NATIONAL HARBOR, Md. -- A large coalition of American Medical Association members met in seclusion Sunday morning here at the interim meeting of the House of Delegates and rapidly found consensus on a proposed resolution for the repeal of Medicare's sustainable growth rate (SGR) formula.
SGR reform is on the fast track these days with Congress releasing a draft SGR-replacement proposal on Oct. 31. The AMA responded to the document by the Nov. 12 deadline, to various parts of the proposal.
"We were just told the other morning by our senior leadership that now is the time for unity because the proposed bill in Congress will soon be set in stone," , chair of the Florida delegation, told 番茄社区. "We only get together as a group twice a year -- and the next time is in June. So this was the time for the House of Delegates to speak."
Rather than bring the original resolution before a reference committee where it would be subjected to protracted arguments pro and con, the coalition of AMA members worked behind the scenes for about 2 hours to craft a document that would satisfy all stakeholders.
The coalition believed it was important for the AMA to be seen as united on the issue of SGR reform, especially since the draft SGR fix has support from both Republicans and Democrats, as well as from both the House and Senate.
"Just like Congress has unifying support to try and get this fixed, so does the American Medical Association," , chair of the California delegation, told 番茄社区.
"We often work in coalitions, but it's been a long time since I've seen such a large gathering reach consensus so rapidly, particularly on a issue like SGR reform, which we've been dealing with for over 10 years," said , chair of the New England delegation, which represents six states.
The coalition comprised representatives from the New England delegation, the Florida delegation, and the California delegation, as well as from the American College of Physicians, the American College of Surgeons, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Academy of Dermatology, the American Association of Neurological Surgeons, the Medical Students Section, and the Organized Medical Staff Section.
The authors of the original resolution -- who were members of the Organized Medical Staff Section -- viewed the changes to the resolution, as did a former AMA board member, and the response was "overwhelmingly positive," said Deren.
When the reference committee opened the floor for discussion of the proposed resolution, a long line formed behind the microphone tagged for supporters and no one ambled up to the dissenting mic -- until close to the end of the discussion when , of the Kansas delegation, suggested adding the words "and Congress" to an amendment, changing it to read: "[The] AMA advocate with CMS and Congress for alternative payment models ... ."
Deren said he hopes the resolution is not referred for more study because of the very narrow window for the current Congress to pass an SGR reform bill. The limited time frame was also an impetus for the rapid coalition development.
, an alternate delegate for Massachusetts, told 番茄社区 that -- among other problems -- the original resolution was too detailed about billing methodology. "We thought it was too specific at this stage of development. We felt we needed flexibility to explore all the different payment models downstream, rather than put something in at this point that might bring the legislation to a halt."
It was also important that the resolution reflect AMA principles, Howard said.
Three of the four proposed amendments maintain that AMA strongly advocate for its Pay-for-Performance Principles and Guidelines while working to repeal the SGR. The directed toward Value-Based Performance programs, and the AMA addressed their concerns with them in its letter of recommendations.
For example, the AMA recommended that Congress develop a prospective method for determining physicians' level of involvement in alternative payment models, rather then use the retrospective method currently outlined in the draft SGR fix. AMA policy also stipulates that prospective methods be used for such determination.
The fourth proposed amendment calls for AMA to work with the Centers for Medicare and Medicaid Services (CMS) to develop alternative payment models for specialty physicians, and include private contracting as an option.
The draft SGR fix actually encourages the "testing" of alternative payment models for specialists. But the AMA in its response to Congress said that alternative payment models "need to be sustainable new programs, not just tests."
The issue of private contracting, however, is essentially off the table with regards to an SGR fix, AMA President Ardis Dee Hoven, MD, had told attendees at the opening ceremony.