The AMA and the Infectious Diseases Specialist: House of Delegates Update
By Alan D. Tice, MD, FACP, Infectious Disease Consultants, John A. Burns School of Medicine, University of Hawaii, Honolulu, is Associate Editor for Infectious Disease Alert.
The American Medical Association convened the biannual House of Delegates meeting in Chicago in June with more than 500 delegates from a variety of societies and organizations. The focus was on health care reform with concerns about practical issues of fee-for-service medical care, scope of practice, conflicts of interest, electronic health records, accountable care organizations, tort reform, and care of minorities and the disadvantaged. There also were discussions about quality of care, payment for performance, and the methods to be used with the help of the Physician Consortium for Performance Improvement.
There were a number of resolutions proposed that are relevant to our specialty. These included vaccine programs, which the AMA recommended be universal for children; the AMA also advocates adequate reward for doctors to provide them.
The IDSA submitted a resolution regarding antibiotic stewardship. It was noted that requirements are likely coming for implementing a program to stave off antimicrobial resistance, limit overuse, and provide optimal and specific therapy. An effective program must incorporate input from physicians, pharmacy, microbiology, and infection control, among others. The IDSA asked that a physician be the leader of this team and that this individual be familiar with the use of antibiotics, such as an infectious diseases specialist, if available. Comments from the delegates usually were supportive, but many were concerned with the possible added expense, even though it was suggested that the funding be taken from Medicare funds to be taken back because of hospital-associated infections. There also was some concern about the resolution being self-serving, although it did not specify that the leader be an infectious diseases specialist. The resolution was not approved in the voting, but was referred to the AMA Board for review and recommendations for the next House of Delegates meeting.
The IDSA also brought up the issue of notes in the electronic medical record, as the work of infectious disease specialists is often in the hospital doing consultations and follow-up visits. Noted were the problems of copy-and-paste notes that satisfy the reimbursement criteria but may be essentially identical from one day to the next as "clones." Concerns surround how to identify daily notes and the criteria for reimbursement, including:
- What should the minimum note include?
- How much needs to be new and different each day?
- How important is it to note changes from day to day and to repeat findings that are the same?
Discussions indicated Medicare and private insurance companies are looking into this issue and are expected to propose suggestions for guidelines soon. The resolution was voted down, but will likely resurface when more information has been received from payers.
Although the infectious diseases specialist may have little interest in issues that are beyond their specialty, it should be noted that the AMA is the only real organization that can speak for physicians. While their membership is primarily doctors in fee-for-service medical care, their influence and interests are far greater than that and also apply to physicians in academics and government service. The AMA has more influence with Congress and payers than any other organization and remains financially comfortable despite limited membership. It is an organization that can and does speak with knowledge of infectious diseases, especially as two Board members are infectious diseases specialists.
Keep your eyes open to payers' concerns and contact the IDSA for their input and with any thoughts you have to contribute to better health care as health care reform unfolds.