The American Medical Association (AMA) held its Interim House of Delegates (HOD) meeting in December of 1999 and took the following actions:
Medicare Payment Issues
Not surprisingly, issues involving Medicare payment, and the actions (or inaction) of the Health Care Financing Administration (HCFA) dominated the agenda. The HOD considered a variety of resolutions pertaining to HCFA that impact neurosurgeons.
- Evaluation and Management Documentation Guidelines. The HOD directed the AMA to: 1) Reaffirm its commitment to the current E&M Code Guidelines and adopt a peer review outlier program instead; 2)Take appropriate action to have HCFA and its carriers suspend all present and future audits under the onerous E&M Code Guidelines; 3)If unsuccessful in achieving these goals with HCFA, seek an interim agreement with HCFA to allow physicians to utilize the guidelines proposed by the AMA to HCFA in May 1999, as well as the 1995 and 1997 guidelines, until such time that there is a final documentation system approved by the AMA; and 4) Immediately pursue simultaneous legal and legislative action to force HCFA to stop its random pre-payment audit and review activities until it completes and reports pilot studies of a peer review outlier program.
The HOD also considered a resolution recommending that the AMA explore the use of a coding scheme based on the time spent by a physician in the face-to-face encounter with a patient. There was considerable opposition for using encounter time as the primary method of determining an E&M service (the AANS opposes this as well). This issue was referred to the AMA Board of Trustees for further consideration. The AMA E&M Documentation Guidelines Task Force is studying this and other issues. AANS member, Troy M. Tippett, MD, is a member of the Task Force, which will make additional recommendations to the HOD.
- Practice Expense Payments. In response to HCFA’s decision to disallow the costs physicians incur when they use their clinical staff to perform services in non-office settings, the HOD directed the AMA to seek legislation directing HCFA to include in the RBRVS practice expense allocation all costs incurred by physicians, including those costs incurred in hospitals and ambulatory surgical centers. The AANS recently filed a lawsuit against HCFA on this issue.
- Medicare Conversion Factor. In December, the AMA filed a lawsuit against HCFA to recoup billions of dollars in physician Medicare revenue that has been lost due to faulty estimates in its spending projection formula. The AANS subsequently submitted a resolution requesting the AMA to implement a process whereby interested specialty societies could join the lawsuit. The HOD referred the matter to the AMA Board of Trustees for decision. In February, the AANS, along with several other specialty societies, officially joined the suit.
Other Issues
- On-Call Physicians. The HOD received a report that addressed the reasons for the growing on- call physician shortage in emergency departments. The report examined possible solutions, including mandatory stipends for on-call physicians, and legislation requiring health plans to pay for on-call services. Given the complexity of this issue, the HOD recommended that the AMA convene a task force with interested organizations to further explore the issues and to make additional recommendations. John A. Kusske, MD, AANS Vice President, and Brian t. Andrews, MD, former Chair of the AANS/CNS Section on Neurotrauma and Critical Care, will represent neurosurgery on the task force.
- Pain Management. Dominating the meeting’s press coverage of the meeting was the HOD’s attempt to reconcile the AMA’s support for states’ rights to regulate pain management with its opposition of Oregon’s physician-assisted suicide law and its support of the federal Pain Reliief Promotion Act (the Hyde-Nickles bill). This bill outlaws physician-assisted suicide, but also establishes federal standards for pain management and palliative care. The bill passed in the House in October of 1999, with strong support from the AMA, and is currently pending before the Senate. In an effort to seek a compromise, the HOD directed the AMA to modify the provisions of the bill that would establish federal protocols and/or regulations for pain management and palliative care. The HOD also approved a new policy prohibiting the AMA from supporting any future legislation that allows the federal government to define appropriate medical practice.
Enhancing Neurosurgery’s Voice
Neurosurgeons need to keep in mind that health care policy makers continue to view the AMA as the spokesorganization for all physicians. We must take a proactive role in shaping AMA policy, so neurosurgery’s concerns are considered in the process. The AANS now has two delegates to the AMA – Mark J. Kubala, MD, and George H. Koenig, MD, as well as one alternate – Adam I. Lewis, MD. The number of our delegates is directly tied to the number of AANS members who are also AMA members.
Mark J. Kubala, MD is a neurosurgeon in private practice in Beaumont, Texas and the AANS delegate to the AMA’s House of Delegates.