AMA Honors ACR for Mammography


ACR Bulletin
January 1995

AMA Honors ACR for Mammography

The American Medical Association, at its interim meeting last month, bestowed upon the American College of Radiology its President''s Citation for Service to the Public. The award was presented by AMA President Robert McAfee in response to the significant contributions made by the College to the improvement of the quality of mammography through its accreditation program. ACR President K. K. Wallace, Jr. of Charlottesville, VA accepted the award on behalf of the College (See story on page 7).

In other business, the delegates said they believed that by the end of the four-day meeting, the AMA was more focused on incremental health reform issues than the comprehensive approach of the last two years. The AMA has reaffirmed its strong support for the Patient Protection Act at both the state and federal level, recognizing that private sector moves toward managed care are unabated, even as the Congress changes leadership and new legislative directions are forged. Support for legislative initiatives in the area of antitrust and medical liability reform, as well as the need for statutory modification of the Employee Retirement Income Security Act (ERISA) to permit more regulation of self-funded plans, remains on the association''s agenda.

Additionally, the AMA leadership announced several organizational changes during the meeting, including a staff realignment as well as the elimination of several staff positions.

The following is a brief report highlighting some of the issues followed by radiologists during the meeting:

Residency Training of Physicians

The ACR submitted a resolution for the delegates'' consideration at the request of the participants at this year''s Radiology Summit meeting. The College''s resolution noted that there had been discussions of legislative reductions in the number and funding of certain residency positions, particularly among specialists. Recognizing that it is preferable to reduce the number of residency programs that train residents on the basis of the program''s quality rather than to reduce all residency positions by an "across-the-board" fixed percentage, the College resolution recommends a role for the Accreditation Council for Graduate Medical Education (ACGME) to assess the quality of programs.

Historically, the ACGME has been reluctant to make allocation decisions regarding the number of residents to be trained nationally or even at a specific training site. In large part, the ACGME feels constrained by potential legal challenges.

The College''s resolution requested that the AMA seek legislative authority to permit the residency review committees and the ACGME to develop relevant quality standards and objective criteria to apply to residency programs free of antitrust and other liability exposure. After considerable debate, the Reference Committee recommended that, because of the complexity of the issues involved in this issue, more study was needed before definitive policy can be developed. The resolution has been referred to the Board of Trustees for study.


Council on Ethical and Judicial Affairs

Since the debate over authority to prescribe ethical rules arising out of the "conflict of interest" discussion of several years ago, the delegates have regularly discussed the relative roles and responsibilities of the House of Delegates in relation to the Council on Ethical and Judicial Affairs (CEJA) to promulgate ethics, and the question as to whether ethical statements must be approved by the House of Delegates. Once again, a proposal was made to specifically authorize the House to approve all ethical opinions of CEJA. Ultimately, the body adopted the following protocol that will be followed by the Council on Ethical and Judicial Affairs, before issuing an ethical opinion or report:

  • CEJA will conduct an open forum at all future meetings of the AMA House of Delegates to discuss pending ethical opinion issues;
  • CEJA will provide, in advance, a detailed description of the ethical issues under study and publicize those issues to the entire membership of the House of Delegates;
  • Delegates will be provided an explanation of the reasons for considering each issue discussed in each report or opinion.

Two items for which an initial report may be discussed at the 1995 AMA annual meeting dealt with ethical guidelines for physicians when testifying as medical expert witnesses, and possible ethical concerns when discounted fees for specialist physicians are undertaken under health plans with contracts with primary care physicians. The author of the resolution dealing with "discounts" argued that such arrangements constituted unethical fee-splitting.


Physician Hospital Organizations

The Board of Trustees reported on its action to followup on a resolution submitted by the ACR last June asking the AMA to develop legislation to prohibit physician-hospital organizations (PHOs) and other integrated health systems from requiring a physician, as a condition for maintaining admitting or clinical privileges, to contract exclusively with managed care organizations through the PHO or integrated system.

Last September, ACR delegate Lee F. Rogers of Chicago, along with radiologist William M. Chandler of Minneapolis, MN, attended a meeting of the Council on Legislation to provide an overview of the issue. The council concluded that this was a timely and important issue for all physicians that needed to be addressed. Of special concern were those physicians who have privileges and who are members of the medical staff of more than one hospital. Facing an all-or-nothing choice between competing PHOs or hospital networks may make it impossible for such physicians to manage their practices effectively.

While physicians may choose to freely enter into an exclusive arrangement with a PHO or other network, the council concluded that such exclusive arrangements should not be a condition for the granting or retention of medical staff privileges. In light of the important nature of the issue, the council developed model legislation that has been approved by the AMA board for distribution to all state medical associations for their consideration.

In another action relating to PHOs and generating considerable debate, the delegates discussed the ramifications of an Internal Revenue Service private letter ruling on physician-hospital organizations. The IRS ruling, believed to be its first call on the tax implications of a not-for-profit hospital''s participation in a PHO, said that the hospital was permitted to proceed, but the structure imposed necessary to satisfy the IRS has generated strong concern. That feature was the limitation of physician representation on the PHO governing board to 20 percent.

The delegates debated a resolution submitted by the Michigan State Medical Association expressing concern about the IRS ruling.

The Reference Committee recommended language offered by ACR alternate delegate George H. Kamp of Tulsa, OK asking the AMA to take steps to inform its members of the IRS private letter ruling and to strongly recommend equitable physician representation on all PHO and other integrated system delivery boards. Ultimately, the complexity of the issue caused the House to refer the matter to the Board of Trustees. The leadership of the AMA informed the House that the matter would be placed on the agenda for the January 1995 Board of Trustees'' meeting.


Physician Credentialing and Privileging

Several resolutions were introduced dealing with the issue of criteria, including board certification, used by hospitals and managed care organizations in their credentialing programs. The delegates requested the AMA to work with national medical specialty societies to educate patients, purchasers of health care services, managed care organizations, and other entities about the need to assess the quality of services provided by individual licensed physicians, using multiple criteria rather than exclusively by the presence or absence of board certification.

The AMA''s Council on Medical Education, which includes among its ranks the Radiological Society of North America''s alternate delegate Thomas S. Harle of Houston, TX has been discussing the development of education guidelines for continuing medical education (CME) used in assessing procedural competence and other credentialing uses. The ACR is monitoring this activity.


JCAHO

The annual and interim meetings of the House of Delegates serves as an ongoing forum to discuss the conduct of the Joint Commission on Accreditation of Health Care Organizations (JCAHO). Among the issues discussed at the interim meeting included Joint Commission standards relating to economic credentialing, restoration of quality standards to the medical staff chapter, and efforts to solidify standards on medical staff self-governance. The delegates expressed concern over the issue of disclosure of organization-specific accreditation performance. Most significantly, the House approved a resolution asking the AMA to study the implication of the AMA withdrawing from sponsorship of the JCAHO.

During the discussion, ACR President K. K. Wallace, Jr. testified that the ACR has long held concerns over the direction of the Joint Commission. Dr. Wallace informed the delegates that, despite the ACR''s long-standing concern, recent efforts on the part of the Joint Commission to improve communication and to express receptivity to reform of certain standards, has made the College cautiously optimistic for the first time in several years that progress can be made.


Effects of Electric and Magnetic Fields

The Council on Scientific Affairs presented a report dealing with the basic principles related to electric and magnetic fields. The report summarized their known effects, and provided recommendation intended to reduce exposure to them. Importantly, however, the report indicated that no scientifically documented health risk has been associated with the usually occurring levels of electro-magnetic fields. Nevertheless, the AMA will continue to monitor developments and issues relating to this issue.


Future Activity

The next meeting of the AMA House of Delegates will take place this June in Chicago. During that meeting, Daniel H. (Stormy) Johnson, Jr. a Metairie, LA radiologist, is expected to be elected president-elect of the AMA, without opposition. Dr. Johnson is currently speaker of the AMA House.

Among those physicians announcing their interest in contesting for the position of vice-speaker of the House is John A. Knote, a radiologist from Lafayette, IN. Dr. Knote currently serves on the AMA Council on Medical Service.