The AMA's voice helped secure an important victory in Sutter v. Oxford Health Plans, allowing individual physicians to come together as a group to fight the unfair business practices of large health insurance companies.
Jeremy Lazarus, M.D., concluded his year as only the third psychiatrist president of the AMA at the June meeting of the House of Delegates.
It was a year of tumult, challenges, and successes that outgoing AMA President Jeremy Lazarus, M.D., recalled in his presidential address last month at the AMA’s House of Delegates meeting in Chicago. Lazarus recounted legislative and legal victories by the AMA regarding physician payment, scope of practice, insurance coverage, and access-to-care issues, as well as the organization’s continued pursuit of the goals of its strategic initiative: enhancing physician professional satisfaction and practice sustainability, changing and improving medical education for the 21st century, and improving health outcomes.
Lazarus noted that in February, he participated in a Senate hearing on the Physician Payment Sunshine Act, the new transparency regulations regarding interaction between physicians and representatives of the pharmaceutical, medical device, and other related industries.
“This provision will require those companies to report any payments or other ‘transfers of value’ they make to physicians on an annual basis and to publish that information via a public database,” he said. “The AMA has long supported greater transparency between physicians and industry, but as I declared to the Senate directly—we want the law implemented appropriately and physician rights to challenge false or misleading reports protected.”
The Centers for Medicare and Medicaid Services starts tracking this information on August 1, and not everyone is aware of it. “So we’ve launched a Sunshine Act resource page on our Web site to educate physicians on the requirements, and we’re offering online modules and webinars to explain it in detail,” he said.
(APA is also undertaking initiatives to educate members about the new law.)
In another practice issue, the AMA has launched the Integrated Physician Practice Section (IPSS) to help physicians shape policy that enhances physician satisfaction and improves practice sustainability. “It’s now crystal-clear to me that the future of medical care depends much on how well physician-led integrated practices work to keep patients healthy and how well they function for their physician members,” Lazarus said. “In my practice, I’ve seen thousands of patients one at a time. Now we can leverage what we can do for so many more patients by working more effectively together. That’s what the IPPS is all about. It will address the issues and needs facing physicians in group and integrated practices and provide a forum for those who have moved into the many new nontraditional types of practice.”
He noted that the AMA earned more than 125 legislative victories at the state level—from insurer transparency to preserving medical liability reforms—by working with state medical societies. Among these was a major decision handed down by the U.S. Supreme Court in Sutter v. Oxford Health Plans that ruled that individual physicians can come together as a group to fight the unfair business practices of large health insurance companies. That decision concluded a dispute that alleged the company systematically bundled, down-coded, and delayed payments for 20,000 physicians in its network.
“The AMA-led brief with the Medical Society of New Jersey noted that health insurers know that arbitrating disputes with individual physicians works to their advantage,” Lazarus said. “They allow contract violations and underpayments to persist and leave physicians helpless to fight them. But thanks to this ruling, thousands of physicians will be allowed to use class arbitration against a health insurer that has underpaid them for more than a decade. This finally gives physicians a weapon to challenge unfair payment practices.”
A past speaker of the APA Assembly, and just the third psychiatrist to be president of the AMA, Lazarus brought a new focus on mental illness and the importance of psychiatry to the larger medical community. In his address to the House of Delegates, Lazarus noted that only a month after his inauguration as AMA president last year, the Aurora, Colo., shooting occurred in which 12 people were killed and some 58 wounded. It was followed by the tragic shooting in Newtown, Conn., in December.
“It brought to the forefront problems with our mental health system and our capacity to prevent at least some of these tragic events,” he said. “And as a psychiatrist, I was at the same time all too aware of the potential backlash against mental health patients…. [W]e know that the vast amount of violence has no relation to mental illness. So we went to work on initiatives to remove the stigma still present against those with mental illness and to offer better treatment options for those affected. Shortly after Sandy Hook, we met with [Obama] administration officials in Washington to discuss a strategy to address gun regulation, mental illness, and public education. We also believe strongly that physicians must be able to have a frank discussion with their patients and families about firearm safety issues and risks…. And we are pleased also that the CDC will again be able to begin epidemiological research on gun violence to better inform the ongoing debate.” ■
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