The American Medical Association - Medical Student Section had its Interim meeting in Honolulu, Hawaii from November 8th to November 10th. The AMA-MSS discussed more than 30 items of business and participated in 10 education programs. The education programs covered a wide range of topics, including leadership development, cultural competency, the healthcare system, and community service.
The policies discussed covered issues from end of life care to the decriminalization of marijuana. Some other important policies of note: the incorporation of health insurance education into the medical school curriculum, organ donation education in driver training programs, and policy and advocacy elective rotations for medical students. Region 6 had a strong showing at the meeting and had 8 of its 16 policies passed.
On Nov. 8th the AMA-MSS held its “Wellness Run” on Waikiki beach where students were able to clean up the beach and enhance the beauty of the environment. On Nov. 9th the AMA MSS held its “AMA Doctors Back to School” event at Honolulu’s Kaewai Elementary School. There were more than 40 medical students and physicians who spoke to 100 fourth- and fifth-graders about healthy lifestyle choices and pursuing a career in medicine.
Lastly, the section held the 10th annual AMA Research Symposium in conjunction with the AMA Resident and Fellow Section and the AMA International Medical Graduates Section. There were more than 180 students who participated in the event and from the 9 winners there was 1 student from Region 6
The Region 6 governing council has begun planning its regional meeting on February 9th and 10th in Washington D.C. at Georgetown University. Stay tuned for more information!
- Juan F. Javier-DesLoges
Policy Chair Region 6
On Wednesday October 24th the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) entered into an agreement to pursue a unified accreditation system for graduate medical education programs (residency) in the United States. The three organizations will work together to make the AOA and AACOM members of the ACGME by July of 2015.
The ACGME is an organization responsible for the accreditation of allopathic residency. The American Osteopathic Association (AOA) is the accrediting agency for osteopathic medical schools and has federal authority to accredit osteopathic residency. The American Association of Colleges of Osteopathic Medicine (AACOM) supports osteopathic medical education, its equivalent being the Association of American Medical Colleges (AAMC) for allopathic medical education.
The three organizations, ACGME, AOA, and AACOM came to this point after a year of intense debate over the “Common Program Requirements”. These requirements were proposed by the ACGME and would restrict the entrance of osteopathic residency graduates into allopathic subspecialty training. For example, an osteopathic medical student who went to an osteopathic residency program in internal medicine would be ineligible to enter an allopathic fellowship program in cardiology. This also makes any graduate from a foreign residency ineligible for fellowship training.
Under the new agreement all osteopathic residency programs would be accredited by the ACGME thus making osteopathic residency graduates eligible for allopathic fellowships. Some of the topics of discussion for the three organizations will be the acceptance of AOA specialty board certification by the ACGME and that the ACGME recognize AOA accredited programs.
"This would provide physicians in the United States with a uniform path of preparation for practice," ACGME Chief Executive Thomas Nasca, MD, said in a press release. "This approach would ensure that the evaluation and accountability for the competency of resident physicians are consistent across all programs."
A once estranged relationship has become a friendly one as allopathic and osteopathic practitioners have worked together in recent history. Osteopathic medical education was founded in the late 1800s and was considered distinct with its use of osteopathic manipulative medicine. Over the years it became more evident that the two training programs were more similar than different. In the late 1980s osteopathic physicians gained practicing rights equal to allopathic physicians in all 50 states.
Although the two professions have been equal since then, discrimination against osteopathic physicians has been rampant in the medical community. The American Medical Association invited osteopathic physicians to join their organization in 1969. Then in 2007 the AMA collaborated with the AOA to discourage discrimination against medical students by institutions and programs based on osteopathic or allopathic training.
This landmark agreement between the ACGME and AOA/AACOM will set universal standards for residency training and will yield improved health outcomes for our patients.
- Juan F. Javier-DesLoges, AMA Region 6 Policy Chair
The “Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act” was introduced on August 2, 2012 by Aaron Shock (R-IL) and Allyson Schwartz (D-PA). If enacted the bill would increase the number of residency spots in graduate medical education by 15,000.
Graduate Medical Education (GME), more commonly known as “medical residency”, was capped in the “Balanced Budget Act” of 1997 because a physician surplus was being predicted. The AMA has supported lifting the 1997 funding cap and advocates for an increase in GME positions to address a now foreseeable physician shortage. Throughout the last several years, new allopathic and osteopathic medical schools have been established and existing schools have increased their class sizes. Unfortunately the US continues to produce the same number of physicians, as residency positions have not mirrored this increase.
The funding for GME comes mainly from the Medicare budget, an estimated $9.5 billion annually. This amount is then split into two parts: $3 billion is for resident salaries called Direct Medical Education and $6.5 billion to subsidize the cost of running a training program, called Indirect Medical Education.
Every year there are 23,000 slots open to graduating medical students and overall there are 115,000 residency positions throughout the nation. Within these 23,000 slots, graduates from U.S. allopathic and osteopathic schools fill 16,000 positions and graduates of non-US schools fill the remaining 7,000 slots. It is for this reason that there are conflicting views on whether or not to raise the cap. The president of the American Medical Student Association stated that the cap shouldn’t be lifted, as 7,000 positions remain open to American graduates.
The main problem with increasing the number of residency spots is money, the AAMC estimates that between $12 billion and $15 billion dollars would be required to increase the number of GME positions by 15,000. The idea of cutting residency spots is more likely as the Medicare Payment Advisory Commission, who determines how Medicare funds are used, judged that 50% of GME funding is “empirically unjustified”. If 50% of GME funding were to be cut there would be a loss of 33,000 GME positions, a devastating blow to training physicians.
The new bill proposes to increase the number of residency slots by 3,000 each year between 2013-2017. At least half of the new slots must be used for medical specialties deemed to be facing a shortage. In order to determine which hospital would receive slots, the Center for Medicaid and Medicare Services would give priority to hospitals in states with new medical schools, hospitals that emphasize training in community health centers, and hospitals eligible for electronic health record incentive payments.
The Health and Human Services Secretary will have to establish measures of “patient care priorities” in Graduate Medical Education. If a hospital were to not meet the patient care measures it will have its Indirect Medical Education payments reduced by 2%. The Secretary must also issue an annual report on Graduate Medical Education payments made to the hospitals and factors contributing to higher patient care costs at each hospital.
The likelihood that this new bill is enacted is slim considering only 4% of proposed bills are enacted in a given year. Nevertheless, the expansion of health insurance coverage will increase the demand for physicians and this issue will need to be addressed in the near future.
Region 6 Policy Chair
The state of Oregon was recently awarded $1.9 billion in funds from the Affordable Care Act to test out a pilot program called the “Coordinated Care Organization”. A former emergency room physician and now Oregon state governor Dr. John Kitzhaber developed this idea. The basic concept of this program is to provide physical, mental, dental and long-term care in the same office while providing financial incentives for health outcomes of patients. Currently, Managed Care Organizations provide mental and physical care under the same roof, but this innovative approach provides a multi-professional and whole patient centered model.
In Oregon there are currently 600,000 people who are on the state’s Medicaid program, Oregon Health Plan. The CCO program will target Medicaid patients and hopes to shift the costs of medical care from tertiary acute emergency care to primary long-term care. This program will make CCOs accountable for a host of metrics such as access to care, clinical outcomes, and patient safety. Dr. Kitzhaber who recently spoke on National Public Radio, gives a great example of the effectiveness of this strategy:
“…if you have a 90-year-old woman who lives alone with well managed stable congestive heart failure in an unairconditioned apartment and there is a heat wave and the ambient temperature goes up to say 102 degrees, that’s enough strain on a heart to full blown CHF. On the current system, you don’t know about it until she shows up in the ED. Under this system, there will be obviously an incentive to have community health workers checking on her on a regular basis to make sure she is okay. Under the current reimbursement system, under both Medicare and Medicaid, they will pay $50,000 for the hospitalization, they won’t pay $200 for window air conditioner which is all she needs to say in her home and out of the medical system. So the difference there is $49,800 which could then be used to create some additional reimbursements for physicians and hospitals.”
The funds spent on Medicaid have been an overwhelming challenge for states since the recession began in 2007. It is estimated that nearly 23.6 % of a state’s budget goes towards funding Medicaid, more money than a state spends on education. If the CCO model proves to be successful, the United States Department of Human Health Services could use it as a model for implementation at the national level. The result, a savings of $1.5 trillion in healthcare costs over 10 years if every state chooses to adopt this model.
- Juan Javier-DesLoges
Region 6 Policy Chair
Yesterday, the “Patient Protection and Affordable Care Act” (PPACA) was deemed to be constitutional, almost in its entirety, by the Supreme Court. The decision came on the morning of June 28th, which stated that the vote was in favor of the law by a narrow margin of 5-4.
Since the act’s passing in March of 2010, it has come under heavy scrutiny by many states that deemed the law to be unconstitutional. In particular, the health insurance mandate has been berated, it stated that individuals who are able to buy health insurance must do so or be fined. In total, 26 states petitioned to the Supreme Court on the legality of the law, who later agreed to hear the case. In March of 2012, the Supreme Court heard three days of oral testimony. Arguments against the law seemed to be strong. Meanwhile, Solicitor General Donald Verilli’s testimony in support of the law was severely criticized, but yesterday he received vindication.
As the Supreme Court Justices pondered the future of the law, many speculated that it would be rejected, not only because of its essence, but also because a majority of the justices are conservatives. Chief Justice of the United States, John Roberts, appointed by George W. Bush in 2005, overlooked political divisions as he sided with liberal justices to support the law.
" ꞌIt is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance,ꞌChief Justice John Roberts wrote in the majority opinion. ꞌSuch legislation is within Congress’s power to tax.ꞌ”
The only part of the law that was decided to be unconstitutional is the mandatory expansion of the qualifications for Medicaid. The PPACA declares that states must comply with this expansion or their existing Medicaid funding will be suspended. However, today’s ruling stated that the penalty will need to be removed.
The recently inaugurated president of the American Medical Association, Dr. Jeremy A. Lazarus praised the ruling on the PPACA by writing:
"A longtime supporter of health insurance coverage for all, the AMA remains committed to working on behalf of America’s physicians and patients to ensure the law is implemented in ways that support and incentivize better health outcomes and improve the nation’s health care system".
Threats to the future of the law continue to loom as the leading Republican presidential candidate Mitt Romney – who passed a similar mandate in Massachusetts – rallied Republicans by vowing to repeal the law if he is elected.
In the end, the delivery of quality care to patients remains our upmost priority and this law serves as an opportunity to transcend our nation’s health disparities.
Region 6 Policy Chair