Several folks have been kind enough to point out this story, and suggest that I may have an opinion on it:
[A woman from] Shrewsbury, Mass., claims that Dr. Helen Carter, a primary care physician at the UMass Memorial Medical Center in Worchester, refused to treat her because she is clinically obese…
It seems the good doctor has decided not to care for anyone (it is unclear if the prohibition applied to all patients or just to females) weighing over 200 lbs. Apparently there was a nearby specialty facility capable of caring for obese patients, so no one was being sent away with no resource to medical care.
There is nothing either illegal or unethical about this policy, according to the AMA and others. Much hullabaloo has ensued in the various comment trails, with many people stating that it should be (illegal. unethical, or both.) They are wrong. The only thing this physician has done is set her weight limit unreasonably low.
Here are the magic words: Scope of Practice. It means that doctors have not only the right but the ethical and legal responsibility to limit the care they provide based on their capabilities, their training and their experience, which together also translate to “comfort level”.
Continue reading “The Ethics of Stupidity: Should a Good Doctor Refuse to Treat an Obese Patient?”
Filed Under: Physicians
Tagged: AMA, Dinosaur MD, Medical Ethics, Obesity, Scope of Practice
Sep 26, 2012
There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.
In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.
Then, in the 1970s, 80s, 90s, it came apart and now has the least representation of actual members of a widely diverse base than ever and shows few signs of recuperation. Recently, I advocated that ALL American physicians should become members of the AMA for their entire time in medicine.
Responses, both published and unpublished, were vigorous.
The divide between physicians who think that the AMA should fight for them and those who think that the AMA should fight for the health of the people seems too large to bridge in 2012.
Continue reading “How to Replace the AMA”
Filed Under: Physicians, THCB
Tagged: AMA, George Lundberg, Kaiser Permanente, Lobbying
Aug 29, 2012
All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies.
Why? Because they are the only games in town, and both security and safety are top Maslow imperatives.
The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a group.
American physicians, if united, would have huge clout, speaking with one voice. American physicians, divided as now, speak with hundreds of thousands of individual voices, a cacophony of futility.
As The Bard saith in Macbeth “… tales told by idiots, full of sound and fury, signifying nothing.”
If you are an American physician and you don’t like what the AMA has done and is doing, if you are not a member, shut your mouth, you have no right to complain.
Continue reading “All American Physicians Should Be Members of the AMA”
Filed Under: OP-ED
Tagged: AMA, George Lundberg
Aug 18, 2012
As physicians, our primary concern is ensuring the health and safety of our patients. The Food and Drug Administration has offered a new concept to make more prescription drugs available over the counter (OTC). Proponents claim it could improve patient health and outcomes, reduce patient costs and promote proper medication use. We are skeptical that it would achieve any of these goals.
The American Medical Association is concerned about patients taking certain drugs without physician involvement — especially patients with chronic diseases. No evidence has been offered that the innovative technologies underpinning this concept would actually allow patients with high blood pressure, high cholesterol, asthma or migraine headaches to self-diagnose and manage these serious chronic medical conditions safely on their own.
As a chronic condition evolves, treatment changes are often needed from a physician. Without physician involvement, patients might take the wrong medication or dose for their needs, potentially causing harm. Self-diagnosis and treatment conflict with the care coordination and disease management that new health care payment and delivery models are trying to achieve.
Continue reading “Don’t Bypass Physicians”
Filed Under: THCB
Tagged: AMA, chronic diseases, Costs, FDA, Health Outcomes, OTC drugs, Peter W. Carmel, physician involvement, prescription medication, self-diagnosis
May 13, 2012
After years of telling us they are serious this time and everyone in the health care system had better be ready on time to implement the new disease coding system, CMS said today the whole project is going to be delayed indefinitely.
The new ICD-10 system requires payers and providers to convert from the old system of 13,000 codes to the new system of 68,000 codes.
All payers and providers were supposed to be ready by October 1, 2013. The acting CMS Administrator said, “There is a concern that folks cannot get their work done around meaningful use [of information technology], ICD-10 implementation, and be ready for [insurance] exchanges. So we decided to listen and be responsive.”
Apparently, a new timeline will be developed through a “rule making process.”
Fine, but that has not been the message for months now and lots of people have spent lots of money for apparently no good reason.
The concerns that particularly physicians would not be ready on time have not been minor. CMS conducted a survey between January and March of 2011 that clearly showed there were big problems ahead. But in the year since that survey, they continued to tell stakeholders to keep going ahead full speed, spending big money to be ready.
But in the last few weeks, the American Medical Association has been sounding the alarm–their people wouldn’t be ready.
Sounds like the lowest common denominator in the health care system wins out.
Here are the results from a survey CMS conducted from January to March of 2011 by type of industry participant. AHIP is the insurance industry trade association, HBMA and AAPC are associations of industry coding and billing providers, ACP is the American College of Physicians and the AMA is the American Medical Association. The survey also measured readiness for the Version 5100 standards for electronic health transactions that were effective in January 2012, but for which enforcement has been delayed until March 31, 2012.
Continue reading “Oops! ICD-10 To Be Delayed Indefinitely. Never Mind!”
Filed Under: THCB
Tagged: AMA, CMS, ICD-10
Feb 15, 2012
I have been asked to write up some of the core takeaways from the health care social media presentations I have been giving recently, so I am sharing a version of this narrative on HealthBlawg, in two parts. You may wish to begin with Part I.
Professional responsibility and malpractice liability
The American Medical Association has promulgated a social media policy; so has the Veterans Administration. The two represent very different approaches. The AMA essentially advocates proceeding with caution, and being cognizant of the damage that one’s own social media activities – and one’s colleagues’ – may do to the profession. The VA, on the other hand, is out in front on this issue – just as it was with electronic health records – encouraging the use of social media tools to disseminate information and engage patients and caregivers in productive dialogue likely to improve overall wellbeing and health care outcomes.
Patient care should not be provided in open social media forums, but appropriate disclaimers on blogs, Facebook pages, YouTube channel pages, and the like, should be sufficient protection for providers seeking to use these tools for sharing of general advice and information.
Continue reading “Health Care Social Media – How to Engage Online Without Getting into Trouble (Part II)”
Filed Under: Health 2.0, THCB
Tagged: AMA, company policies, Social Media, VA
Jan 12, 2012
We’re seeing a lot of pushback against ICD-10 implementation, with the American Medical Association’s “vigorous opposition” at the extreme. Gloom and doom types equate to potential IT disaster to Y2K. Ever since watching T. Bedirhan Üstün, M.D. — curator of the International Classification of Diseases, the master coding set from which ICD-10 is derived – present at the American Health Information Managers (AHIMA) annual meeting last October, a question’s been gnawing at me:
If flipping the switch on ICD-10 come Oct. 1, 2013 will be such a disaster as groups like the AMA claim it will be, then why didn’t it bring down the European and Asian health systems that implemented their own flavors of ICD-10 years ago?
The reporter in me – especially when hearing people couch ICD-10 in terms like “unfunded mandate” and “sky-is-falling” hyperbole – suspects it’s all about politics. During the course of debate in these times, it seems as if people on both the left and right resort to browbeating rhetoric faster than I’ve ever seen in my life. And why not? Reciting the catchphrase du jour requires far less reasoning than a well-constructed, original thought.
Continue reading “Why Didn’t ICD-10 Implementation Bring Down Europe’s Health System?”
Filed Under: THCB
Tagged: AMA, HIPAA 5010, HIT, ICD-10
Jan 10, 2012
In a recent Wall Street Journal article, Barbara Levy, Chairwoman of the Relative Value Scale Update Committee (RUC), commented on the American Medical Association’s (AMA’s) decision to have minimal primary care participation on the RUC, saying the committee is an “expert panel” and not meant to be representative. Since the committee is made up of 27 specialists, one family doc, and a pediatrician, the AMA apparently believes it requires little in the way of primary care expertise but lots of experts from every minute surgical specialty.
This is, of course, reflected in the AMA’s coding system. Most of primary care is condensed into four Evaluation and Management (E/M) codes: a “focused” encounter, an “expanded” encounter, a “detailed” encounter, and a “comprehensive” encounter (99212-99215). It does not matter whether the problem is a cold or an acute myocardial infarction. It does not matter if you worked with just the patient or the entire family spanning three generations. It does not matter if the problem was simple and common (eg, essential hypertension) or rare and complex (eg, pheochromocytoma). It does not matter whether you completed everything in a single visit or spent hours fighting with an insurance company for payment. And it does not matter whether you dealt with a couple of well-established problems or a dozen new ones. It is clear that the AMA has little expertise in this area. What is amazing is that they think they have enough!
In contrast, there are 400 pages in the CPT book to help proceduralists get maximum pay for their work. In general, procedure coding follows a scheme based on the part of the body, the number of times you repeat a procedure, how fancy the equipment is, and how many different names you can come up with to do the same work (eg, vein ablation, injection, sclerosing, ligation, interruption, excision, or stripping). This is obviously a boon for many physicians’ income. Continue reading “A Modest Proposal: What If All Specialty Procedures Were Coded with 4 CPT Codes?”
Filed Under: THCB
Tagged: AMA, Coding, RUC
Apr 26, 2011
An under-the-radar revolution is going on out there. It is a revolt of primary care physicians against the AMA and CMS. It is a request for parity with specialists. It is a movement to replace how primary care practitioners are paid.
Why the revolt against the AMA and CMS? Because primary care doctors yearn to correct myths about primary care vis-à-vis specialists, and because they believe, by altering how the AMA and CMS pay doctors, health costs can be brought down, and primary care can be re-invigorated. Health systems with a broad primary care base have lower costs. In the U.S., two-thirds of doctors are specialists, and one-third are in primary care, the reverse of most nations, which have 50% or lower costs.
In the early 1990s, the AMA formed the Relative Value Scale Update Committee (RUC), which specialists now dominate. RUC sets payment codes for doctors. Since RUC’s inception, the payment differential has been growing between primary care doctors and specialists, so much so that the typical primary care doctor now makes only 30% of what an orthopedic surgeon makes. On average, primary care incomes are 50% of those of specialists. Continue reading “Primary Care Revolt: Replace the RUC”
Filed Under: THCB
Tagged: AMA, CMS, primary care, Richard Reece, RUC, specialists
Apr 21, 2011
By BRIAN KLEPPER
On Wednesday, 47 American medical specialty societies sent Rep. Jim McDermott (D-WA) a letter, with copies to all members of Congress, containing a detailed defense of the American Medical Association’s (AMA’s) Relative Value Scale Update Committee’s (RUC). For 20 years, the RUC has exclusively advised the Centers for Medicare and Medicaid Services (CMS) on physician procedure valuation and reimbursement. On its face, the letter responds to a seemingly minor piece of legislation introduced by Rep. McDermott, H.R. 1256, the Medicare Physician Payment Transparency and Assessment Act, that would require CMS to use processes outside the RUC to verify the RUC’s recommendations on medical services values.
Conspicuously absent from the letter’s signatures were the nation’s three main primary care societies: the American Academy of Family Physicians (AAFP) – which has formally endorsed Mr. McDermott’s bill – the American College of Physicians (ACP) and the American Academy of Pediatrics (AAP). Last week, the New Jersey Academy of Family Physicians sent a letter to its parent organization, AAFP, “strongly encouraging” it to quit the RUC. It is as though the long-compromised primary care physician community, that makes up one third of American physician and handles half of our office visits, is suddenly mobilizing.
The medical societies’ letter is more than a response to just Rep. McDermott’s bill. It also responds to the primary care physician community’s stirrings. Marshaling the influence and discipline of a medical establishment obviously distressed by the prospect of having its economic franchise disrupted, it was the third public defense of the RUC in a little more than a week, following a column on Kaiser Health News by the RUC’s Chair, Barbara Levy MD, and a letter this past Tuesday to Rep. McDermott by AMA CEO Michael Maves. After 20 years of easily-validated intentional obscurity – ask virtually any room of physicians what the RUC is and watch the majority’s blank responses – this open activity favoring the RUC is unprecedented.
The letter is also obviously orchestrated, using many of the same tactics and arguments that Drs. Levy and Maves employed in their defenses. It carefully avoids talking about the abysmal real world consequences of the RUC’s historical approach. It ignores the dramatic under-valuing of primary care, the plummeting rates of medical students choosing primary care, the over-valuing and over-utilization of a wide variety of specialty procedures, and the inherent incentive for the RUC to focus on under-valued rather than over-valued procedures.
Instead, it obfuscates. To counter the McDermott proposal that CMS should use means other than the RUC to assess the RUC’s recommendations, the letter argues that past efforts to use contractors have failed. Therefore, it is senseless to go down this path again. Continue reading “The RUC’s Defense”
Filed Under: THCB
Tagged: AAFP, AMA, RUC
Apr 10, 2011