Susan Birk

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If doctors join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists,” determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, the American Osteopathic Association, and the Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on HIT use by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said. “As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue.”

Dr. Leibowitz said the FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If doctors join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists,” determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, the American Osteopathic Association, and the Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on HIT use by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said. “As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue.”

Dr. Leibowitz said the FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If doctors join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists,” determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, the American Osteopathic Association, and the Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on HIT use by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said. “As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue.”

Dr. Leibowitz said the FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February-March 2010 by 200 practices in 43 states.

Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, she said.

Insurers made gains in some areas, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said.

“There's still a need for better transparency. But we're optimistic that if payers continue to demonstrate some of the improvements that they've shown” additional efficiencies can be gained, Dr. Rieger added.

Coventry Health Care Inc. had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corporation, Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

The AMA asked physicians to do their part to improve the claims process by working to submit claims correctly the first time and implementing practice efficiencies such as an effective electronic practice management system, Tammy Banks, director of practice management and payment advocacy for the AMA, said.

Administrative portals for claims processing “are a great short-term solution—they're getting us where we need to be,” but they are not a long-term replacement for a direct relationship with payers through an effective electronic practice management system, Ms. Banks said.

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February-March 2010 by 200 practices in 43 states.

Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, she said.

Insurers made gains in some areas, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said.

“There's still a need for better transparency. But we're optimistic that if payers continue to demonstrate some of the improvements that they've shown” additional efficiencies can be gained, Dr. Rieger added.

Coventry Health Care Inc. had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corporation, Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

The AMA asked physicians to do their part to improve the claims process by working to submit claims correctly the first time and implementing practice efficiencies such as an effective electronic practice management system, Tammy Banks, director of practice management and payment advocacy for the AMA, said.

Administrative portals for claims processing “are a great short-term solution—they're getting us where we need to be,” but they are not a long-term replacement for a direct relationship with payers through an effective electronic practice management system, Ms. Banks said.

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February-March 2010 by 200 practices in 43 states.

Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, she said.

Insurers made gains in some areas, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said.

“There's still a need for better transparency. But we're optimistic that if payers continue to demonstrate some of the improvements that they've shown” additional efficiencies can be gained, Dr. Rieger added.

Coventry Health Care Inc. had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corporation, Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

The AMA asked physicians to do their part to improve the claims process by working to submit claims correctly the first time and implementing practice efficiencies such as an effective electronic practice management system, Tammy Banks, director of practice management and payment advocacy for the AMA, said.

Administrative portals for claims processing “are a great short-term solution—they're getting us where we need to be,” but they are not a long-term replacement for a direct relationship with payers through an effective electronic practice management system, Ms. Banks said.

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If physicians join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists” who are determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, the American Osteopathic Association, and the Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said that the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all of them stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on the use of HIT by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said.

“As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue,” he added.

The FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If physicians join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists” who are determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, the American Osteopathic Association, and the Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said that the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all of them stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on the use of HIT by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said.

“As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue,” he added.

The FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If physicians join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists” who are determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, the American Osteopathic Association, and the Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said that the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all of them stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on the use of HIT by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said.

“As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue,” he added.

The FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If doctors join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists,” determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, American Osteopathic Association, and Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Dr. Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on HIT use by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said. “As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue.” He said the FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If doctors join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists,” determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, American Osteopathic Association, and Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Dr. Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on HIT use by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said. “As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue.” He said the FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Contrary to common perception, “the nation's antitrust laws allow—even encourage—doctors to collaborate in ways that lower costs and improve patient care,” according to Jon Leibowitz, chairman of the Federal Trade Commission.

If doctors join forces to fix prices, the FTC will stop them, but if they work together to deliver affordable, high-quality care, “not only will we leave you alone, we'll applaud you. And we'll do everything we can to help you put together a plan that avoids antitrust pitfalls,” Mr. Leibowitz said in a speech that sought to dispel any stereotype that physicians might have of the commission as being run by “fastidious bureaucrats” and “surreptitious socialists,” determined to keep doctors from charging fair prices for their services.

“Too often, I believe, our antitrust enforcement actions are portrayed as a barrier to improved care. If there is any stereotype I would like to disabuse you of today, that's the one,” he said.

The relationship between organized medicine and the FTC has become strained recently by physician opposition to the “Red Flags Rule” that requires small businesses, including medical practices, to develop policies to detect and prevent identity theft.

The American Medical Association, American Osteopathic Association, and Medical Society of the District of Columbia filed suit against the FTC in May to block it from enforcing the rule against physicians. The “bureaucratic burden” imposed by the rule “outweighs any benefit to the public,” Dr. Cecil B. Wilson, then AMA president-elect, said in a statement.

Mr. Leibowitz said the commission agrees with physicians that the rule is overreaching, and has urged Congress to provide a legislative fix for the issue as soon as possible. “Fastidious bureaucrats aren't pushing Congress to work quickly to fix the Red Flags Rule that has unintentionally swept up countless small businesses. … The FTC is,” he said.

Mr. Leibowitz cited several areas for potential cooperation between physicians and the FTC, all stemming from the Affordable Care Act. The use of health information technology to improve work flow and monitor populations and individuals; clinical integration; and accountable care organizations (ACO) are among the areas that hold potential for collaboration to improve quality and lower health care costs, he said.

Although they are not “a free pass to fix prices,” he said that health information technology systems “can be an important tool” to make patient care more effective and affordable. The FTC recently issued three favorable advisory opinions on HIT use by health care providers.

In the area of clinical integration, the FTC provides guidance to providers in the form of advisory opinions regarding joint ventures. The FTC will analyze a proposal and, where feasible, provide an opinion on whether it would recommend an enforcement action if the proposal were implemented, he said.

With regard to ACOs (integrated health systems that will be responsible for providing care to defined populations), “there is already talk of their moving into the private sector,” and “we want to work with you moving forward” to avoid competition issues, he said. “As long as the government purchases the services and unilaterally sets payment levels and terms, there won't be an antitrust issue.” He said the FTC will hold a public workshop this fall on competition policy, payment reform, and new care models, including ACOs.

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February through March 2010 by 200 practices in 43 states.

Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, Dr. Nielsen said.

Insurers made gains in some areas, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said. “Where the payer makes the fee schedule available, we have higher match rates.”

“We've got a long way to go,” he said. “There's still a need for better transparency. But we're optimistic that if payers continue to demonstrate some of the improvements that they've shown” additional efficiencies can be gained.

Coventry Health Care Inc. had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corp., Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

The AMA asked physicians to do their part to improve the claims process by working to submit claims correctly the first time and implementing practice efficiencies such as an effective electronic practice management system, Tammy Banks, director of practice management and payment advocacy for the AMA, said.

“There's a lot going on in the next 5- 10 years. Make sure that your vendor is willing to notify you of changes and upgrades” in federal and state mandates and transaction codes, she emphasized.

Administrative portals for claims processing “are a great short-term solution—they're getting us where we need to be,” but they are not a long-term replacement for a direct relationship with payers through an effective electronic practice management system, Ms. Banks said.

The National Health Insurer Report Card is available at www.ama-ssn.org/ama1/pub/upload/mm/368/2010-nhirc-results.pdf

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February through March 2010 by 200 practices in 43 states.

Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, Dr. Nielsen said.

Insurers made gains in some areas, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said. “Where the payer makes the fee schedule available, we have higher match rates.”

“We've got a long way to go,” he said. “There's still a need for better transparency. But we're optimistic that if payers continue to demonstrate some of the improvements that they've shown” additional efficiencies can be gained.

Coventry Health Care Inc. had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corp., Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

The AMA asked physicians to do their part to improve the claims process by working to submit claims correctly the first time and implementing practice efficiencies such as an effective electronic practice management system, Tammy Banks, director of practice management and payment advocacy for the AMA, said.

“There's a lot going on in the next 5- 10 years. Make sure that your vendor is willing to notify you of changes and upgrades” in federal and state mandates and transaction codes, she emphasized.

Administrative portals for claims processing “are a great short-term solution—they're getting us where we need to be,” but they are not a long-term replacement for a direct relationship with payers through an effective electronic practice management system, Ms. Banks said.

The National Health Insurer Report Card is available at www.ama-ssn.org/ama1/pub/upload/mm/368/2010-nhirc-results.pdf

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February through March 2010 by 200 practices in 43 states.

Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, Dr. Nielsen said.

Insurers made gains in some areas, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said. “Where the payer makes the fee schedule available, we have higher match rates.”

“We've got a long way to go,” he said. “There's still a need for better transparency. But we're optimistic that if payers continue to demonstrate some of the improvements that they've shown” additional efficiencies can be gained.

Coventry Health Care Inc. had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corp., Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

The AMA asked physicians to do their part to improve the claims process by working to submit claims correctly the first time and implementing practice efficiencies such as an effective electronic practice management system, Tammy Banks, director of practice management and payment advocacy for the AMA, said.

“There's a lot going on in the next 5- 10 years. Make sure that your vendor is willing to notify you of changes and upgrades” in federal and state mandates and transaction codes, she emphasized.

Administrative portals for claims processing “are a great short-term solution—they're getting us where we need to be,” but they are not a long-term replacement for a direct relationship with payers through an effective electronic practice management system, Ms. Banks said.

The National Health Insurer Report Card is available at www.ama-ssn.org/ama1/pub/upload/mm/368/2010-nhirc-results.pdf

CHICAGO – Whether the activity involves putting brush to paper or assembling images into a collage, expression through the visual arts can powerfully improve the quality of life for people with dementia and terminal illness.

Guided art activities can rekindle a sense of self in people with Alzheimer's disease and other dementias by facilitating a reconnection with long-term memories, said Cordula Dick-Muehlke, Ph.D., executive director of the Alzheimer's Family Services Center, Huntington Beach, Calif. For hospice patients, art therapy can afford the opportunity to find meaning and closure through the concrete expression of personal accomplishments, important relationships, and cherished experiences, Katy Barrington, Ph.D., professor of art therapy at the Adler School of Professional Psychology, Chicago, said in a separate presentation.

Profound Meaning

“The process of dying is a unique and vulnerable time for anybody,” Dr. Barrington said, and art therapy can provide an excellent catalyst for the expression of thoughts and feelings as hospice patients near the end of life.

She presented the results of a qualitative study of three elderly female hospice patients in rural Wisconsin. The study was based on existential philosophy, which emphasizes the importance of individual responsibility, choices, actions, and self-examination.

With guidance from Dr. Barrington and a hospice social worker over the course of four visits, patients completed a collage in collaboration with a selected loved one based on a story about their lives. She also asked each selected individual to tell a highlighted story that included the patient. The collages were framed and presented to patients and their loved one in the final session.

The process of creating a piece about one's life harmonizes with the goals and principles of hospice, which stress connectedness, dignity, respect for the patients' choices, and giving patients as much control over their lives as possible as they attend to psychological, physical, social, and spiritual concerns, Dr. Barrington said.

Art therapy helps patients cope with anxiety about death and encourages meaningful reminiscence. The latter is particularly valuable because it enables patients to take stock of their contributions and legacies at a time when they might wonder whether they have accomplished anything worthwhile in their lives, she said. Dr. Barrington analyzed the meaning in the finished art pieces using grounded theory, a qualitative research methodology in the social sciences in which data (in this study, patients' comments) are coded and grouped into similar concepts to generate a theory.

She said that she anticipated having to “pull” stories out of the three patients. Instead, “all of them unloaded on me … and I probably had 20 different stories. This tells me that confronting death is huge, and that there is a need to talk or bring it all together–to bring life together.”

Each of the three patients talked about mentors in their lives who had helped them deal with struggles and personal choices. Creativity (skill in embroidery, quilting, and sewing) had also played a prominent role in each woman's life, providing a means of navigating hardships, developing pride and dignity, saving money, and improving the quality of life for themselves and others. Their skills were parts of their legacies.

Through the creative process, patients “recognized that their experience was valuable, that it constituted knowledge, and that meaning came from that knowledge,” Dr. Barrington said. The project gave patients “choices and decisions to make, which made them whole and made them feel they were contributing to bettering their own lives, even as they confronted death.”

Creativity Despite Dementia

For people with dementia, activities have a different value. While providing an excellent vehicle for emotional release and social connection, art also can enhance cognitive functioning by helping individuals tap into brain functions that remain relatively intact, including long-term memory systems, Dr. Dick-Muehlke said.

“When we talk about art, we always talk about the creative process and the emotional process … but it's important for us to recognize that art allows people with Alzheimer's disease to use their preserved cognitive skills,” said Dr. Dick-Muehlke. She noted evidence that cognitive stimulation with medication might be more effective than medication alone (Dement. Geriatr. Cogn. Disord. 2006;22:339-45).

The neurodegenerative process of dementia impairs short-term memory, language, judgment, and visual spatial abilities. “We place a great deal of value on those [abilities] in our society. And we often forget about that other aspect of that person–the aspect of the person that is still so alive,” she said.

By tapping into what a person can still do and feel successful at, art helps individuals express essential features of themselves. Episodic autobiographical memories, such as “the day I got married” or “when I went to college,” as well as the long-term memories of skills and procedures called procedural memories often endure.

“People are very surprised that people with dementia can create such beautiful art,” said Dr. Dick-Muehlke. “Every time you see someone's mouth drop is a time that you decrease the stigma of what it means to have Alzheimer's disease.”

Initially intimidated, a patient in the program wanted “to paint the colors of Tuscany.” And so she did.

Source Courtesy Alzheimer's Family Service Center

CHICAGO – Whether the activity involves putting brush to paper or assembling images into a collage, expression through the visual arts can powerfully improve the quality of life for people with dementia and terminal illness.

Guided art activities can rekindle a sense of self in people with Alzheimer's disease and other dementias by facilitating a reconnection with long-term memories, said Cordula Dick-Muehlke, Ph.D., executive director of the Alzheimer's Family Services Center, Huntington Beach, Calif. For hospice patients, art therapy can afford the opportunity to find meaning and closure through the concrete expression of personal accomplishments, important relationships, and cherished experiences, Katy Barrington, Ph.D., professor of art therapy at the Adler School of Professional Psychology, Chicago, said in a separate presentation.

Profound Meaning

“The process of dying is a unique and vulnerable time for anybody,” Dr. Barrington said, and art therapy can provide an excellent catalyst for the expression of thoughts and feelings as hospice patients near the end of life.

She presented the results of a qualitative study of three elderly female hospice patients in rural Wisconsin. The study was based on existential philosophy, which emphasizes the importance of individual responsibility, choices, actions, and self-examination.

With guidance from Dr. Barrington and a hospice social worker over the course of four visits, patients completed a collage in collaboration with a selected loved one based on a story about their lives. She also asked each selected individual to tell a highlighted story that included the patient. The collages were framed and presented to patients and their loved one in the final session.

The process of creating a piece about one's life harmonizes with the goals and principles of hospice, which stress connectedness, dignity, respect for the patients' choices, and giving patients as much control over their lives as possible as they attend to psychological, physical, social, and spiritual concerns, Dr. Barrington said.

Art therapy helps patients cope with anxiety about death and encourages meaningful reminiscence. The latter is particularly valuable because it enables patients to take stock of their contributions and legacies at a time when they might wonder whether they have accomplished anything worthwhile in their lives, she said. Dr. Barrington analyzed the meaning in the finished art pieces using grounded theory, a qualitative research methodology in the social sciences in which data (in this study, patients' comments) are coded and grouped into similar concepts to generate a theory.

She said that she anticipated having to “pull” stories out of the three patients. Instead, “all of them unloaded on me … and I probably had 20 different stories. This tells me that confronting death is huge, and that there is a need to talk or bring it all together–to bring life together.”

Each of the three patients talked about mentors in their lives who had helped them deal with struggles and personal choices. Creativity (skill in embroidery, quilting, and sewing) had also played a prominent role in each woman's life, providing a means of navigating hardships, developing pride and dignity, saving money, and improving the quality of life for themselves and others. Their skills were parts of their legacies.

Through the creative process, patients “recognized that their experience was valuable, that it constituted knowledge, and that meaning came from that knowledge,” Dr. Barrington said. The project gave patients “choices and decisions to make, which made them whole and made them feel they were contributing to bettering their own lives, even as they confronted death.”

Creativity Despite Dementia

For people with dementia, activities have a different value. While providing an excellent vehicle for emotional release and social connection, art also can enhance cognitive functioning by helping individuals tap into brain functions that remain relatively intact, including long-term memory systems, Dr. Dick-Muehlke said.

“When we talk about art, we always talk about the creative process and the emotional process … but it's important for us to recognize that art allows people with Alzheimer's disease to use their preserved cognitive skills,” said Dr. Dick-Muehlke. She noted evidence that cognitive stimulation with medication might be more effective than medication alone (Dement. Geriatr. Cogn. Disord. 2006;22:339-45).

The neurodegenerative process of dementia impairs short-term memory, language, judgment, and visual spatial abilities. “We place a great deal of value on those [abilities] in our society. And we often forget about that other aspect of that person–the aspect of the person that is still so alive,” she said.

By tapping into what a person can still do and feel successful at, art helps individuals express essential features of themselves. Episodic autobiographical memories, such as “the day I got married” or “when I went to college,” as well as the long-term memories of skills and procedures called procedural memories often endure.

“People are very surprised that people with dementia can create such beautiful art,” said Dr. Dick-Muehlke. “Every time you see someone's mouth drop is a time that you decrease the stigma of what it means to have Alzheimer's disease.”

Initially intimidated, a patient in the program wanted “to paint the colors of Tuscany.” And so she did.

Source Courtesy Alzheimer's Family Service Center

CHICAGO – Whether the activity involves putting brush to paper or assembling images into a collage, expression through the visual arts can powerfully improve the quality of life for people with dementia and terminal illness.

Guided art activities can rekindle a sense of self in people with Alzheimer's disease and other dementias by facilitating a reconnection with long-term memories, said Cordula Dick-Muehlke, Ph.D., executive director of the Alzheimer's Family Services Center, Huntington Beach, Calif. For hospice patients, art therapy can afford the opportunity to find meaning and closure through the concrete expression of personal accomplishments, important relationships, and cherished experiences, Katy Barrington, Ph.D., professor of art therapy at the Adler School of Professional Psychology, Chicago, said in a separate presentation.

Profound Meaning

“The process of dying is a unique and vulnerable time for anybody,” Dr. Barrington said, and art therapy can provide an excellent catalyst for the expression of thoughts and feelings as hospice patients near the end of life.

She presented the results of a qualitative study of three elderly female hospice patients in rural Wisconsin. The study was based on existential philosophy, which emphasizes the importance of individual responsibility, choices, actions, and self-examination.

With guidance from Dr. Barrington and a hospice social worker over the course of four visits, patients completed a collage in collaboration with a selected loved one based on a story about their lives. She also asked each selected individual to tell a highlighted story that included the patient. The collages were framed and presented to patients and their loved one in the final session.

The process of creating a piece about one's life harmonizes with the goals and principles of hospice, which stress connectedness, dignity, respect for the patients' choices, and giving patients as much control over their lives as possible as they attend to psychological, physical, social, and spiritual concerns, Dr. Barrington said.

Art therapy helps patients cope with anxiety about death and encourages meaningful reminiscence. The latter is particularly valuable because it enables patients to take stock of their contributions and legacies at a time when they might wonder whether they have accomplished anything worthwhile in their lives, she said. Dr. Barrington analyzed the meaning in the finished art pieces using grounded theory, a qualitative research methodology in the social sciences in which data (in this study, patients' comments) are coded and grouped into similar concepts to generate a theory.

She said that she anticipated having to “pull” stories out of the three patients. Instead, “all of them unloaded on me … and I probably had 20 different stories. This tells me that confronting death is huge, and that there is a need to talk or bring it all together–to bring life together.”

Each of the three patients talked about mentors in their lives who had helped them deal with struggles and personal choices. Creativity (skill in embroidery, quilting, and sewing) had also played a prominent role in each woman's life, providing a means of navigating hardships, developing pride and dignity, saving money, and improving the quality of life for themselves and others. Their skills were parts of their legacies.

Through the creative process, patients “recognized that their experience was valuable, that it constituted knowledge, and that meaning came from that knowledge,” Dr. Barrington said. The project gave patients “choices and decisions to make, which made them whole and made them feel they were contributing to bettering their own lives, even as they confronted death.”

Creativity Despite Dementia

For people with dementia, activities have a different value. While providing an excellent vehicle for emotional release and social connection, art also can enhance cognitive functioning by helping individuals tap into brain functions that remain relatively intact, including long-term memory systems, Dr. Dick-Muehlke said.

“When we talk about art, we always talk about the creative process and the emotional process … but it's important for us to recognize that art allows people with Alzheimer's disease to use their preserved cognitive skills,” said Dr. Dick-Muehlke. She noted evidence that cognitive stimulation with medication might be more effective than medication alone (Dement. Geriatr. Cogn. Disord. 2006;22:339-45).

The neurodegenerative process of dementia impairs short-term memory, language, judgment, and visual spatial abilities. “We place a great deal of value on those [abilities] in our society. And we often forget about that other aspect of that person–the aspect of the person that is still so alive,” she said.

By tapping into what a person can still do and feel successful at, art helps individuals express essential features of themselves. Episodic autobiographical memories, such as “the day I got married” or “when I went to college,” as well as the long-term memories of skills and procedures called procedural memories often endure.

“People are very surprised that people with dementia can create such beautiful art,” said Dr. Dick-Muehlke. “Every time you see someone's mouth drop is a time that you decrease the stigma of what it means to have Alzheimer's disease.”

Initially intimidated, a patient in the program wanted “to paint the colors of Tuscany.” And so she did.

Source Courtesy Alzheimer's Family Service Center

CHICAGO - Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage when the American Medical Association's legislative body met at the annual meeting of the AMA's House of Delegates.

Delegates passed a resolution calling for the AMA to "immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule."

Such a fee-for-service option would allow physicians to balance bill--for the difference between the Medicare fee schedule and their regular fee schedules.

The option would help physicians keep pace with inflation and "give patients control of their Medicare benefit" by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of "the very strict confines of a participating Medicare physician provider," Dr. David O. Barbe of the AMA board of trustees, said in an interview. According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

Patients "want the conversation about health care to come from their doctors," Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin. "I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study; we need action."

At a "Write Coat Rally" prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

"Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw," Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting. He cited a recent AMA survey of 9,000 physicians indicating that one in five overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

At the rally, delegates wrote on white lab coats about the urgent need for a workable alternative to the Sustainable Growth Rate (SGR) formula. The lab coats were delivered to Congress after the meeting.

Support for the resolution during the voting session was strong but not unanimous.
AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits "is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies."

He recommended focusing instead on changing the 2-year dropout rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years. "Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can," he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

"We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down," said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. "None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us."

According to Dr. Jeff Terry of the Alabama delegation, "We're not asking for more. … We're asking for continued access for our patients to care. This is not greedy to say the least."

Dr. Barbe added, "If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians . . . then take off the [price] caps. Pay whatever you can pay . . . and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth."

Although the SGR and physician pay dominated action at the House of Delegates meeting, other topics were deliberated. Among them:

Skin cancer awareness. Delegates voted for the AMA to work with public health agencies and specialty societies, such as the American Academy of Dermatology, to promote skin cancer screening and education about sun-protective behavior among people of color. Five-year survival rates for melanoma are significantly lower among African Americans than whites (58.8% vs. 84.8%), and melanoma incidence among Hispanics now approaches that of whites, according to a statement from the AMA. Noting that African Americans and Hispanics are much less likely to practice sun-protective behaviors, AMA board of trustees member Peter W. Carmel said, "All patients regardless of race or ethnicity should use the same sun-protection measures including sunscreen of at least SPF 15, avoid the sun during peak hours, and [get] regular exams."

Support for new antibiotics. Delegates adopted policy to educate the public, physicians, the Obama administration, and Congress regarding the looming problem of antimicrobial resistance and the shortage of new antibiotic drugs in the development pipeline. Specifically, the policy endorses the "10 20" initiative sponsored by the Infectious Diseases Society of America, which urges global action by political, scientific, medical, industry, and policy leaders to drive the development of at least 10 effective new antibiotics by 2020.

Smoke-free housing. Delegates passed a resolution to encourage federal, state, and local housing authorities to adopt policies prohibiting smoking in multi-unit housing. The word "public" was removed from language recommended by the public health reference committee to broaden support for efforts to include private multi-unit housing as well. Mention was made on the floor of evidence pointing to the health hazards of third-hand smoke, the residue that remains on walls, carpeting, and other surfaces for extended periods.

E-cigarette regulation. Delegates voted in favor of a report from the AMA Council on Science and Public Health recommending that e-cigarettes be classified as drug delivery devices and be subject to regulation by the Food and Drug Administration with standards for identity, strength, purity, packaging, and labeling, and with instructions and contraindications for use. The new policy also asks state legislatures to prohibit the sale of non-FDA approved e-cigarettes and recommends that the devices be covered by smoke-free laws but be classified separately from tobacco products.

Education about the Gulf oil spill. Delegates approved policy advocating that the AMA work to educate health professionals and the public on the potential health risks of oil spills and to encourage research on the Gulf oil spill's impact on air and water quality.

CHICAGO - Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage when the American Medical Association's legislative body met at the annual meeting of the AMA's House of Delegates.

Delegates passed a resolution calling for the AMA to "immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule."

Such a fee-for-service option would allow physicians to balance bill--for the difference between the Medicare fee schedule and their regular fee schedules.

The option would help physicians keep pace with inflation and "give patients control of their Medicare benefit" by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of "the very strict confines of a participating Medicare physician provider," Dr. David O. Barbe of the AMA board of trustees, said in an interview. According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

Patients "want the conversation about health care to come from their doctors," Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin. "I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study; we need action."

At a "Write Coat Rally" prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

"Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw," Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting. He cited a recent AMA survey of 9,000 physicians indicating that one in five overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

At the rally, delegates wrote on white lab coats about the urgent need for a workable alternative to the Sustainable Growth Rate (SGR) formula. The lab coats were delivered to Congress after the meeting.

Support for the resolution during the voting session was strong but not unanimous.
AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits "is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies."

He recommended focusing instead on changing the 2-year dropout rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years. "Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can," he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

"We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down," said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. "None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us."

According to Dr. Jeff Terry of the Alabama delegation, "We're not asking for more. … We're asking for continued access for our patients to care. This is not greedy to say the least."

Dr. Barbe added, "If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians . . . then take off the [price] caps. Pay whatever you can pay . . . and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth."

Although the SGR and physician pay dominated action at the House of Delegates meeting, other topics were deliberated. Among them:

Skin cancer awareness. Delegates voted for the AMA to work with public health agencies and specialty societies, such as the American Academy of Dermatology, to promote skin cancer screening and education about sun-protective behavior among people of color. Five-year survival rates for melanoma are significantly lower among African Americans than whites (58.8% vs. 84.8%), and melanoma incidence among Hispanics now approaches that of whites, according to a statement from the AMA. Noting that African Americans and Hispanics are much less likely to practice sun-protective behaviors, AMA board of trustees member Peter W. Carmel said, "All patients regardless of race or ethnicity should use the same sun-protection measures including sunscreen of at least SPF 15, avoid the sun during peak hours, and [get] regular exams."

Support for new antibiotics. Delegates adopted policy to educate the public, physicians, the Obama administration, and Congress regarding the looming problem of antimicrobial resistance and the shortage of new antibiotic drugs in the development pipeline. Specifically, the policy endorses the "10 20" initiative sponsored by the Infectious Diseases Society of America, which urges global action by political, scientific, medical, industry, and policy leaders to drive the development of at least 10 effective new antibiotics by 2020.

Smoke-free housing. Delegates passed a resolution to encourage federal, state, and local housing authorities to adopt policies prohibiting smoking in multi-unit housing. The word "public" was removed from language recommended by the public health reference committee to broaden support for efforts to include private multi-unit housing as well. Mention was made on the floor of evidence pointing to the health hazards of third-hand smoke, the residue that remains on walls, carpeting, and other surfaces for extended periods.

E-cigarette regulation. Delegates voted in favor of a report from the AMA Council on Science and Public Health recommending that e-cigarettes be classified as drug delivery devices and be subject to regulation by the Food and Drug Administration with standards for identity, strength, purity, packaging, and labeling, and with instructions and contraindications for use. The new policy also asks state legislatures to prohibit the sale of non-FDA approved e-cigarettes and recommends that the devices be covered by smoke-free laws but be classified separately from tobacco products.

Education about the Gulf oil spill. Delegates approved policy advocating that the AMA work to educate health professionals and the public on the potential health risks of oil spills and to encourage research on the Gulf oil spill's impact on air and water quality.

CHICAGO - Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage when the American Medical Association's legislative body met at the annual meeting of the AMA's House of Delegates.

Delegates passed a resolution calling for the AMA to "immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule."

Such a fee-for-service option would allow physicians to balance bill--for the difference between the Medicare fee schedule and their regular fee schedules.

The option would help physicians keep pace with inflation and "give patients control of their Medicare benefit" by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of "the very strict confines of a participating Medicare physician provider," Dr. David O. Barbe of the AMA board of trustees, said in an interview. According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

Patients "want the conversation about health care to come from their doctors," Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin. "I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study; we need action."

At a "Write Coat Rally" prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

"Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw," Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting. He cited a recent AMA survey of 9,000 physicians indicating that one in five overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

At the rally, delegates wrote on white lab coats about the urgent need for a workable alternative to the Sustainable Growth Rate (SGR) formula. The lab coats were delivered to Congress after the meeting.

Support for the resolution during the voting session was strong but not unanimous.
AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits "is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies."

He recommended focusing instead on changing the 2-year dropout rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years. "Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can," he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

"We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down," said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. "None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us."

According to Dr. Jeff Terry of the Alabama delegation, "We're not asking for more. … We're asking for continued access for our patients to care. This is not greedy to say the least."

Dr. Barbe added, "If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians . . . then take off the [price] caps. Pay whatever you can pay . . . and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth."

Although the SGR and physician pay dominated action at the House of Delegates meeting, other topics were deliberated. Among them:

Skin cancer awareness. Delegates voted for the AMA to work with public health agencies and specialty societies, such as the American Academy of Dermatology, to promote skin cancer screening and education about sun-protective behavior among people of color. Five-year survival rates for melanoma are significantly lower among African Americans than whites (58.8% vs. 84.8%), and melanoma incidence among Hispanics now approaches that of whites, according to a statement from the AMA. Noting that African Americans and Hispanics are much less likely to practice sun-protective behaviors, AMA board of trustees member Peter W. Carmel said, "All patients regardless of race or ethnicity should use the same sun-protection measures including sunscreen of at least SPF 15, avoid the sun during peak hours, and [get] regular exams."

Support for new antibiotics. Delegates adopted policy to educate the public, physicians, the Obama administration, and Congress regarding the looming problem of antimicrobial resistance and the shortage of new antibiotic drugs in the development pipeline. Specifically, the policy endorses the "10 20" initiative sponsored by the Infectious Diseases Society of America, which urges global action by political, scientific, medical, industry, and policy leaders to drive the development of at least 10 effective new antibiotics by 2020.

Smoke-free housing. Delegates passed a resolution to encourage federal, state, and local housing authorities to adopt policies prohibiting smoking in multi-unit housing. The word "public" was removed from language recommended by the public health reference committee to broaden support for efforts to include private multi-unit housing as well. Mention was made on the floor of evidence pointing to the health hazards of third-hand smoke, the residue that remains on walls, carpeting, and other surfaces for extended periods.

E-cigarette regulation. Delegates voted in favor of a report from the AMA Council on Science and Public Health recommending that e-cigarettes be classified as drug delivery devices and be subject to regulation by the Food and Drug Administration with standards for identity, strength, purity, packaging, and labeling, and with instructions and contraindications for use. The new policy also asks state legislatures to prohibit the sale of non-FDA approved e-cigarettes and recommends that the devices be covered by smoke-free laws but be classified separately from tobacco products.

Education about the Gulf oil spill. Delegates approved policy advocating that the AMA work to educate health professionals and the public on the potential health risks of oil spills and to encourage research on the Gulf oil spill's impact on air and water quality.

CHICAGO — Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage as the American Medical Association's legislative body met here.

Delegates passed a resolution calling for the AMA to “immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule.”

Such a fee-for-service option would allow physicians to balance bill—they could bill patients for the difference between the Medicare fee schedule and their regular fee schedules.

In addition to helping physicians keep pace with inflation, the option would “give patients control of their Medicare benefit” by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of “the very strict confines of a participating Medicare physician provider,” Dr. David O. Barbe, a member of the AMA board of trustees, said in an interview.

According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

“I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study, we need action,” Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin.

At a rally prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

“Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw,” Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting. He cited a recent AMA survey of 9,000 physicians indicating that one in five physicians overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because they feel Medicare payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

Support for the resolution during the voting session was strong but not unanimous.

AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits “is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies.”

He recommended focusing instead on changing the 2-year drop-out rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years.

“Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can,” he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

“We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down,” said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. “None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us.”

According to Dr. Jeff Terry of the Alabama delegation, “We're not asking for more. … We're asking for continued access for our patients to care. This is not greedy to say the least.”

Dr. Barbe added, “If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians … then take off the [price] caps. Pay whatever you can pay … and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth.”

CHICAGO — Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage as the American Medical Association's legislative body met here.

Delegates passed a resolution calling for the AMA to “immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule.”

Such a fee-for-service option would allow physicians to balance bill—they could bill patients for the difference between the Medicare fee schedule and their regular fee schedules.

In addition to helping physicians keep pace with inflation, the option would “give patients control of their Medicare benefit” by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of “the very strict confines of a participating Medicare physician provider,” Dr. David O. Barbe, a member of the AMA board of trustees, said in an interview.

According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

“I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study, we need action,” Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin.

At a rally prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

“Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw,” Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting. He cited a recent AMA survey of 9,000 physicians indicating that one in five physicians overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because they feel Medicare payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

Support for the resolution during the voting session was strong but not unanimous.

AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits “is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies.”

He recommended focusing instead on changing the 2-year drop-out rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years.

“Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can,” he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

“We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down,” said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. “None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us.”

According to Dr. Jeff Terry of the Alabama delegation, “We're not asking for more. … We're asking for continued access for our patients to care. This is not greedy to say the least.”

Dr. Barbe added, “If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians … then take off the [price] caps. Pay whatever you can pay … and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth.”

CHICAGO — Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage as the American Medical Association's legislative body met here.

Delegates passed a resolution calling for the AMA to “immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule.”

Such a fee-for-service option would allow physicians to balance bill—they could bill patients for the difference between the Medicare fee schedule and their regular fee schedules.

In addition to helping physicians keep pace with inflation, the option would “give patients control of their Medicare benefit” by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of “the very strict confines of a participating Medicare physician provider,” Dr. David O. Barbe, a member of the AMA board of trustees, said in an interview.

According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

“I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study, we need action,” Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin.

At a rally prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

“Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw,” Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting. He cited a recent AMA survey of 9,000 physicians indicating that one in five physicians overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because they feel Medicare payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

Support for the resolution during the voting session was strong but not unanimous.

AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits “is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies.”

He recommended focusing instead on changing the 2-year drop-out rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years.

“Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can,” he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

“We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down,” said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. “None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us.”

According to Dr. Jeff Terry of the Alabama delegation, “We're not asking for more. … We're asking for continued access for our patients to care. This is not greedy to say the least.”

Dr. Barbe added, “If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians … then take off the [price] caps. Pay whatever you can pay … and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth.”

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February-March 2010 by 200 practices in 43 states. Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, Dr. Nielsen said.

Insurers made some gains, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said. “Where the payer makes the fee schedule available we have higher match rates.”

Coventry Health Care had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corporation, Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February-March 2010 by 200 practices in 43 states. Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, Dr. Nielsen said.

Insurers made some gains, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said. “Where the payer makes the fee schedule available we have higher match rates.”

Coventry Health Care had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corporation, Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

CHICAGO — Twenty percent of health insurance claims are processed inaccurately, according to the American Medical Association's third annual National Health Insurer Report Card, which rates the nation's largest commercial insurers on timeliness and accuracy of claims processing.

Eliminating discrepancies in expected payment amounts would save doctors and insurers $15.5 billion annually, according to the report, which is based on a random sample of 2 million claims for 3.5 million services filed electronically February-March 2010 by 200 practices in 43 states. Each year, claims processing costs as much as $210 billion and takes up 10%-14% of physicians' gross revenue and the equivalent for each physician of 5 work weeks, Dr. Nancy H. Nielsen, then immediate past president of the AMA, said in an educational session. “Physicians are drowning in this.”

To remedy the problem, the AMA urges the creation of a single, transparent insurance industry standard “so that everybody knows in a seamless way how those claims are to be submitted and processed,” Dr. Nielsen said, adding that such a standard would reduce errors and free physicians to focus more on patients and less on administrative red tape.

The report card “has actually turned out to be not just a 'gotcha' against the insurers, but an actual 'win win' between national payers and the AMA” because the insurers appear to be using the feedback to improve, Dr. Nielsen said.

Insurers made some gains, including accuracy in the reporting of contract fees to physicians. They correctly reported contract fees 78%-94% of the time in 2010 versus 62%-87% of the time in 2008.

They also increased the transparency and accessibility of their fee schedules, according to Mark Rieger, chief executive officer of National Healthcare Exchange Services Inc. of Sacramento, which conducted the research.

Physicians' electronic access to complete fee schedules plays a major role in processing accuracy, he said. “Where the payer makes the fee schedule available we have higher match rates.”

Coventry Health Care had the highest overall accuracy (88%), while Anthem Blue Cross Blue Shield had the lowest (74%). Other insurers addressed by the report were Aetna, CIGNA, Health Care Services Corporation, Humana, and UnitedHealth Group.

Mr. Rieger said that every 1% increase in the match rate for claims would generate a conservatively estimated $777.6 million for physicians and payers. A 100% match rate would yield an annual savings of $15.5 billion.

CHICAGO — Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage as the American Medical Association's legislative body met here.

Delegates passed a resolution calling for the AMA to “immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule.”

Such a fee-for-service option would allow physicians to balance-bill—they could bill patients for the difference between the Medicare fee schedule and their regular fee schedules.

In addition to helping physicians keep pace with inflation, the option would “give patients control of their Medicare benefit” by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of “the very strict confines of a participating Medicare physician provider,” Dr. David O. Barbe, a member of the AMA board of trustees, said in an interview.

According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

Patients “want the conversation about health care to come from their doctors,” Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin. “I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study, we need action,” she added.

At a “Write Coat Rally” prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

“Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw,” Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting.

He cited a recent AMA survey of 9,000 physicians indicating that one in five physicians overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because they feel Medicare payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

At the rally, delegates wrote on white lab coats about the urgent need for a workable alternative to the Sustainable Growth Rate (SGR) formula. The lab coats were delivered to Congress after the meeting.

Support for the resolution during the voting session was strong but not unanimous.

AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits “is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies.”

He recommended focusing instead on changing the 2-year drop-out rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years.

“Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can,” he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

“We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down,” said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. “None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us.”

According to Dr. Jeff Terry of the Alabama delegation, “We're not asking for more.… We're asking for continued access for our patients to care. This is not greedy to say the least.”

Dr. Jeffrey W. Cozzens of the American Association of Neurological Surgeons added, “By having legislation that we wrote, we'll show the world that we have solutions to this problem.”

Dr. Barbe added, “If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians … then take off the [price] caps. Pay whatever you can pay … and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth.”

Although the SGR and physician pay dominated action at the House of Delegates meeting, other topics were deliberated. Among them:

▸ Skin cancer awareness. Delegates voted for the AMA to work with public health agencies and specialty societies, such as the American Academy of Dermatology, to promote skin cancer screening and education about sun-protective behavior among people of color. Five-year survival rates for melanoma are significantly lower among African Americans than whites (58.8% vs. 84.8%), and melanoma incidence among Hispanics now approaches that of whites, according to a statement from the AMA. Noting that African Americans and Hispanics are much less likely to practice sun-protective behaviors, AMA board of trustees member Peter W. Carmel said, “All patients regardless of race or ethnicity should use the same sun-protection measures including sunscreen of at least SPF 15, avoid the sun during peak hours, and [get] regular exams.”

▸ Support for new antibiotics. Delegates adopted policy to educate the public, physicians, the Obama administration, and Congress regarding the looming problem of antimicrobial resistance and the shortage of new antibiotic drugs in the development pipeline. Specifically, the policy endorses the “10 20” initiative sponsored by the Infectious Diseases Society of America, which urges global action by political, scientific, medical, industry, and policy leaders to drive the development of at least 10 effective new antibiotics by 2020.

▸ Smoke-free housing. Delegates passed a resolution to encourage federal, state, and local housing authorities to adopt policies prohibiting smoking in multi-unit housing. The word “public” was removed from language recommended by the public health reference committee to broaden support for efforts to include private multi-unit housing as well. Mention was made on the floor of evidence pointing to the health hazards of third-hand smoke, the residue that remains on walls, carpeting, and other surfaces for extended periods.

▸ E-cigarette regulation. Delegates voted in favor of a report from the AMA Council on Science and Public Health recommending that e-cigarettes be classified as drug delivery devices and be subject to regulation by the Food and Drug Administration with standards for identity, strength, purity, packaging, and labeling, and with instructions and contraindications for use. The new policy also asks state legislatures to prohibit the sale of non–FDA approved e-cigarettes and recommends that the devices be covered by smoke-free laws but be classified separately from tobacco products.

▸ Education about the Gulf oil spill. Delegates approved policy advocating that the AMA work to educate health professionals and the public on the potential health risks of oil spills and to encourage research on the Gulf oil spill's impact on air and water quality.

CHICAGO — Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage as the American Medical Association's legislative body met here.

Delegates passed a resolution calling for the AMA to “immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule.”

Such a fee-for-service option would allow physicians to balance-bill—they could bill patients for the difference between the Medicare fee schedule and their regular fee schedules.

In addition to helping physicians keep pace with inflation, the option would “give patients control of their Medicare benefit” by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of “the very strict confines of a participating Medicare physician provider,” Dr. David O. Barbe, a member of the AMA board of trustees, said in an interview.

According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

Patients “want the conversation about health care to come from their doctors,” Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin. “I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study, we need action,” she added.

At a “Write Coat Rally” prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

“Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw,” Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting.

He cited a recent AMA survey of 9,000 physicians indicating that one in five physicians overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because they feel Medicare payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

At the rally, delegates wrote on white lab coats about the urgent need for a workable alternative to the Sustainable Growth Rate (SGR) formula. The lab coats were delivered to Congress after the meeting.

Support for the resolution during the voting session was strong but not unanimous.

AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits “is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies.”

He recommended focusing instead on changing the 2-year drop-out rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years.

“Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can,” he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

“We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down,” said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. “None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us.”

According to Dr. Jeff Terry of the Alabama delegation, “We're not asking for more.… We're asking for continued access for our patients to care. This is not greedy to say the least.”

Dr. Jeffrey W. Cozzens of the American Association of Neurological Surgeons added, “By having legislation that we wrote, we'll show the world that we have solutions to this problem.”

Dr. Barbe added, “If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians … then take off the [price] caps. Pay whatever you can pay … and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth.”

Although the SGR and physician pay dominated action at the House of Delegates meeting, other topics were deliberated. Among them:

▸ Skin cancer awareness. Delegates voted for the AMA to work with public health agencies and specialty societies, such as the American Academy of Dermatology, to promote skin cancer screening and education about sun-protective behavior among people of color. Five-year survival rates for melanoma are significantly lower among African Americans than whites (58.8% vs. 84.8%), and melanoma incidence among Hispanics now approaches that of whites, according to a statement from the AMA. Noting that African Americans and Hispanics are much less likely to practice sun-protective behaviors, AMA board of trustees member Peter W. Carmel said, “All patients regardless of race or ethnicity should use the same sun-protection measures including sunscreen of at least SPF 15, avoid the sun during peak hours, and [get] regular exams.”

▸ Support for new antibiotics. Delegates adopted policy to educate the public, physicians, the Obama administration, and Congress regarding the looming problem of antimicrobial resistance and the shortage of new antibiotic drugs in the development pipeline. Specifically, the policy endorses the “10 20” initiative sponsored by the Infectious Diseases Society of America, which urges global action by political, scientific, medical, industry, and policy leaders to drive the development of at least 10 effective new antibiotics by 2020.

▸ Smoke-free housing. Delegates passed a resolution to encourage federal, state, and local housing authorities to adopt policies prohibiting smoking in multi-unit housing. The word “public” was removed from language recommended by the public health reference committee to broaden support for efforts to include private multi-unit housing as well. Mention was made on the floor of evidence pointing to the health hazards of third-hand smoke, the residue that remains on walls, carpeting, and other surfaces for extended periods.

▸ E-cigarette regulation. Delegates voted in favor of a report from the AMA Council on Science and Public Health recommending that e-cigarettes be classified as drug delivery devices and be subject to regulation by the Food and Drug Administration with standards for identity, strength, purity, packaging, and labeling, and with instructions and contraindications for use. The new policy also asks state legislatures to prohibit the sale of non–FDA approved e-cigarettes and recommends that the devices be covered by smoke-free laws but be classified separately from tobacco products.

▸ Education about the Gulf oil spill. Delegates approved policy advocating that the AMA work to educate health professionals and the public on the potential health risks of oil spills and to encourage research on the Gulf oil spill's impact on air and water quality.

CHICAGO — Frustration and concern about the lack of a permanent replacement for the Medicare Sustainable Growth Rate formula held center stage as the American Medical Association's legislative body met here.

Delegates passed a resolution calling for the AMA to “immediately formulate legislation for an additional payment option in Medicare fee-for-service that allows patients and physicians to freely contract, without penalty to either party, for a fee that differs from the Medicare payment schedule.”

Such a fee-for-service option would allow physicians to balance-bill—they could bill patients for the difference between the Medicare fee schedule and their regular fee schedules.

In addition to helping physicians keep pace with inflation, the option would “give patients control of their Medicare benefit” by allowing them to use the 80% of the fee schedule that they receive from the government plan with physicians outside of “the very strict confines of a participating Medicare physician provider,” Dr. David O. Barbe, a member of the AMA board of trustees, said in an interview.

According to the resolution, the AMA must present the legislative language to its members by Sept. 30.

Introduced as an amendment from the floor during voting, the resolution provided teeth and proactive fervor to another proposed resolution from the AMA's legislative reference committee calling for the organization to study alternative payment options. The resolution that was passed eliminates this step.

Patients “want the conversation about health care to come from their doctors,” Dr. Marcy Zwelling-Aamot, president of the American Academy of Private Physicians, said in support of the substitute resolution, which passed by a large margin. “I don't want Congress writing the bill about how I'm going to take care of my patients. We should write the bill. We don't need a study, we need action,” she added.

At a “Write Coat Rally” prior to the start of the house proceedings, delegates expressed opposition to the current Medicare payment system.

“Physicians want to care for seniors, but multiple short-term delays have created instability for physician practices nationwide, and this cut is basically the last straw,” Dr. J. James Rohack, then president of the AMA, said during a press conference at the meeting.

He cited a recent AMA survey of 9,000 physicians indicating that one in five physicians overall and nearly one in three primary care physicians currently restrict the number of Medicare patients they see because they feel Medicare payment rates are too low or that the likelihood of additional cuts makes Medicare an unreliable payer.

At the rally, delegates wrote on white lab coats about the urgent need for a workable alternative to the Sustainable Growth Rate (SGR) formula. The lab coats were delivered to Congress after the meeting.

Support for the resolution during the voting session was strong but not unanimous.

AMA Past President Richard F. Corlin said that a bill from the AMA asking that physicians be allowed to contract for a fee that differs from Medicare payment and that does not forfeit benefits “is completely unachievable and will cause us to not be taken seriously by other people who would like to be our allies.”

He recommended focusing instead on changing the 2-year drop-out rule that prohibits physicians who opt out of Medicare from submitting claims to Medicare for any of their patients for 2 years.

“Let me abide by the Medicare limits for the patient who can't afford any more, and let me go my own way and bill what I want for the patient who can,” he argued.

Other delegates felt the resolution was too narrowly focused on physicians' financial interests and could ultimately do physicians more harm than good.

“We cannot keep going and asking for more and more money based on what we want to get without cutting the costs down,” said Dr. Lynn Parry, a Denver neurologist who received applause for her comments. “None of this discussion has talked about our responsibilities; it's just talked about what we want. It's going to make us look stupid, it's going to make us look greedy, it's going to come back and haunt us.”

According to Dr. Jeff Terry of the Alabama delegation, “We're not asking for more.… We're asking for continued access for our patients to care. This is not greedy to say the least.”

Dr. Jeffrey W. Cozzens of the American Association of Neurological Surgeons added, “By having legislation that we wrote, we'll show the world that we have solutions to this problem.”

Dr. Barbe added, “If [the federal government is] not able to provide access for patients by providing appropriate reimbursement to physicians … then take off the [price] caps. Pay whatever you can pay … and then let the market take care of the rest. Let the patient and the doctor decide what that service is worth.”

Although the SGR and physician pay dominated action at the House of Delegates meeting, other topics were deliberated. Among them:

▸ Skin cancer awareness. Delegates voted for the AMA to work with public health agencies and specialty societies, such as the American Academy of Dermatology, to promote skin cancer screening and education about sun-protective behavior among people of color. Five-year survival rates for melanoma are significantly lower among African Americans than whites (58.8% vs. 84.8%), and melanoma incidence among Hispanics now approaches that of whites, according to a statement from the AMA. Noting that African Americans and Hispanics are much less likely to practice sun-protective behaviors, AMA board of trustees member Peter W. Carmel said, “All patients regardless of race or ethnicity should use the same sun-protection measures including sunscreen of at least SPF 15, avoid the sun during peak hours, and [get] regular exams.”

▸ Support for new antibiotics. Delegates adopted policy to educate the public, physicians, the Obama administration, and Congress regarding the looming problem of antimicrobial resistance and the shortage of new antibiotic drugs in the development pipeline. Specifically, the policy endorses the “10 20” initiative sponsored by the Infectious Diseases Society of America, which urges global action by political, scientific, medical, industry, and policy leaders to drive the development of at least 10 effective new antibiotics by 2020.

▸ Smoke-free housing. Delegates passed a resolution to encourage federal, state, and local housing authorities to adopt policies prohibiting smoking in multi-unit housing. The word “public” was removed from language recommended by the public health reference committee to broaden support for efforts to include private multi-unit housing as well. Mention was made on the floor of evidence pointing to the health hazards of third-hand smoke, the residue that remains on walls, carpeting, and other surfaces for extended periods.

▸ E-cigarette regulation. Delegates voted in favor of a report from the AMA Council on Science and Public Health recommending that e-cigarettes be classified as drug delivery devices and be subject to regulation by the Food and Drug Administration with standards for identity, strength, purity, packaging, and labeling, and with instructions and contraindications for use. The new policy also asks state legislatures to prohibit the sale of non–FDA approved e-cigarettes and recommends that the devices be covered by smoke-free laws but be classified separately from tobacco products.

▸ Education about the Gulf oil spill. Delegates approved policy advocating that the AMA work to educate health professionals and the public on the potential health risks of oil spills and to encourage research on the Gulf oil spill's impact on air and water quality.