-3211.