There is a certain satisfaction in talking to JCAHO, the state medical society and Congress, and in a small and indirect way that is how I spent part of the month of June. I joined some of our medical staff colleagues from around the country to attend the 47th AMA Organized Medical Staff Section (OMSS) meeting in Chicago.

The OMSS deliberates on business related to medical staffs and forwards recommendations and agenda items to the larger AMA House of Delegates. While many of you may understandably ask, “What relevance does this have to me or even to SHC’s medical staff?” I’d like to remind you - as I remind myself periodically - that the OMSS and the AMA have great influence with regulating organizations such as the JCAHO, CMS, Congress, etc. Unfortunately, it is just about the only organization speaking for all physicians to these regulators. I will tell you about some of the items considered at the meeting.

JCAHO transparency
The OMSS is demanding greater transparency in the methods and rationale the JCAHO uses to develop what many consider to be their increasingly onerous regulatory rules. Currently, changes to JCAHO standards are developed without a meaningful explanation or discussion of consequences. The OMSS is asking JCAHO to lift a cloak of secrecy and publish the rationale for each proposed regulatory change with a clear analysis of the possible effects of the change on hospitals and medical staffs.

Hospitalists and the low-admitters
Hospitalists are rapidly increasing in number across the country at hospitals, including SHC. Many family medicine and internal medicine physicians are giving up their hospital care of patients. Since this then results in low or no admissions for these physicians, it poses a dilemma for hospital medical staffs. According to JCAHO regulations, hospital medical staffs must evaluate the quality of care of all its physicians. If a physician is a “low-admitter”, there is not enough clinical activity for this required evaluation. Many medical staffs, including Stanford’s, have been forced to require “low-admitters” to resign from the medical staff because it can’t accurately determine quality of care. Stanford is now struggling with this problem. On one hand, we want to keep physicians involved with the hospital through medical staff membership, but yet we are unable to complete the required quality of care evaluation at reappointment time.

The OMSS is trying to find methods to make the AMA relevant to both hospitalists and the primary care physicians on hospitals’ organized medical staffs by attempting to find ways to work out realistic membership rules comfortable for the JCAHO.

Elections- diversity- OMSS future
The AMA and OMSS leadership tends to be composed of a homogeneous group of men who in the face of dwindling attendance have struggled through many years of AMA activity to achieve these elected positions. This year, a young, black, female internist ran for office. I voted for her because I felt she would bring some new ideas to the OMSS. Unfortunately, she lost. The AMA and the OMSS are concerned about the need to encourage inclusiveness and diversity in the leadership structure. If these organizations are to continue to be effective, younger, more demographically diverse physicians must be included. I am not sure if the AMA will be able to change its culture to meet this goal.

CMS Voluntary reporting program-P4P
We all know that Congress and CMS have decided to ultimately tie physician reimbursement to measures of quality of care via a program called “Pay for Performance.” CMS announced in October 2005 the launch of its Physician Voluntary Reporting Program (PVRP). Under this program, physicians can report their data on 16 core performance measures to a federal database. Physicians can register in this program through a website, www.qualitynet. org/pvrpintent. Data is reported using G-codes and CPT II codes on Medicare claim forms. The intent of this program is to gain experience with the reporting mechanism so that it can ultimately be used as a method of compensating physicians based on the quality of care they provide.

Physicians who participate in this voluntary program now will be able to compare their performance with peers through confidential reports and hone their reporting methods before the compensation component of the program kicks in. More information on the PVRP can be obtained at www.cms. hhs.gov/pvrp.

Disaster management
The OMSS held a four-hour program on Disaster Management: Preparing for a New Reality. Speakers discussed the problems that occurred during the Katrina disaster, the looming threats of bioterrorism and pandemic flu, and our state of preparedness for such disasters. I must say that these sessions are very depressing - I leave with a sense of pessimism about the ability of our government and society to develop and provide the resources to meet these threats. For those interested in learning more about disaster preparedness, I highly recommend the AMA public health/disaster web site:

www.ama-assn.org/ama/pub/category/6206.html

The AMA has a free CD-ROM available on Management of Public Health Emergencies - A Resource Guide for Physicians and other Community Responders. Also, there is a new program called National Disaster Life Support, a training program for mass casualty events. The CD-ROM and NDLS manual can also be obtained on the publication website above.

Medicare physician payment reform
The AMA continues to fight the losing battle with Congress and the CMS over decreasing physician reimbursement for Medicare patients. If Congress fails to act before the November elections, Medicare will cut physician payments by about 5 percent on Jan. 1, 2007. Cuts would total 34 percent or greater through 2015. And while physician payments plummet, practice costs during the same nine-year period are expected to increase 22 percent. The cuts cannot be sustained and could lead to a health care access crisis for America’s seniors. A majority of physicians surveyed by the AMA said they would be forced to halt nursing home visits if cuts of the discussed magnitude were made.

Physicians are encouraged to take action by contacting their representatives about this problem. The website: www.ama-assn.org/ama/pub/category/ 13097.html has more information on how you can do this.

New AMA President
William G. Plested III, MD, a thoracic and cardiovascular surgeon from Brentwood, in the Delta, was inaugurated as the 161st president of the AMA June 13 during the association’s 2006 Annual Meeting.

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I continue to feel that we must all participate in medical politics at the local, state, and federal levels. Toward this end, we have enrolled every member of our Medical Board in the Santa Clara County Medical Association and the California Medical Association. Non-participation by physicians only means more control over the practice of medicine by non-physicians and politicians. If you are interested, here are some good websites to check out:

CMA: http://www.cmanet.org/
Santa Clara County Medical Association: http://www.sccma.org/default.asp

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Closer to home on a lighter note… I hope, by now, that you have all visited the new Medical Staff Center located across from the Gift Shop on the first floor of the hospital. I hope you all enjoy this area as a place to relax and visit with your colleagues. You can see a picture of me and our colleague, neurologist and former staff president Bruce T. Adornato, enjoying the lounge on the homepage.