American Medical Association (AMA): Annual Meeting of the House of Delegates

CHICAGO – Is obesity a chronic disease on par with diabetes and rheumatoid arthritis that warrants separate coding and reimbursement? That was one question the American Medical Association House of Delegates grappled with at its annual meeting.

The AMA’s policy-making body approached obesity from several different angles, from physical education to soda taxes to physician counseling.

The Illinois delegation put forward a resolution urging the AMA to "recognize obesity and overweight as a chronic medical condition (de facto disease state) and urgent public health problem." As such, the resolution said, the AMA should also recommend that insurers and government agencies pay appropriately for obesity intervention services and develop an ICD code for managing and treating obese and overweight patients.

In committee debates, most delegates agreed that physicians should be paid for managing obesity, but there was a difference of opinion as to whether it should be classified as a disease. Current AMA policy labels obesity a major health problem; the group previously has called for better coding and payment for obesity-related treatment.

When the measure came to the floor for a vote, the delegates voted to study further whether obesity should be classified as a disease.

The House also agreed to a report written by the AMA Council on Science and Public Health that found that taxes on sugar-sweetened beverages are a potentially effective way to reduce consumption. This would be a new policy for the AMA. But the report found that the beverages are a contributing factor to the obesity epidemic. The report also said that the tax revenue should be used to fund programs to prevent obesity.

The new policy was not without its detractors. Dr. Daniel Koretz, an alternate from New York, wanted to amend the report so that the word tax was removed.

"I would hate to see the headline that the AMA is in favor of increased taxes," he said. He also said he felt that taxes should not be used as a method to induce people to act in their best interests. "This is a question of individuals’ freedom to make their own choices about health free of government coercion," he said.

Dr. Russell Kridel, a member of the Council on Science and Public Health, noted that the report merely explored whether a tax would reduce consumption.

"Our council looked at the science. We don’t advocate yes or no on taxes," said Dr. Kridel, a Houston plastic surgeon.

In the end, the House agreed to the Council report as written.

The House also delved into whether enough was being done in the schools to combat obesity. It approved a resolution that would back legislation or new policies to have "meaningful yearly instruction in nutrition, including instruction in the causes, consequences, and prevention of obesity, in grades 1 through 12 in public schools."

The delegates also considered a measure urging the AMA to create a checklist or guidelines for patients who wanted to resume physical activity after an illness or surgery. Delegates agreed that physical activity was important for quality of life and to combat obesity, but some were concerned that physicians might face liability – or be challenged outside their scope of knowledge – when signing off on a return to physical activity.

The House referred the idea for further study.

CHICAGO – Is obesity a chronic disease on par with diabetes and rheumatoid arthritis that warrants separate coding and reimbursement? That was one question the American Medical Association House of Delegates grappled with at its annual meeting.

The AMA’s policy-making body approached obesity from several different angles, from physical education to soda taxes to physician counseling.

The Illinois delegation put forward a resolution urging the AMA to "recognize obesity and overweight as a chronic medical condition (de facto disease state) and urgent public health problem." As such, the resolution said, the AMA should also recommend that insurers and government agencies pay appropriately for obesity intervention services and develop an ICD code for managing and treating obese and overweight patients.

In committee debates, most delegates agreed that physicians should be paid for managing obesity, but there was a difference of opinion as to whether it should be classified as a disease. Current AMA policy labels obesity a major health problem; the group previously has called for better coding and payment for obesity-related treatment.

When the measure came to the floor for a vote, the delegates voted to study further whether obesity should be classified as a disease.

The House also agreed to a report written by the AMA Council on Science and Public Health that found that taxes on sugar-sweetened beverages are a potentially effective way to reduce consumption. This would be a new policy for the AMA. But the report found that the beverages are a contributing factor to the obesity epidemic. The report also said that the tax revenue should be used to fund programs to prevent obesity.

The new policy was not without its detractors. Dr. Daniel Koretz, an alternate from New York, wanted to amend the report so that the word tax was removed.

"I would hate to see the headline that the AMA is in favor of increased taxes," he said. He also said he felt that taxes should not be used as a method to induce people to act in their best interests. "This is a question of individuals’ freedom to make their own choices about health free of government coercion," he said.

Dr. Russell Kridel, a member of the Council on Science and Public Health, noted that the report merely explored whether a tax would reduce consumption.

"Our council looked at the science. We don’t advocate yes or no on taxes," said Dr. Kridel, a Houston plastic surgeon.

In the end, the House agreed to the Council report as written.

The House also delved into whether enough was being done in the schools to combat obesity. It approved a resolution that would back legislation or new policies to have "meaningful yearly instruction in nutrition, including instruction in the causes, consequences, and prevention of obesity, in grades 1 through 12 in public schools."

The delegates also considered a measure urging the AMA to create a checklist or guidelines for patients who wanted to resume physical activity after an illness or surgery. Delegates agreed that physical activity was important for quality of life and to combat obesity, but some were concerned that physicians might face liability – or be challenged outside their scope of knowledge – when signing off on a return to physical activity.

The House referred the idea for further study.

CHICAGO – Is obesity a chronic disease on par with diabetes and rheumatoid arthritis that warrants separate coding and reimbursement? That was one question the American Medical Association House of Delegates grappled with at its annual meeting.

The AMA’s policy-making body approached obesity from several different angles, from physical education to soda taxes to physician counseling.

The Illinois delegation put forward a resolution urging the AMA to "recognize obesity and overweight as a chronic medical condition (de facto disease state) and urgent public health problem." As such, the resolution said, the AMA should also recommend that insurers and government agencies pay appropriately for obesity intervention services and develop an ICD code for managing and treating obese and overweight patients.

In committee debates, most delegates agreed that physicians should be paid for managing obesity, but there was a difference of opinion as to whether it should be classified as a disease. Current AMA policy labels obesity a major health problem; the group previously has called for better coding and payment for obesity-related treatment.

When the measure came to the floor for a vote, the delegates voted to study further whether obesity should be classified as a disease.

The House also agreed to a report written by the AMA Council on Science and Public Health that found that taxes on sugar-sweetened beverages are a potentially effective way to reduce consumption. This would be a new policy for the AMA. But the report found that the beverages are a contributing factor to the obesity epidemic. The report also said that the tax revenue should be used to fund programs to prevent obesity.

The new policy was not without its detractors. Dr. Daniel Koretz, an alternate from New York, wanted to amend the report so that the word tax was removed.

"I would hate to see the headline that the AMA is in favor of increased taxes," he said. He also said he felt that taxes should not be used as a method to induce people to act in their best interests. "This is a question of individuals’ freedom to make their own choices about health free of government coercion," he said.

Dr. Russell Kridel, a member of the Council on Science and Public Health, noted that the report merely explored whether a tax would reduce consumption.

"Our council looked at the science. We don’t advocate yes or no on taxes," said Dr. Kridel, a Houston plastic surgeon.

In the end, the House agreed to the Council report as written.

The House also delved into whether enough was being done in the schools to combat obesity. It approved a resolution that would back legislation or new policies to have "meaningful yearly instruction in nutrition, including instruction in the causes, consequences, and prevention of obesity, in grades 1 through 12 in public schools."

The delegates also considered a measure urging the AMA to create a checklist or guidelines for patients who wanted to resume physical activity after an illness or surgery. Delegates agreed that physical activity was important for quality of life and to combat obesity, but some were concerned that physicians might face liability – or be challenged outside their scope of knowledge – when signing off on a return to physical activity.

The House referred the idea for further study.

CHICAGO – It may have been this year’s tempest in a teapot: After some premeeting scuffles and a marginally exercised debate in committee, the American Medical Association’s House of Delegates calmly voted to direct the organization to explore Medicare financing options, including a defined-contribution program.

The vote was a step back from the wholehearted endorsement of a so-called premium support plan that had circulated before the meeting.

The AMA’s Council on Medical Service had prepared a report for delegates to debate, on options for propping up Medicare over the long term. The report came out in favor of building "on existing policies to support making Medicare a defined contribution program," and crafted a resolution urging the AMA to support "transitioning Medicare to a premium support program."

But a few days before the House got underway, the council withdrew its report and recommendation. Dr. Tom Sullivan, the council chairman, said in a statement that it was withdrawn because the council "believes there is a need to put in additional work on a revised report that addresses a number of complicated policy issues."

The Louisiana delegation was not pleased. It sought – and eventually won – the ability to put the council’s resolution back on the table. That resolution was hotly debated during a committee hearing on the second day of the House of Delegates meeting.

Many delegates argued in favor of supporting a defined-contribution plan for Medicare, saying that the idea already was incorporated into existing AMA policy.

But others worried about what taking a stand on Medicare financing could do to the AMA’s credibility and standing in an election year.

"It’s a potentially politically polarizing stance we’re asking the AMA to take," said Dr. Charles Rothberg, an ophthalmologist with the New York delegation. He also asked why the House was being asked to take such urgent action.

Dr. Nancy Nielsen, the immediate past-president of the AMA, also cautioned against moving too quickly. She urged delegates to take more time to think about Medicare financing options, noting that a wrong move could raise the ire of senior citizens.

When the issue came to the floor for a vote, delegates voted to approve a weakened substitute resolution that directed the AMA to explore all options, including premium support, and "to consider mechanisms to adjust contributions in order to ensure that health insurance coverage remains affordable for all beneficiaries."

The council was directed to report back to the AMA at its interim meeting, which will be held after the November election.

After the vote, Dr. Donald Palmisano, a former AMA president and member of the Louisiana delegation, said in an interview that "it confirms long-standing policy use of a defined-contribution model for the purchase of insurance." Dr. Palmisano added, "We need a system that protects seniors and the disabled and also keeps doctors in the practice of medicine."

Dr. William E. Golden, head of the American College of Physicians’ delegation, said in an interview that the ACP was pleased with the notion that the AMA would further study premium support. The ACP has urged against a quick transformation of Medicare from a defined benefit to a defined contribution.

But in a white paper on Medicare reform released in April the ACP backed a deeper investigation of premium support.

CHICAGO – It may have been this year’s tempest in a teapot: After some premeeting scuffles and a marginally exercised debate in committee, the American Medical Association’s House of Delegates calmly voted to direct the organization to explore Medicare financing options, including a defined-contribution program.

The vote was a step back from the wholehearted endorsement of a so-called premium support plan that had circulated before the meeting.

The AMA’s Council on Medical Service had prepared a report for delegates to debate, on options for propping up Medicare over the long term. The report came out in favor of building "on existing policies to support making Medicare a defined contribution program," and crafted a resolution urging the AMA to support "transitioning Medicare to a premium support program."

But a few days before the House got underway, the council withdrew its report and recommendation. Dr. Tom Sullivan, the council chairman, said in a statement that it was withdrawn because the council "believes there is a need to put in additional work on a revised report that addresses a number of complicated policy issues."

The Louisiana delegation was not pleased. It sought – and eventually won – the ability to put the council’s resolution back on the table. That resolution was hotly debated during a committee hearing on the second day of the House of Delegates meeting.

Many delegates argued in favor of supporting a defined-contribution plan for Medicare, saying that the idea already was incorporated into existing AMA policy.

But others worried about what taking a stand on Medicare financing could do to the AMA’s credibility and standing in an election year.

"It’s a potentially politically polarizing stance we’re asking the AMA to take," said Dr. Charles Rothberg, an ophthalmologist with the New York delegation. He also asked why the House was being asked to take such urgent action.

Dr. Nancy Nielsen, the immediate past-president of the AMA, also cautioned against moving too quickly. She urged delegates to take more time to think about Medicare financing options, noting that a wrong move could raise the ire of senior citizens.

When the issue came to the floor for a vote, delegates voted to approve a weakened substitute resolution that directed the AMA to explore all options, including premium support, and "to consider mechanisms to adjust contributions in order to ensure that health insurance coverage remains affordable for all beneficiaries."

The council was directed to report back to the AMA at its interim meeting, which will be held after the November election.

After the vote, Dr. Donald Palmisano, a former AMA president and member of the Louisiana delegation, said in an interview that "it confirms long-standing policy use of a defined-contribution model for the purchase of insurance." Dr. Palmisano added, "We need a system that protects seniors and the disabled and also keeps doctors in the practice of medicine."

Dr. William E. Golden, head of the American College of Physicians’ delegation, said in an interview that the ACP was pleased with the notion that the AMA would further study premium support. The ACP has urged against a quick transformation of Medicare from a defined benefit to a defined contribution.

But in a white paper on Medicare reform released in April the ACP backed a deeper investigation of premium support.

CHICAGO – It may have been this year’s tempest in a teapot: After some premeeting scuffles and a marginally exercised debate in committee, the American Medical Association’s House of Delegates calmly voted to direct the organization to explore Medicare financing options, including a defined-contribution program.

The vote was a step back from the wholehearted endorsement of a so-called premium support plan that had circulated before the meeting.

The AMA’s Council on Medical Service had prepared a report for delegates to debate, on options for propping up Medicare over the long term. The report came out in favor of building "on existing policies to support making Medicare a defined contribution program," and crafted a resolution urging the AMA to support "transitioning Medicare to a premium support program."

But a few days before the House got underway, the council withdrew its report and recommendation. Dr. Tom Sullivan, the council chairman, said in a statement that it was withdrawn because the council "believes there is a need to put in additional work on a revised report that addresses a number of complicated policy issues."

The Louisiana delegation was not pleased. It sought – and eventually won – the ability to put the council’s resolution back on the table. That resolution was hotly debated during a committee hearing on the second day of the House of Delegates meeting.

Many delegates argued in favor of supporting a defined-contribution plan for Medicare, saying that the idea already was incorporated into existing AMA policy.

But others worried about what taking a stand on Medicare financing could do to the AMA’s credibility and standing in an election year.

"It’s a potentially politically polarizing stance we’re asking the AMA to take," said Dr. Charles Rothberg, an ophthalmologist with the New York delegation. He also asked why the House was being asked to take such urgent action.

Dr. Nancy Nielsen, the immediate past-president of the AMA, also cautioned against moving too quickly. She urged delegates to take more time to think about Medicare financing options, noting that a wrong move could raise the ire of senior citizens.

When the issue came to the floor for a vote, delegates voted to approve a weakened substitute resolution that directed the AMA to explore all options, including premium support, and "to consider mechanisms to adjust contributions in order to ensure that health insurance coverage remains affordable for all beneficiaries."

The council was directed to report back to the AMA at its interim meeting, which will be held after the November election.

After the vote, Dr. Donald Palmisano, a former AMA president and member of the Louisiana delegation, said in an interview that "it confirms long-standing policy use of a defined-contribution model for the purchase of insurance." Dr. Palmisano added, "We need a system that protects seniors and the disabled and also keeps doctors in the practice of medicine."

Dr. William E. Golden, head of the American College of Physicians’ delegation, said in an interview that the ACP was pleased with the notion that the AMA would further study premium support. The ACP has urged against a quick transformation of Medicare from a defined benefit to a defined contribution.

But in a white paper on Medicare reform released in April the ACP backed a deeper investigation of premium support.

CHICAGO – Delegates to the American Medical Association’s legislative body are not happy with the U.S. Preventive Services Task Force.

They voted overwhelmingly (322 to 93) to express "concern" over the task force’s recommendations on screening mammography and prostate-specific antigen screening. Both recommendations attracted a firestorm of criticism when they were issued – the mammography recommendation in 2009 and those on PSA testing in May.

Many delegates also said they thought that the USPSTF, a quasi-governmental group operating under the auspices of the Agency for Healthcare Research and Quality, had reached its decisions without proper input from specialty societies or experts in each field.

In a second resolution, the delegates voted to encourage the USPSTF to "implement procedures that allow for meaningful input on recommendation development from specialists and stakeholders in the topic area under study."

Alicia Ault/IMNG Medical Media

Dr. Arl Van Moore Jr., a delegate from the American College of Radiology, said that neither the ACR nor any prominent breast imaging or surgical societies were contacted by the USPSTF in creating the screening mammography recommendations.

"None of the recognized experts in the field were contacted, to the best of our knowledge," said Dr. Moore, an interventional radiologist in Charlotte, N.C.

The American Urological Association delegate, Dr. William Gee, did not mince words when it came to the PSA screening guidelines.

"The [USPSTF] did not use an open process and ignored the public in reaching their conclusions," he said.

But Dr. Sally J. Trippel, a preventive medicine specialist at the Mayo Clinic and delegate from Minnesota, defended the USPSTF and its process. The task force is "about as politically independent as any national organization can get," and "about as free of conflict of interest as is possible in any organization developing guidelines for American clinicians," she said.

She quoted from task force documents showing that urologists provided peer review of the PSA evidence review. "So there were experts from urology involved in the development of that guideline," and also for the one on screening mammography.

To further show its consternation with the task force, AMA delegates also approved a report that stated that starting at age 40, women should be "eligible for screening mammography," and encouraging physicians "to regularly discuss with their individual patients the benefits and risks of screening mammography, and whether screening is appropriate for each clinical situation given that the balance of benefits and risks will be viewed differently by each patient."

Primary care delegates from the American Academy of Family Physicians and the American College of Physicians opposed the resolutions of concern against the USPSTF and the mammography report.

The AAFP supported the task force when it issued its mammography recommendations "because it was the most comprehensive pattern and set of preventive guidelines using current methodology with what was available in science at that time," said Dr. Roland Goertz, AAFP delegate.

The task force basically recommends what the AMA report urged: that physicians have discussions with their patients about risks and benefits, he said. The problem is not the USPSTF recommendations, but that they are being used to deny payment, he added.

Alicia Ault/IMNG Medical Media

Dr. Richard Reiling, a delegate from the American College of Surgeons, said that the task force had confused patients with its mammography recommendation, and called for the AMA to convene all interested parties to craft a single guideline. The USPSTF was "wrong in presenting this report without listening to the stakeholders in the past," he said, adding, "let’s get one guideline out there."

Dr. Goertz agreed that there needed to be a common guideline.

ACP Delegate Dr. William Golden expressed the ACP’s view that the House of Delegates was not the appropriate venue for voting on particular guidelines. "The House should not be in the position of voting on what guideline is best," he said.

CHICAGO – Delegates to the American Medical Association’s legislative body are not happy with the U.S. Preventive Services Task Force.

They voted overwhelmingly (322 to 93) to express "concern" over the task force’s recommendations on screening mammography and prostate-specific antigen screening. Both recommendations attracted a firestorm of criticism when they were issued – the mammography recommendation in 2009 and those on PSA testing in May.

Many delegates also said they thought that the USPSTF, a quasi-governmental group operating under the auspices of the Agency for Healthcare Research and Quality, had reached its decisions without proper input from specialty societies or experts in each field.

In a second resolution, the delegates voted to encourage the USPSTF to "implement procedures that allow for meaningful input on recommendation development from specialists and stakeholders in the topic area under study."

Alicia Ault/IMNG Medical Media

Dr. Arl Van Moore Jr., a delegate from the American College of Radiology, said that neither the ACR nor any prominent breast imaging or surgical societies were contacted by the USPSTF in creating the screening mammography recommendations.

"None of the recognized experts in the field were contacted, to the best of our knowledge," said Dr. Moore, an interventional radiologist in Charlotte, N.C.

The American Urological Association delegate, Dr. William Gee, did not mince words when it came to the PSA screening guidelines.

"The [USPSTF] did not use an open process and ignored the public in reaching their conclusions," he said.

But Dr. Sally J. Trippel, a preventive medicine specialist at the Mayo Clinic and delegate from Minnesota, defended the USPSTF and its process. The task force is "about as politically independent as any national organization can get," and "about as free of conflict of interest as is possible in any organization developing guidelines for American clinicians," she said.

She quoted from task force documents showing that urologists provided peer review of the PSA evidence review. "So there were experts from urology involved in the development of that guideline," and also for the one on screening mammography.

To further show its consternation with the task force, AMA delegates also approved a report that stated that starting at age 40, women should be "eligible for screening mammography," and encouraging physicians "to regularly discuss with their individual patients the benefits and risks of screening mammography, and whether screening is appropriate for each clinical situation given that the balance of benefits and risks will be viewed differently by each patient."

Primary care delegates from the American Academy of Family Physicians and the American College of Physicians opposed the resolutions of concern against the USPSTF and the mammography report.

The AAFP supported the task force when it issued its mammography recommendations "because it was the most comprehensive pattern and set of preventive guidelines using current methodology with what was available in science at that time," said Dr. Roland Goertz, AAFP delegate.

The task force basically recommends what the AMA report urged: that physicians have discussions with their patients about risks and benefits, he said. The problem is not the USPSTF recommendations, but that they are being used to deny payment, he added.

Alicia Ault/IMNG Medical Media

Dr. Richard Reiling, a delegate from the American College of Surgeons, said that the task force had confused patients with its mammography recommendation, and called for the AMA to convene all interested parties to craft a single guideline. The USPSTF was "wrong in presenting this report without listening to the stakeholders in the past," he said, adding, "let’s get one guideline out there."

Dr. Goertz agreed that there needed to be a common guideline.

ACP Delegate Dr. William Golden expressed the ACP’s view that the House of Delegates was not the appropriate venue for voting on particular guidelines. "The House should not be in the position of voting on what guideline is best," he said.

CHICAGO – Delegates to the American Medical Association’s legislative body are not happy with the U.S. Preventive Services Task Force.

They voted overwhelmingly (322 to 93) to express "concern" over the task force’s recommendations on screening mammography and prostate-specific antigen screening. Both recommendations attracted a firestorm of criticism when they were issued – the mammography recommendation in 2009 and those on PSA testing in May.

Many delegates also said they thought that the USPSTF, a quasi-governmental group operating under the auspices of the Agency for Healthcare Research and Quality, had reached its decisions without proper input from specialty societies or experts in each field.

In a second resolution, the delegates voted to encourage the USPSTF to "implement procedures that allow for meaningful input on recommendation development from specialists and stakeholders in the topic area under study."

Alicia Ault/IMNG Medical Media

Dr. Arl Van Moore Jr., a delegate from the American College of Radiology, said that neither the ACR nor any prominent breast imaging or surgical societies were contacted by the USPSTF in creating the screening mammography recommendations.

"None of the recognized experts in the field were contacted, to the best of our knowledge," said Dr. Moore, an interventional radiologist in Charlotte, N.C.

The American Urological Association delegate, Dr. William Gee, did not mince words when it came to the PSA screening guidelines.

"The [USPSTF] did not use an open process and ignored the public in reaching their conclusions," he said.

But Dr. Sally J. Trippel, a preventive medicine specialist at the Mayo Clinic and delegate from Minnesota, defended the USPSTF and its process. The task force is "about as politically independent as any national organization can get," and "about as free of conflict of interest as is possible in any organization developing guidelines for American clinicians," she said.

She quoted from task force documents showing that urologists provided peer review of the PSA evidence review. "So there were experts from urology involved in the development of that guideline," and also for the one on screening mammography.

To further show its consternation with the task force, AMA delegates also approved a report that stated that starting at age 40, women should be "eligible for screening mammography," and encouraging physicians "to regularly discuss with their individual patients the benefits and risks of screening mammography, and whether screening is appropriate for each clinical situation given that the balance of benefits and risks will be viewed differently by each patient."

Primary care delegates from the American Academy of Family Physicians and the American College of Physicians opposed the resolutions of concern against the USPSTF and the mammography report.

The AAFP supported the task force when it issued its mammography recommendations "because it was the most comprehensive pattern and set of preventive guidelines using current methodology with what was available in science at that time," said Dr. Roland Goertz, AAFP delegate.

The task force basically recommends what the AMA report urged: that physicians have discussions with their patients about risks and benefits, he said. The problem is not the USPSTF recommendations, but that they are being used to deny payment, he added.

Alicia Ault/IMNG Medical Media

Dr. Richard Reiling, a delegate from the American College of Surgeons, said that the task force had confused patients with its mammography recommendation, and called for the AMA to convene all interested parties to craft a single guideline. The USPSTF was "wrong in presenting this report without listening to the stakeholders in the past," he said, adding, "let’s get one guideline out there."

Dr. Goertz agreed that there needed to be a common guideline.

ACP Delegate Dr. William Golden expressed the ACP’s view that the House of Delegates was not the appropriate venue for voting on particular guidelines. "The House should not be in the position of voting on what guideline is best," he said.

CHICAGO – Health insurers are paying claims more quickly and with greater accuracy, but they’re also erecting barriers by requiring more prior authorization, a new report from the American Medical Association has found.

The AMA’s fifth annual National Health Insurer Report Card shows that error rates on paid claims dropped from 19% in 2011 to just over 9% in 2012. The organization took some credit for the improvement.

"The AMA has been working constructively with insurers, and we are encouraged by their response to our concerns regarding errors, inefficiency, and waste that take a heavy toll on patients and physicians," Dr. Robert M. Wah, chairman of the AMA board of trustees, said in a statement.

The AMA estimated that the reduction in errors saved the health system $8 billion. If insurers paid claims in a more consistent fashion, another $7 billion could be saved, according to the report card.

The report analyzed claims for seven private insurers –- Aetna, Anthem Blue Cross/Blue Shield, Cigna, Health Care Service Corporation (HCSC), Humana, Regence, and UnitedHealthcare – as well as Medicare. It looked at data based on 1.8 million services billed on 1.1 million claims in February and March of 2012. Some 12,000 physicians submitted data.

Over the last several years, both timeliness and accuracy have improved for this group. From 2008 to the current report, response times have risen by 17%. HCSC and Humana had the fastest response times, at a median of 6 days. Aetna was the slowest, with a median response of 14 days.

Aetna was the third most accurate payer, however, with a 95% accuracy rate. Medicare scored highest, with a 99% rate, followed by United at 98%. Humana and HCSC were the least accurate at 87%.

The good news was tempered by two troubling trends, according to the AMA. After declining from 2008 to 2011, claim denials grew in 2012. In 2011, the overall denial rate among private insurers was 2%; that rose to almost 3.5% in 2012. Anthem Blue Cross/Blue Shield had the highest denial rate (5%).

Private insurers also began making more use of prior authorization. Humana’s prior authorization rate rose from 5% of claims in 2011 to 14% in 2012. That was the highest rate among the seven insurers and Medicare. Cigna had the second highest frequency, at 7%, up from 6% in 2011. Regence and Medicare had the lowest rates of prior authorization, at about 0.7%.

"The costly administrative burdens of the prior authorization process can complicate medical decisions and delay or interrupt patient care," said Dr. Wah. He said that the AMA is seeking to replace "the largely manual process with an automated decision support system that will enhance patient care and reduce paperwork costs."

CHICAGO – Health insurers are paying claims more quickly and with greater accuracy, but they’re also erecting barriers by requiring more prior authorization, a new report from the American Medical Association has found.

The AMA’s fifth annual National Health Insurer Report Card shows that error rates on paid claims dropped from 19% in 2011 to just over 9% in 2012. The organization took some credit for the improvement.

"The AMA has been working constructively with insurers, and we are encouraged by their response to our concerns regarding errors, inefficiency, and waste that take a heavy toll on patients and physicians," Dr. Robert M. Wah, chairman of the AMA board of trustees, said in a statement.

The AMA estimated that the reduction in errors saved the health system $8 billion. If insurers paid claims in a more consistent fashion, another $7 billion could be saved, according to the report card.

The report analyzed claims for seven private insurers –- Aetna, Anthem Blue Cross/Blue Shield, Cigna, Health Care Service Corporation (HCSC), Humana, Regence, and UnitedHealthcare – as well as Medicare. It looked at data based on 1.8 million services billed on 1.1 million claims in February and March of 2012. Some 12,000 physicians submitted data.

Over the last several years, both timeliness and accuracy have improved for this group. From 2008 to the current report, response times have risen by 17%. HCSC and Humana had the fastest response times, at a median of 6 days. Aetna was the slowest, with a median response of 14 days.

Aetna was the third most accurate payer, however, with a 95% accuracy rate. Medicare scored highest, with a 99% rate, followed by United at 98%. Humana and HCSC were the least accurate at 87%.

The good news was tempered by two troubling trends, according to the AMA. After declining from 2008 to 2011, claim denials grew in 2012. In 2011, the overall denial rate among private insurers was 2%; that rose to almost 3.5% in 2012. Anthem Blue Cross/Blue Shield had the highest denial rate (5%).

Private insurers also began making more use of prior authorization. Humana’s prior authorization rate rose from 5% of claims in 2011 to 14% in 2012. That was the highest rate among the seven insurers and Medicare. Cigna had the second highest frequency, at 7%, up from 6% in 2011. Regence and Medicare had the lowest rates of prior authorization, at about 0.7%.

"The costly administrative burdens of the prior authorization process can complicate medical decisions and delay or interrupt patient care," said Dr. Wah. He said that the AMA is seeking to replace "the largely manual process with an automated decision support system that will enhance patient care and reduce paperwork costs."

CHICAGO – Health insurers are paying claims more quickly and with greater accuracy, but they’re also erecting barriers by requiring more prior authorization, a new report from the American Medical Association has found.

The AMA’s fifth annual National Health Insurer Report Card shows that error rates on paid claims dropped from 19% in 2011 to just over 9% in 2012. The organization took some credit for the improvement.

"The AMA has been working constructively with insurers, and we are encouraged by their response to our concerns regarding errors, inefficiency, and waste that take a heavy toll on patients and physicians," Dr. Robert M. Wah, chairman of the AMA board of trustees, said in a statement.

The AMA estimated that the reduction in errors saved the health system $8 billion. If insurers paid claims in a more consistent fashion, another $7 billion could be saved, according to the report card.

The report analyzed claims for seven private insurers –- Aetna, Anthem Blue Cross/Blue Shield, Cigna, Health Care Service Corporation (HCSC), Humana, Regence, and UnitedHealthcare – as well as Medicare. It looked at data based on 1.8 million services billed on 1.1 million claims in February and March of 2012. Some 12,000 physicians submitted data.

Over the last several years, both timeliness and accuracy have improved for this group. From 2008 to the current report, response times have risen by 17%. HCSC and Humana had the fastest response times, at a median of 6 days. Aetna was the slowest, with a median response of 14 days.

Aetna was the third most accurate payer, however, with a 95% accuracy rate. Medicare scored highest, with a 99% rate, followed by United at 98%. Humana and HCSC were the least accurate at 87%.

The good news was tempered by two troubling trends, according to the AMA. After declining from 2008 to 2011, claim denials grew in 2012. In 2011, the overall denial rate among private insurers was 2%; that rose to almost 3.5% in 2012. Anthem Blue Cross/Blue Shield had the highest denial rate (5%).

Private insurers also began making more use of prior authorization. Humana’s prior authorization rate rose from 5% of claims in 2011 to 14% in 2012. That was the highest rate among the seven insurers and Medicare. Cigna had the second highest frequency, at 7%, up from 6% in 2011. Regence and Medicare had the lowest rates of prior authorization, at about 0.7%.

"The costly administrative burdens of the prior authorization process can complicate medical decisions and delay or interrupt patient care," said Dr. Wah. He said that the AMA is seeking to replace "the largely manual process with an automated decision support system that will enhance patient care and reduce paperwork costs."

CHICAGO – As its annual House of Delegates meeting opened, officials from the American Medical Association sought to convince members that the organization remains as vital as ever to advancing physicians’ cause in Washington, in the state houses, and with insurers.

The pep talk came as the officials noted that, after a slide in membership over the last few years, the AMA added 1,636 members in 2011, for a gain of 0.8%. The group ended the year with 217,490 members.

Overall, there are about 954,000 physicians in America, according to AMA data.

"This past year, our membership increased modestly," said Dr. James Madara, executive vice president and chief executive officer of the AMA. "And while we are pleased, we are hardly complacent."

The AMA continues to feel the fallout related to its support of the Affordable Care Act (ACA). Its endorsement led to membership defections and fractious debate at the House of Delegates meetings over the last few years.

While the current meeting was shaping up to be less controversial, in committee meetings on Sunday – held in advance of Monday and Tuesday’s floor debates and votes – some delegates expressed their continued dismay with the health reform law, in particular the Independent Payment Advisory Board (IPAB).

In his address on Saturday, AMA President Peter Carmel made oblique reference to the organization’s role in health reform. He said that, by using the AMA’s position as "the indisputable voice of America’s physicians," the organization had become an advocate for health reform and for the uninsured in 2007.

Without citing the ACA by name, Dr. Carmel highlighted its achievements. He noted that 2.5 million Americans under age 26 years had gained insurance through their parents, and that 100 million people no longer had to worry about lifetime insurance caps. Another 54 million had gained prevention and wellness coverage, Dr. Carmel said.

"All of this has already happened – today – regardless of what the Supreme Court decides," he added.

His recitations drew lukewarm applause.

Dr. Carmel acknowledged that the ACA and the changing health care environment had put physicians on edge. "The only thing worse than that anxiety is the fear many physicians have: the fear that they’re being lied to," he said. For instance, said Dr. Carmel, "If Congress really wants to improve the health care system, why hasn’t it eliminated the [Sustainable Growth Rate formula]?"

He said that the AMA had notched several recent legislative and regulatory victories, including leaning on the Centers for Medicare and Medicaid Services to make accountable care organization criteria more physician friendly and to delay the ICD-10 implementation.

But Dr. Madara said it was not enough. "The AMA must bring a tighter focus to what we do so that our efforts are concentrated on the long term," he said.

The AMA’s senior management has spent months putting together what he called a "rolling 5-year strategic plan." The goal is to ensure that the AMA attracts a broader physician base and has the "credibility, competence, and resources to make a significant impact," he said.

The areas of most intense focus will be improving health outcomes, accelerating change in medical education, and "shaping delivery and payment models that demonstrate high-quality care and value while enhancing physician satisfaction and practice sustainability," Dr. Madara said.

In the outcomes area, the AMA will build on its Physician Consortium for Performance Improvement. It will select two to three outcomes this year to put on a national "AMA dashboard" that will be promoted to quality improvement organizations and physicians. The outcomes will be tracked and used to evaluate impact on productivity and costs.

The goal in the education area is to close the gap between how physicians are being trained and the future needs of the health system, Dr. Madara said. The AMA will push for a new emphasis on learning around patient-centered care and performance improvement and understanding of health care financing and delivery.

Finally, the AMA aims to study what makes physicians happy and then use that data to help develop new practice models, he said. "We will use this information to drive and implement change across practice settings by showcasing delivery and payment models that demonstrate high quality and value while preserving, restoring, and enhancing professional satisfaction for physicians," said Dr. Madara.

The process won’t be easy, but he said that the AMA had hired Dr. Francis J. Crosson to help. Dr. Crosson, a former executive on the physician side of Kaiser Permanente and a former Medicare Payment Advisory Commission member, will join the AMA on July 1 as the vice president of professional satisfaction, care delivery, and payment.

Dr. Madara said that the AMA had "changed the world during its 165-year history" and that he expected more in the future. "No other organization has done more to shape health and health care in this country than has our AMA," he said.

CHICAGO – As its annual House of Delegates meeting opened, officials from the American Medical Association sought to convince members that the organization remains as vital as ever to advancing physicians’ cause in Washington, in the state houses, and with insurers.

The pep talk came as the officials noted that, after a slide in membership over the last few years, the AMA added 1,636 members in 2011, for a gain of 0.8%. The group ended the year with 217,490 members.

Overall, there are about 954,000 physicians in America, according to AMA data.

"This past year, our membership increased modestly," said Dr. James Madara, executive vice president and chief executive officer of the AMA. "And while we are pleased, we are hardly complacent."

The AMA continues to feel the fallout related to its support of the Affordable Care Act (ACA). Its endorsement led to membership defections and fractious debate at the House of Delegates meetings over the last few years.

While the current meeting was shaping up to be less controversial, in committee meetings on Sunday – held in advance of Monday and Tuesday’s floor debates and votes – some delegates expressed their continued dismay with the health reform law, in particular the Independent Payment Advisory Board (IPAB).

In his address on Saturday, AMA President Peter Carmel made oblique reference to the organization’s role in health reform. He said that, by using the AMA’s position as "the indisputable voice of America’s physicians," the organization had become an advocate for health reform and for the uninsured in 2007.

Without citing the ACA by name, Dr. Carmel highlighted its achievements. He noted that 2.5 million Americans under age 26 years had gained insurance through their parents, and that 100 million people no longer had to worry about lifetime insurance caps. Another 54 million had gained prevention and wellness coverage, Dr. Carmel said.

"All of this has already happened – today – regardless of what the Supreme Court decides," he added.

His recitations drew lukewarm applause.

Dr. Carmel acknowledged that the ACA and the changing health care environment had put physicians on edge. "The only thing worse than that anxiety is the fear many physicians have: the fear that they’re being lied to," he said. For instance, said Dr. Carmel, "If Congress really wants to improve the health care system, why hasn’t it eliminated the [Sustainable Growth Rate formula]?"

He said that the AMA had notched several recent legislative and regulatory victories, including leaning on the Centers for Medicare and Medicaid Services to make accountable care organization criteria more physician friendly and to delay the ICD-10 implementation.

But Dr. Madara said it was not enough. "The AMA must bring a tighter focus to what we do so that our efforts are concentrated on the long term," he said.

The AMA’s senior management has spent months putting together what he called a "rolling 5-year strategic plan." The goal is to ensure that the AMA attracts a broader physician base and has the "credibility, competence, and resources to make a significant impact," he said.

The areas of most intense focus will be improving health outcomes, accelerating change in medical education, and "shaping delivery and payment models that demonstrate high-quality care and value while enhancing physician satisfaction and practice sustainability," Dr. Madara said.

In the outcomes area, the AMA will build on its Physician Consortium for Performance Improvement. It will select two to three outcomes this year to put on a national "AMA dashboard" that will be promoted to quality improvement organizations and physicians. The outcomes will be tracked and used to evaluate impact on productivity and costs.

The goal in the education area is to close the gap between how physicians are being trained and the future needs of the health system, Dr. Madara said. The AMA will push for a new emphasis on learning around patient-centered care and performance improvement and understanding of health care financing and delivery.

Finally, the AMA aims to study what makes physicians happy and then use that data to help develop new practice models, he said. "We will use this information to drive and implement change across practice settings by showcasing delivery and payment models that demonstrate high quality and value while preserving, restoring, and enhancing professional satisfaction for physicians," said Dr. Madara.

The process won’t be easy, but he said that the AMA had hired Dr. Francis J. Crosson to help. Dr. Crosson, a former executive on the physician side of Kaiser Permanente and a former Medicare Payment Advisory Commission member, will join the AMA on July 1 as the vice president of professional satisfaction, care delivery, and payment.

Dr. Madara said that the AMA had "changed the world during its 165-year history" and that he expected more in the future. "No other organization has done more to shape health and health care in this country than has our AMA," he said.

CHICAGO – As its annual House of Delegates meeting opened, officials from the American Medical Association sought to convince members that the organization remains as vital as ever to advancing physicians’ cause in Washington, in the state houses, and with insurers.

The pep talk came as the officials noted that, after a slide in membership over the last few years, the AMA added 1,636 members in 2011, for a gain of 0.8%. The group ended the year with 217,490 members.

Overall, there are about 954,000 physicians in America, according to AMA data.

"This past year, our membership increased modestly," said Dr. James Madara, executive vice president and chief executive officer of the AMA. "And while we are pleased, we are hardly complacent."

The AMA continues to feel the fallout related to its support of the Affordable Care Act (ACA). Its endorsement led to membership defections and fractious debate at the House of Delegates meetings over the last few years.

While the current meeting was shaping up to be less controversial, in committee meetings on Sunday – held in advance of Monday and Tuesday’s floor debates and votes – some delegates expressed their continued dismay with the health reform law, in particular the Independent Payment Advisory Board (IPAB).

In his address on Saturday, AMA President Peter Carmel made oblique reference to the organization’s role in health reform. He said that, by using the AMA’s position as "the indisputable voice of America’s physicians," the organization had become an advocate for health reform and for the uninsured in 2007.

Without citing the ACA by name, Dr. Carmel highlighted its achievements. He noted that 2.5 million Americans under age 26 years had gained insurance through their parents, and that 100 million people no longer had to worry about lifetime insurance caps. Another 54 million had gained prevention and wellness coverage, Dr. Carmel said.

"All of this has already happened – today – regardless of what the Supreme Court decides," he added.

His recitations drew lukewarm applause.

Dr. Carmel acknowledged that the ACA and the changing health care environment had put physicians on edge. "The only thing worse than that anxiety is the fear many physicians have: the fear that they’re being lied to," he said. For instance, said Dr. Carmel, "If Congress really wants to improve the health care system, why hasn’t it eliminated the [Sustainable Growth Rate formula]?"

He said that the AMA had notched several recent legislative and regulatory victories, including leaning on the Centers for Medicare and Medicaid Services to make accountable care organization criteria more physician friendly and to delay the ICD-10 implementation.

But Dr. Madara said it was not enough. "The AMA must bring a tighter focus to what we do so that our efforts are concentrated on the long term," he said.

The AMA’s senior management has spent months putting together what he called a "rolling 5-year strategic plan." The goal is to ensure that the AMA attracts a broader physician base and has the "credibility, competence, and resources to make a significant impact," he said.

The areas of most intense focus will be improving health outcomes, accelerating change in medical education, and "shaping delivery and payment models that demonstrate high-quality care and value while enhancing physician satisfaction and practice sustainability," Dr. Madara said.

In the outcomes area, the AMA will build on its Physician Consortium for Performance Improvement. It will select two to three outcomes this year to put on a national "AMA dashboard" that will be promoted to quality improvement organizations and physicians. The outcomes will be tracked and used to evaluate impact on productivity and costs.

The goal in the education area is to close the gap between how physicians are being trained and the future needs of the health system, Dr. Madara said. The AMA will push for a new emphasis on learning around patient-centered care and performance improvement and understanding of health care financing and delivery.

Finally, the AMA aims to study what makes physicians happy and then use that data to help develop new practice models, he said. "We will use this information to drive and implement change across practice settings by showcasing delivery and payment models that demonstrate high quality and value while preserving, restoring, and enhancing professional satisfaction for physicians," said Dr. Madara.

The process won’t be easy, but he said that the AMA had hired Dr. Francis J. Crosson to help. Dr. Crosson, a former executive on the physician side of Kaiser Permanente and a former Medicare Payment Advisory Commission member, will join the AMA on July 1 as the vice president of professional satisfaction, care delivery, and payment.

Dr. Madara said that the AMA had "changed the world during its 165-year history" and that he expected more in the future. "No other organization has done more to shape health and health care in this country than has our AMA," he said.