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Regents debate collective bargaining, confidentiality

From the June 1999 ACP-ASIM Observer, copyright © 1999 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

NEW ORLEANS—At two meetings during Annual Session, the Board of Regents approved a host of items designed to give the College a voice in issues such as collective bargaining for physicians, patient confidentiality and the definition of medical necessity.

With Congress considering a bill that would define whether physicians have the right to collectively bargain, the College's Washington Office had asked the ACP-ASIM Health and Public Policy Committee (HPPC) to take a stand on the issue and communicate that position to legislators, the press and other medical groups.

The HPPC forwarded that request to the Board, sparking considerable discussion among the Regents. The Regents eventually recommended supporting legislation that would allow physicians to collectively bargain with plans "that affect the quality of—and access to—patient care" as long as such efforts would not lead to work stoppages, limits on patient access to care or price-fixing by physicians.

"It's not about striking and it's not about unionization," said Regent Laurence D. Wellikson, FACP, speaking in support of collective bargaining legislation. "It's about the fact that, at this time in this country, physicians are the most disadvantaged players at the bargaining table—even though we have the most to say for our patients."

The Regents also approved a College position paper on confidentiality of electronic medical records, which included the following recommendations:

  • Disclosure of medical information not required for health care-related needs should require a court order.
  • Only medical data that have been stripped of information that could identify patients should be used in medical research and quality improvement processes, unless the nature of the research necessitates identification.
  • Federal privacy protections must be created before a national system of unique identifiers is implemented.
  • Health information transmitted outside a physician's office for research purposes must be encrypted.

Several Regents expressed concern over current encryption options, in part because they can be prohibitively expensive. Paul F. Speckart, FACP, Chair of the Health and Public Policy Committee which recommended adopting the position, acknowledged that electronic encryption is still in a state of "rapid evolution" but said that the College needs to take a stand on confidentiality now. According to the Health Insurance Portability and Accountability Act of 1996, Congress must enact medical privacy legislation by August of this year.

At a time when Congress is debating different versions of a patient protection bill, the Regents also approved a recommendation from the ACP-ASIM Medical Services Committee urging the College to continue supporting legislative language that defines medical necessity as a service or benefit that "is consistent with generally accepted principles of professional medical practice."

The Regents also approved the following:

  • A two-year budget to create Annals Online, which will offer the full text of Annals of Internal Medicine to College members free of charge. Frank Davidoff, FACP, Senior Vice President and Editor of Annals of Internal Medicine told the Regents that Annals Online could eventually allow journal articles to be published the same day that they are accepted. Currently, articles are not published for 10 to 12 weeks.
  • "Medical Ethics, Professionalism and the Changing Practice Environment," the first in a series of statements from the Ethics and Human Rights Committee on ethics and managed care issues.
  • An ACP-ASIM Vision Statement "upholding the best traditions and creating opportunities for excellence in the future of internal medicine."
  • A new process whereby ACP-ASIM Associates would automatically advance to College membership when they become board certified.
  • The purchase of land adjacent to the ACP-ASIM Philadelphia headquarters for $1.65 million. Construction on the College's addition should begin in mid-2000; occupancy is slated for mid-2002.

At a second meeting during Annual Session, the Regents voted on an additional 15 resolutions that had been debated earlier in the week by the Board of Governors and passed to the Regents. The Regents approved resolutions recommending that the College take the following actions:

  • Work to make the recertification process more efficient and more timely;
  • Help members comply with different states' continuing medical education (CME) requirements. Specific ideas included developing mechanisms to document content areas, compiling state CME requirements and encouraging program planners to use that information when creating CME courses;
  • Urge HCFA to continue to delay implementation of its evaluation and management (E&M) documentation guidelines and to reconsider its overall approach to documentation;
  • Encourage HCFA to remove "policing" provisions from its contracts with professional review organizations and instead implement continuous quality improvement projects that educate, not punish, physicians;
  • Encourage medical schools to teach geriatrics;
  • Develop a strategy to promote legislation that would prohibit managed care organizations from deleting medications from closed formularies more than once a year;
  • Communicate to the FDA, the DEA, the Department of Health and Human Services and Congress that methadone should be treated no differently than any other FDA-approved narcotic;
  • Encourage the study of the long-term impact of genetic engineering on the food supply and human health;
  • Work with the AMA and HCFA to include the fee schedule for office laboratory tests with the Medicare Part B annual fee schedules; and
  • Make legislators aware that the College opposes the mandatory use of hospitalists.

The Regents also adopted a resolution that calls on the College to develop guidelines regulating the campaigns of College members seeking elected office. The Board also approved a resolution urging the College to encourage the Royal College of Physicians and Surgeons of Canada to accept MKSAP for study credit. The item was forwarded to the Education Committee for further action.

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