Please send items of interest for the E-News -- and any other feedback -- to E-News editor Dave Cundiff, MD, MPH. Thanks!
SPECIAL PREVIEW OF JUNE 2007 AAPHP/AMA MEETINGS
AND CALL FOR ASSISTANCE
CONTENTS:
1) AAPHP Delegate Goyal Runs for Vice Speaker
2) AAPHP Annual Meeting - Chicago, June 23, 2007
3) Resolutions for AMA Annual Meeting
4) Maintaining Medical Specialty Board Certification Standard
5) Proper FDA Authority to Regulate Tobacco
6) Funding for Prenatal Care to All Pregnant Women
7) Collaboration Between Human and Veterinary Medicine
8) Principles for Health System Reform at State Level
9) Ending AMA Support for PFP and Public Reporting Programs
10) Please Help Us to Help You
1) AAPHP Delegate Goyal Runs for Vice Speaker:
AAPHP Past President (2004-2006) and current AMA Delegate ARVIND K. GOYAL, MD, MPH is a candidate for Vice Speaker of the AMA House of Delegates. The House of Delegates election will be held on Tuesday morning, June 26, 2007. Dr. Goyal's "Candidate Profile", with an introduction by AAPHP President Rausa, is posted at http://www.aaphp.org/special/goyal.html. The Candidate Profile by itself is posted as a PDF file http://www.aaphp.org/special/Goyal%20Profile%2020070503.pdf.
The AMA's Speaker and Vice Speaker preside over the sessions of the House of Delegates, customarily alternating this role. The Speaker and Vice Speaker are voting members of the AMA Board of Trustees, which implements AMA policies between meetings of the House of Delegates.
Dr. Goyal has formal parliamentary training and passed the examination for membership in the National Association of Parliamentarians. He has served as President of the Illinois State Medical Society and of AAPHP, and as the AMA Delegate from each organization. He has served as the Speaker and as Council of Parliamentarians Chair for the American Association of Physicians of Indian Origin for several years.
Dr. Goyal's calm, thoughtful listening skills, and sense of humor, have helped AAPHP move forward over the years. We are proud of his candidacy and we are happy to share him with the rest of our AMA colleagues.
HOW YOU CAN HELP:
A "prudent and reasonable" campaign, informing all AMA delegates about a major candidate, costs thousands of dollars. This is "small change" for a large medical society, but it's a big expense for AAPHP. AAPHP's members and friends can help by renewing and/or upgrading their AAPHP membership. Membership details are in item #10 of this E-News, or contact AAPHP's secretary aaphp@reachone.com or (360) 870-2483.
From each U.S. State and territory, the state or territorial medical society sends delegates to the AMA. If you belong to a specialty other than Public Health, your other specialty society probably has AMA Delegates as well. Full lists of AMA delegates are available to AMA members (login required) at http://www.ama-assn.org/ama/priv/category/3359.html . If you need delegate information in another format, please contact AAPHP's Secretary at aaphp@reachone.com.
Please contact your delegates, or other delegates with whom you share a connection, and tell them about Dr. Goyal's candidacy.
Many delegates will give you feedback or ask questions. If you can't answer a question, tell the delegate or alternate delegate that Dr. Goyal will answer it. Please forward unanswered questions, and any other feedback, to Dr. Goyal at arvindkgoyal@aol.com or by mobile phone at (847) 921-3683.
Dr. Goyal's campaign assistants include AAPHP's Secretary DAVE CUNDIFF, MD, MPH (cundiff@reachone.com), AAPHP Member SUSAN B. KERN, MD (susanbkern@yahoo.com), and other members of AAPHP's Executive Committee and Board. Please let one of us know if we can help.
If you come to Chicago for the AAPHP and AMA Annual Meetings, you will have additional opportunities to tell AMA Delegates about Dr. Goyal. Please join us!
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2) AAPHP Annual Meeting - Chicago, June 23, 2007:
AAPHP's Annual Meeting, and a reception for Dr. Goyal, will be held on June 23, 2007, at 5:30 pm Central Time, in CONTINENTAL BALLROOM A of the Hilton Chicago, 720 South Michigan Avenue, Chicago, Illinois.
We will begin after adjournment of the House of Delegates, approximately 5:30 pm, with a pizza and soft drink reception for AMA Delegates and AAPHP's members and friends. Outgoing AMA President WILLIAM G. PLESTED III, MD will speak on "The AMA and the Public Health Agenda" at 5:45 pm. The AAPHP business meeting, including election of officers and trustees, will be held in Continental Ballroom A after Dr. Plested's talk. Due to the press of other activities, we hope to adjourn before 7:00 pm.
AAPHP Members attending the Annual Meeting have been invited to a dinner Saturday night 2007-06-23 honoring AMA's incoming President (and AAPHP member) RONALD M. DAVIS, MD, MS. There may be a few spaces left at this dinner. Please contact AAPHP's President ALFIO RAUSA, MD, MPH "alfio.rausa@msdh.state.ms.us" or mobile phone (662) 822-0357 for dinner arrangements.
AAPHP's Annual Meeting is open to all AAPHP members and guests. There is no fee or registration requirement. We hope to see you there!
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3) Resolutions for AMA Annual Meeting:
After reflections and input from AAPHP's Board, AAPHP's AMA Delegate ARVIND K. GOYAL, MD, MPH and Alternate Delegate JOSEPH L. MURPHY, MD have introduced three resolutions and co-sponsored three others for the AMA Annual Meeting June 22-27, 2007.
The three resolutions primarily authored by AAPHP are "Maintaining Medical Specialty Board Certification Standard", "Proper FDA Authority to Regulate Tobacco", and "Funding for Prenatal Care to All Pregnant Women" (Items #4-6 below).
The three resolutions co-sponsored by AAPHP are "Collaboration Between Human and Veterinary Medicine", "Principles for Health System Reform at State Level", and "Ending AMA Support for PFP and Public Reporting Programs" (Items #7-9 below).
HOW YOU CAN HELP:
If you have time, please review the resolutions and give input to our delegates and to the AMA. The AMA allows members to give on-line input on some resolutions; we'll give details on this option if it is available. All resolutions will be considered at Reference Committees in Chicago on Sunday, June 24, 2007. Any AMA member may testify at the Reference Committee meetings.
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4) Maintaining Medical Specialty Board Certification Standard
Introduced for Annual Meeting 2007 by AAPHP.
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Whereas, the National Board of Public Health Examiners (NBPHE), a new independent organization is developing a nationally standardized multiple choice test in conjunction with the national Board of Medical Examiners (NBME) to be given in the near future to candidates for a Masters in Public Health Degree (MPH), at various schools of Public Health, and
Whereas, this process will confer the status of "Board Certification" to a successful candidate, whether or not a physician, will be much less rigorous and much less time consuming to achieve than a board certification granted by any ABMS Specialty Board, and
Whereas, the NBPHE Board Certification will occur without the ABMS approval, oversight or performance based assessments common to all ABMS recognized Specialty Boards, and
Whereas, the similarity of terms will inevitably create confusion among the public as well the hiring authorities who have come to associate "Board Certification" with those who have received Medical Education and Residency Training in a recognized specialty, and may thus harm the public while providing some potential benefit to those receiving NBPHE Board Certification, and
Whereas, it is rumored that more such "quasi-boards" may come about in other specialties in the near future causing further blurring of Board Certification standards and prestige, be it therefore,
RESOLVED, that our AMA oppose any action, regardless of intent, that appears likely to confuse the public about the unique credentials of Board Certified physicians in any medical specialty, or take advantage of the prestige of any medical specialty for purposes contrary to the public good and safety, and be it further,
RESOLVED, that our AMA communicate its concerns about the diminished use of the term "Board Certification" by NBPHE and others to the Specialty and Service Societies in the Federation (SSS), the Association of the Schools of Public Health, the ABMS, the ACGME, the NBME and the Institute of Medicine.
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AAPHP Editor's Note: This resolution follows on AAPHP's discussions -- so far fruitless -- with NBPHE leaders. We still hope for an amicable resolution of NBPHE's proposal to mimic, and thus devalue, the certification of residency-trained physician specialists in Public Health and General Preventive Medicine.
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5) Proper FDA Authority to Regulate Tobacco
Introduced for Annual Meeting 2007 by AAPHP.
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Whereas, Tobacco products remain the #1 preventable cause of premature death, disability and disease in the United States, and
Whereas, Effective Federal Regulation of the manufacture, distribution and advertising of tobacco products could help substantially reduce the burden of ill health borne by the public, and
Whereas, the FDA currently regulates Food, Cosmetics and Drugs sold to the consumers thus assuring the public of the effectiveness and safety of the product about to be consumed, and exercises its authority in banning or requiring appropriate warning on a product considered to be potentially harmful, and
Whereas, SB 625/HR 1108, the "Family Smoking Prevention and Control Act" is a bill currently under consideration by the United States Congress that would provide a limited FDA authority to regulate tobacco; the FDA could not ban tobacco products as it could, the other regulated products found harmful by the FDA; the FDA could not prohibit changes in composition that would make the tobacco products less attractive to adult smokers; and, the addition of new and potentially less hazardous tobacco products will be strictly regulated but the current tobacco contents including Nicotine will be "grandfathered" under this bill, thus making the current level of toxicity acceptable to the Congress and the FDA and half a million American lives will continue to be lost annually, and
Whereas, SB 625/HR 1108 will prohibit the tobacco advertising clearly directed to underage children, but marketing attractive to children and ostensibly aimed at young adults will be protected from FDA regulation and most in-store promotions which reinforce dominant brands would persist under the First Amendment, be it therefore,
RESOLVED, that our AMA reiterate its support, in principle, for effective federal regulation of tobacco products, and, further
RESOLVED, that our AMA condition their support of SB 625/HR 1108 on adoption of amendments needed to extend the FDA, the same unabridged authority currently granted for regulation of Food, Cosmetics and Drugs, that would effectively reduce or eliminate tobacco related illness and death in the American Society and tobacco use by our youth.
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AAPHP Editor's Note: AAPHP's briefing pages on the Philip Morris/CTFK bill (S.625/H.R.1108) are at http://www.aaphp.org/Feb07tobaccbill.html.
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6) Funding for Prenatal Care to All Pregnant Women
Introduced for Annual Meeting 2007 by AAPHP.
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Whereas, the issue of uncompensated prenatal care, whether due to citizenship status or insurance status, is a growing problem in several states, and
Whereas, there is clear evidence that points to worse birth outcomes in the absence of prenatal care, thus increasing our national burden of premature death and disability, and
Whereas all babies born in the United States are U.S. Citizens, regardless of the citizenship or immigration status of their mothers, and
Whereas, Texas, California, New York and seven other states have taken steps to provide Medicaid or other funding for prenatal care to most non-U.S. citizens, while several other states continue to act “penny wise and pound foolish” by ignoring the problem or depending on the “safety net” systems in their local communities which are progressively wearing thin, and
Whereas, from 1996-2005, just in the State of Florida, which does not have special provisions for coverage of unfunded prenatal care, the number of Emergency Medicaid Deliveries for women who did not receive any prenatal care increased four-fold to 17,678, representing roughly 8 percent of all deliveries in the state, be it therefore
RESOLVED, that our AMA urge the Centers for Medicare and Medicaid Services to require all states to provide basic prenatal care to all pregnant women, regardless of their citizenship or immigration status, as a condition of participation in the Medicaid program, and further
RESOLVED, that our AMA encourage the State Medical Associations to write to their respective Governors and Legislative leaders to explore various public and private funding options to ensure the provision of prenatal care to all pregnant women, and implement in their respective states, the concept of Presumptive Eligibility for Pregnant Women (PEPW), whereby all pregnant women coming in for prenatal care within the first three months of pregnancy are assured immediate access to the Medicaid system, and further
RESOLVED, that our AMA support a nationwide campaign to educate women and families about the benefits of early and immediate prenatal care.
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7) Collaboration Between Human and Veterinary Medicine
Introduced for Annual Meeting 2007 by American College of Preventive Medicine, American College of Occupational and Environmental Medicine, AAPHP, and Academy of Pharmaceutical Physicians and Investigators.
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Whereas, The majority of the emerging infectious diseases, including the bioterrorist agents, are zoonoses; and
Whereas, Zoonoses can, by definition, infect both animals and humans; and
Whereas, By their very nature, the fields of human medicine and veterinary medicine are complementary and synergistic in confronting, controlling, and preventing zoonotic diseases from infecting across species; and
Whereas, Collaboration and communication between human medicine and veterinary medicine have been limited in recent decades; and
Whereas, An initiative, often called the “One Health” initiative, is being developed to improve the lives of all species—human and animal—through the integration of human and veterinary medicine (J. Zinsstag, et al. Lancet 2005; 366: 2142-2145 and E.P.J. Gibbs. Veterinary Record 2005; 157: 673-679); and
Whereas, “One Health,” previously coined as “One Medicine” by Calvin Schwabe, aims to promote and implement close meaningful collaboration/communication between human medicine, veterinary medicine, and all allied health scientists with the goal of hastening human public health efficacy as well as advanced health care options for humans (and animals) via comparative biomedical research; and
Whereas, The challenges of the 21st century demand that these two professions work together; and
Whereas, The President of the American Veterinary Medical Association is advocating for an initiative to promote collaboration between human and veterinary medicine (http://www.avma.org/onlnews/javma/sep06/060901d.asp); and
Whereas, Our AMA recognizes the ways in which animals and animal care may affect human health and disease through policies on the use of animals in research, medical education, and product safety testing (H-295.957, H-460.932, H-460.979, H-460.985); xenotransplantation (H-370.972, E-2.169); animal-transmissible spongiform encephalopathies in humans (H-150.959, D-150.990); non-therapeutic use in animals of antimicrobials that are also used in humans (H-440.895); and protection against avian influenza (D-440.962, D-440.965); therefore be it
RESOLVED, That our American Medical Association support an initiative designed to promote collaboration between human and veterinary medicine (Directive to Take Action); and be it further
RESOLVED, That our AMA support joint educational efforts between human medical and veterinary medical schools (Directive to Take Action); and be it further
RESOLVED, That our AMA encourage joint efforts in clinical care through the assessment, treatment, and prevention of cross-species disease transmission (Directive to Take Action); and be it further
RESOLVED, That our AMA support cross-species disease surveillance and control efforts in public health (Directive to Take Action); and be it further
RESOLVED, That our AMA support joint efforts in the development and evaluation of new diagnostic methods, medicines, and vaccines for the prevention and control of diseases across species (Directive to Take Action); and be it further
RESOLVED, That our AMA engage in a dialogue with the American Veterinary Medical Association to discuss strategies for enhancing collaboration between the medical and veterinary medical professions in medical education, clinical care, public health, and biomedical research (Directive to Take Action).
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AAPHP Editor's Note: The lead author of this resolution is AAPHP Lifetime Member LAURA H. KAHN, MD, MPH, MPP. A fifteen-page article on this concept, by Dr. Kahn with Bruce Kaplan DVM and James H. Steele DVM, was published earlier this year in the veterinary public health journal Veterinaria Italiana. This article is not yet available on the Web. It is available by individual request only, as a PDF file "KahnKaplanSteele2007.pdf", from AAPHP's Secretary aaphp@reachone.com.
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8) Principles for Health System Reform at State Level
Introduced for Annual Meeting 2007 by New Mexico Medical Society and AAPHP.
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WHEREAS those that deliver health care must focus on improving health care quality and safety in order to assure optimal outcomes; and
WHEREAS those that fund health care must focus on patient oriented, quality driven and community centric interventions; and
WHEREAS those that deliver, finance and utilize health care must share stewardship of finite collective health resources; and
WHEREAS in the absence of national health system reform, legislation to reform health systems at a state level may be regarded by many states as necessary not only to improve the individual and collective health of state residents but also for states to remain economically competitive in the global market; and
WHEREAS our American Medical Association has established a set of principles for national health care reform (in particular, H-165.888 "Evaluating Health System Reform Proposals" and H-165.904 "Universal Health Coverage") that may not prove adequate when physicians participate in the development and evaluation of state level health system reform efforts; and
WHEREAS the Colorado Medical Society and the Colorado Physicians' Congress on Health Reform should be commended for their outstanding work in pursuing health system reform, for their creation of a succinct but thorough statement of principles for health system reform at the state level (included below) and an evaluation tool based on those principles, and for their collegiality in working with other states engaged in similar pursuits, including their willingness to make their work freely available; therefore, be it
RESOLVED that our American Medical Association adopt the following set of principles against which state level health system reform proposals may be measured:
1. Coverage - Health care coverage for state residents should be universal, continuous, portable and mandatory.
2. Benefits - An essential benefits package should be uniform and include behavioral health; with the option to obtain additional benefits.
3. Delivery system - The system must ensure choice of physician and preserve patient/physician relationships. The system must focus on providing care that is safe, timely, efficient, effective, patient-centered and equitable.
4. Administration and governance - The system must be simple, transparent, accountable, and efficient and effective in order to reduce administrative costs and maximize funding for patient care. The system should be overseen by a governing body that includes regulatory agencies, payers, consumers, and care givers and is accountable to the citizens.
5. Financing - Health care coverage should be equitable, affordable and sustainable. The financing strategy should strive for simplicity, transparency and efficiency. It should emphasize personal responsibility as well as societal obligations, due to the limited nature of resources available for health care.
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AAPHP Editor's Note: One AAPHP member has suggested a sixth principle, explicitly recommending participation of governmental public health officials in preparation of health system reform proposals. We hope to have input, as co-sponsors, in the Reference Committee.
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9) Ending AMA Support for PFP and Public Reporting Programs
Introduced for Annual Meeting 2007 by Medical Society of District of Columbia, Oklahoma State Medical Association, Triological Society, American Association of Gynecologic Laparoscopists, and AAPHP.
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Whereas, Medicare and Third Party Payers seek to impose pre-determined medical care on patients through Pay-for-Performance and Public Reporting Programs (HHS “Health Care Transparency Initiative”) that report compliance with process, structural and outcome measures which are being implemented through a multidisciplinary consensus-building organization, the Ambulatory Care Quality Alliance (AQA); and
Whereas, AMA President, Dr. William Plested III wrote in an opinion piece in the AMEDNEWS of Feb 19, 2007 that the Pay-for-Performance and Public Reporting are about cost control, not quality, and that participation in a PFP program may be unethical; and
Whereas, Such programs have been hastily constructed to satisfy arbitrarily created deadlines of Third Parties, large corporations and the government, leading to adoption of measures without accurate supporting science or proper vetting through medical specialty societies; and
Whereas, The valid, peer review studies published in the medical literature have demonstrated that
- Pay-For-Performance programs have not aided in improving medical care and have simply re-directed valuable health care dollars to groups already in compliance with government and third party standards;
- Compliance with such process measures have not improved patient outcomes in areas such as acute myocardial infarction and congestive heart failure;
- Physicians “game” the system to demonstrate improved compliance numbers in public reporting programs without necessarily improving patient care;
- Physicians avoid high risk patients to allow their reported numbers used in PFP and Public Reporting Programs to appear favorable;
- Valid risk adjustment methods have yet to be fully developed for public reporting programs;
- Minority populations appear at risk to be adversely affected by such programs due to increased incidence of high risk conditions and socioeconomic challenges impairing access to medical care; and
Whereas, Third Parties have been abusing the use of quality and efficiency measures to demonize publicly and to disadvantage economically physicians for the benefit of the third party payers and large corporations; and
Whereas, The AMA has established principles and guidelines on Pay-For-Performance that have been largely ignored by the government and third party payers; and
Whereas, The AMA has worked hard to assist third parties and government authorities to create valid and fair public reporting and Pay-For-Performance Programs, but the development of such Programs has largely been controlled by large corporations and Third Party Payers; therefore be it
RESOLVED, That our AMA finds that Pay-For-Performance and Public Reporting Programs pose more risks to patients than benefits and calls for an immediate cessation of such programs by private and public Third Party Payers; and be it further
RESOLVED, That our AMA Chair and Board of Trustees advise the Secretary of Health and Human Services and the Ambulatory Care Quality Alliance (AQA) that the AMA will no longer participate in the creation, development or implementation of the Secretary's "Transparency Initiative" or other Pay-For-Performance Programs; and be it further
RESOLVED, That our AMA Board of Trustees (a) mount a properly resourced public relations and media campaign by November, 2007, to educate Americans on the risks and benefits of the Pay-For-Performance and Public Reporting Programs and other elements of the DHHS “Health Care Transparency Initiative” being promoted by Medicare and Private Insurance Companies and (b) present a progress report at each of the HOD meetings over the next 3 years, as called for in I-05 (Sub. Res. 902 “Protecting Patients Rights”)
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10) Please Help Us to Help You:
AAPHP accomplishes its work with a maximum of volunteer labor and a minimum of cash expense. We are proud to make the E-News and other AAPHP materials available without charge to physicians and medical students interested in public health.
We face two expensive challenges in 2007, though, for which the volunteer work of public health physicians cannot suffice alone. First, we have the opportunity to elect AAPHP's Past President ARVIND K. GOYAL as AMA's Vice Speaker. Second, we will need to defend the value of Public Health Physicians (Board certified and otherwise) against proposals to extend similar-sounding credentials to others including non-physicians. Both efforts will challenge AAPHP's financial resources this year.
If you haven't done so already, please download AAPHP's 2007 Membership Form right away at http://www.aaphp.org/Membership/2007MembForm.pdf and send it to us by fax or postal mail. Please make your 2007 membership as generous as you can. Consider "Supporting" or "Sustaining" membership for 2007 if you are able to do so.
AAPHP is a 501(c)(6) professional membership organization that informs and represents Public Health Physicians. AAPHP dues may be deductible as an "ordinary and necessary" business expense under the Internal Revenue Code. Details may differ based on your individual situation.
AAPHP dues can be paid by credit card -- either by faxing the membership form to (847) 255-0559 or by calling the AAPHP Secretary's secure mobile/voicemail at (360) 870-2483.
Please also tell your friends and colleagues about AAPHP's representation of Public Health Physicians. E-News subscriptions are still free, on request, to any interested physician or medical student. We welcome new subscribers and members.
Thank you for your support
Dave Cundiff, MD, MPH (cundiff@reachone.com)
AAPHP Secretary and E-News Editor************ About AAPHP E-News ************
This message is an electronic update from the American Association of Public Health Physicians (AAPHP) to public health physicians.
More information about AAPHP is at http://www.aaphp.org.
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