RBRVS, HIV top AMA House of Delegates issues for physician executives - revisions in the Medicare physician payment reform, American Medical Association - AMA Report

Physician Executive, Nov-Dec, 1992 by James E. Hartfield

The principal issues for physician executives addressed by the AMA House of Delegates at its 1992 Annual Meeting in Chicago, Ill., June 21-25, involved continuing revisions in the Medicare physician payment reform (RBRVS), HIV infection among physicians, and recurring concerns over peer review organizations and Health Access America. In addition to considering the largest agenda in its history, containing 104 reports from boards and committees plus 311 resolutions, the House chose Joseph T. Painter, MD, of Texas as its President-Elect.

The House adopted the following policy statement to guide the AMA's future actions concerning Medicare physician payment reform:

"Resolved, that the AMA take all necessary legal, legislative, and other action to redress the inequities in the implementation of the RBRVS, including but not limited to:

1. Reduction of allowances for new physicians.

2. The nonpayment of EKG interpretations.

3. Defects in the Geographic Practice Cost Indices and area designations.

4. Inappropriate Resource-Based Relative Value Units.

5. The deteriorating economic condition of physicians' practice disproportionately affected by the Medicare payment system.

6. The need for restoration of the RBRVS conversion factor to levels consistent with the statutory requirements for budget neutrality.

7. The inadequacy of payment for services of assistant surgeons.

8. Loss of a surgical tray benefit for many outpatient surgical procedures."

Further, the House resolved that the AMA seek adequate publication of modifiers and descriptors and consistent interpretation of global fees. Much of the testimony in reference committees and on the House floor illustrated the frustration among physicians nationwide about implementation of HCFA payment polices and rising practice costs.

HIV Infection Among Physicians

A comprehensive report by the Board of Trustees outlined AMA positions on a wide variety of issues surrounding the AIDS epidemic. Among the widely debated positions were that:

* Explicit consent should not always be required prior to HIV testing, although pre- and posttest counselling is essential.

* Any HIV-infected physician should disclose his/her serostatus to state public health officials or a local review committee.

* Physicians who perform patient care procedures that pose "a significant risk of HIV infection transmission" should voluntarily determine their serostatus.

* AMA remains opposed to mandatory HIV testing. While many states have adopted laws governing consent and confidentially, physician executives should be aware of the AMA official posture. A "White Paper" outlining AMA policy on HIV/AIDS is planned for future publication and will undoubtedly form the basis for many state medical society policies, legislative debate/actions, and medical-legal confrontation.

In an associated report, the AMA Board of Trustees issued findings regarding "Multiple Drug Resistant Tuberculosis: A Multifaceted Problem," which reviewed preventive, diagnostic, and therapeutic recommendations on this critical new disease pattern. The significantly more communicable nature of TB has largely been overlooked in recent OSHA requirements and HIV focus. Yet it poses an equally ominous threat of achieving epidemic status nationwide.

Peer Review Organizations

The AMA House focused on concerns regarding the Uniform Clinical Data Set (UCDS) and the appropriate application of the UCDS system in individual practice. Questions of confidentiality of individual physician data, the punitive rather than educational emphasis, and the lack of physician involvement in data set development (as well as in PRO activities) were raised in multiple "Resolve" clauses and amendments on this subject.

Specialty Society Representation n the AMA House

Of particular interest to ACPE members is the growing discomfort in the House of Delegates with the number of specialty societies seeking and being admitted to Delegate status. Efforts have been defeated in recent meetings to place a cap on delegate numbers or to restrict society membership on the basis of ABMS certification. The primary argument for restrictions contends that while every American physician is represented through state delegations, most are also represented by some specialty society delegate. With the continuing addition of organizations representing the many facets of some specialties (e.g., American Academy of Facial Plastic and Reconstructive Surgery, American Association of Electrodiagnostic Medicine, etc.) or reflecting techniques or special interests (e.g., American Society of Cataract and Refractive Surgery, American Society of Addictive Medicine, etc.), many physicians have multiple delegate representation. Proponents of this enlarged delegate base argue that the addition of subspecialty interest delegates reflects better representation of AMA members than the larger umbrella societies. The AMA should be seeking rather than discouraging this representation if it truly seeks to reflect the broad arena of medicine, these proponents say.