AMA Scope of Practice Partnership – Its Hx & anti-homebirth, Ricky Lake bashing resolutions passed by its House of Delegates

REPORT OF THE BOARD OF TRUSTEES (of the AMA)

Limited Licensure Health Care Provider Training and Certification Standards

Duane M. Cady, MD, Chair

INTRODUCTION

At the 2005 American Medical Association (AMA) Interim Meeting, the House of Delegates (HOD) adopted as amended Resolution 814 entitled “Limited Licensure Health Care Provider Training and Certification Standards.”

Resolution 814 calls on the AMA, along with the Scope of Practice Partnership (SOPP) and interested Federation partners, to study the qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of the limited licensure health care providers and limited independent practitioners, as identified by the SOPP.

Reference Committee recommended that the initial resolve be modified to reflect the involvement of the SOPP in conducting the study called for in Resolution 814.

Definition of occupations included those that “function in a newly expanded medical support role to the physician in the provision of patient care.”

“physician-support occupations” based on ….. the physician’s capability and competence to supervise such an assistant.”

{faith’s NOTE: this distinction identifies the primary function of nurse practitioners, nurse midwives, registered nurse anesthetics and physician assistants as “physician extenders” or an ‘assistant‘, rather than a primary provider of care who purpose it to meet the needs of the patients. Apparently, physicians require more professional support and “help than sick people}

AMA  HOD rule #160.949 – Practicing Medicine by Non-Physicians. H-160.949 states that “[o]ur AMA:

(1) …“substitution of a non-physician in the diagnosis, treatment, education, direction and medical procedures where clear-cut documentation of assured quality has not been carried out, and where suchalters the traditional pattern of practice in which the physician directs and supervises the care given; {note: and get paid for services he or she did not provide}

(3) [AMA] continues to actively oppose legislation allowing non-physician groups to engage in the practice of medicine without physician (MD, DO) training or appropriate physician (MD, DO) supervision;

(4) [AMA] continues to encourage state medical societies to oppose state legislation allowing non-physician groups to engage in the practice of medicine without physician (MD, DO) training or appropriate physician (MD, DO) supervision; and

(5) through legislative and regulatory efforts, vigorously support and advocate for the requirement of appropriate physician supervision of non-physician clinical staff in all areas of medicine.

SCOPE OF PRACTICE PARTNERSHIP

History

The Scope of Practice Partnership (SOPP) was created by a coalition comprised of the AMA, six national medical specialty societies:

American Academy of Ophthalmology,

American Academy of Orthopaedic Surgeons,

American Academy of Otolaryngology – Head and Neck Surgery,

American Psychiatric Association,

American Society of Anesthesiologists,

American Society of Plastic Surgeons

Six state medical associations (California Medical Association, Colorado Medical Society, Maine Medical Association, Massachusetts Medical Society, New Mexico Medical Society, and Texas Medical Association).

Members of this coalition (referred to as the “SOPP Steering Committee”) agreed that it was necessary to concentrate the resources of organized medicine to oppose scope of practice expansions by allied health professionals that threaten the health and safety of the public.

The SOPP Steering Committee agreed that this would best be accomplished through a wide-range of efforts, including a combination of

legislative

regulatory and judicial advocacy

programs of information

research

education.

Moreover, the SOPP Steering Committee was committed to creating a true partnership that operated by consensus and functioned in a cooperative and coordinated manner.

The SOPP Steering Committee has met either in person or via conference call quarterly for the last two years. During this time, it developed various core documents that serve as the foundation for the SOPP. Three main principles that the SOPP Steering Committee agreed to are as follows:

·      Membership: Input from all state medical associations and national medical specialty societies will be vital to the viability of the SOPP. The SOPP and its Steering Committee will be open for participation by any state medical association and/or national medical specialty society represented in the AMA HOD. The greater the number of members, the greater the resources (both financial and in-kind) the SOPP will have to advance its advocacy efforts.

·      Funding: SOPP project funding will be derived solely from the annual dues collected from all medical societies participating in the SOPP. In other words, the amount of dues raised in any given year will dictate the SOPP’s level of involvement in scope of practice initiatives.

The AMA also sought a detailed and exhaustive legal review of the SOPP by its Office of General Counsel (OGC).

This was done in order to ensure that the creation of the SOPP was not in violation of any existing antitrust, truth in advertising, election, or lobbying laws. Understandably, this was a very extensive review. Ultimately, the AMA OGC approved of the underlying principles governing the SOPP.

{{Faith’s NOTE -> faith: Their lawyers insisted that the phrase “in a manner that threatens the health and safety of the public” always be apart of the phrase “to oppose allied health professions that seek to expand their scope of practice”, so they could pass their unfair business practicesoff asaltruistic concern over ‘patient safety‘.}}

From its inception, the SOPP Steering Committee has envisioned that the SOPP’s involvement in scope of practice “campaigns” would be multi-dimensional. The members of the SOPP Steering Committee had the foresight to see that the SOPP would become involved not only in the individual state legislative, regulatory, and judicial advocacy, but also in programs of information, research and education. From the very start, the SOPP Steering Committee’s discussions focused on two “top priority” research projects. Both studies would be extensive and therefore, benefited from the formation of the SOPP and the concentration of the Federation’s resources.

The first of these studies would focus on discrediting access to care arguments repeatedly made by various allied health professionals when seeking to expand their respective scope of practice, particularly in rural states.

The second study, and arguably the more extensive of the two, would concentrate on completing educational/training/licensure comparisons of specific allied health professions and the medical profession. Obviously the second study aligns perfectly with Resolution 814.

Official Roll-Out of SOPP

The SOPP was officially rolled out at the AMA Advocacy Resource Center’s (ARC) 2006 State Legislative Strategy Conference in January. Up to that point in time, the SOPP had been favorably received by the Federation**-2 [of State Medical Boards] and was enthusiastically embraced by the attendees of the conference.

(2) discrediting access to care arguments made by various allied health professionals, particularly in rural areas of a state;

(3) creating maps that identify the locations of physicians, by specialty, to be used to counter claims that physicians do not exist in certain areas of a given state; and

(4) same as (1) but for the medical profession and specific complementary /alternative medicine professions.

It is notable that the draft SOPP Work Plan clearly identifies (1) as its “top priority” for SOPP projects in 2006.

Next Steps

Since the 2006 State Legislative Strategy Conference, ARC (Advocacy Resource Center) staff has sent letters to the executive directors of all state medical associations and national medical specialty societies recognized by the AMA HOD.

These letters included … the SOPP’s core documents, as well as the Statement of Legal Compliance for all medical societies to sign and an invoice for annual dues for all national medical specialty societies and the AMA to process. ARC staff is currently fielding any questions associated with these memos and processing all dues that are sent by the Federation * [of State Medical Boards].

The SOPP Steering Committee considered the draft SOPP Work Plan at its face-to-face meeting on March 13, 2006. The priority for this meeting was determining the amount of annual dues raised and based on that, identifying SOPP 2006 projects.

Shortly after the SOPP Steering Committee meeting, the ARC team added a new full-time legislative attorney who was hired to focus their attention on scope of practice issues.**-1

This is an exciting addition to the ARC team and signifies the AMA’s continued commitment to addressing scope of practice issues in an effective, collaborative and cooperative manner with its Federation**-2 partners.

ARC staff will continue to monitor and track scope of practice developments at the state level, expand its Scope of Practice Campaign when deemed necessary, and work with affected state medical associations and national medical specialty societies, at their request, to oppose allied health professions that seek to expand their scope of practice in a manner that threatens the health and safety of the public. **

The Federation [of State Medical Boards] has been energized by the development of the SOPP and the AMA will continue **its work in bringing organized medicine together to fight these scope of practice battles.

======= HOD’s resolution 902 ===

Whereas, Our AMA and the Scope of Practice Partnership are uniquely positioned and well qualified to address this matter of extreme urgency so that our state laws and regulations can be upheld and the authority of state medical boards can be re-established as having full jurisdiction, oversight and authority over medical scope-of-practice activities by mid-level practitioners;

therefore be it

RESOLVED, That it shall be the policy of our American Medical Association that state medical boards shall have full authority to regulate the practice of medicine by all persons within a state notwithstanding claims to the contrary by boards of nursing, mid-level practitioners or other entities (New HOD Policy); and be it further

RESOLVED, That our AMA, through the Scope of Practice Partnership, work jointly with state medical boards to assist law enforcement authorities in the prosecution of unlicensed medical practice by limited or mid-level practitioners (Directive to Take Action); and be it further

RESOLVED, That our AMA, through the Scope of Practice Partnership, immediately embark on a campaign to identify and have elected or appointed to state medical boards physicians (MDs or DOs) who are committed to asserting and exercising their full authority to regulate the practice of medicine by all persons within a state, not withstanding efforts by boards of nursing or other entities that seek to unilaterally redefine their scope of practice into areas that are true medical practice. (Directive to Take Action)

Whereas, There is a growing trend of non-physician personnel seeking to expand their scopes of work into functions that traditionally constitute the practice of medicine; and

Whereas, The diagnosis of disease constitutes the practice of medicine and requires the integration of the interpretation of a study or studies with clinical experience and training;

AMA Policy H-35.988 furthers the public interest in quality medical care by opposing enactment of legislation to authorize the independent practice of medicine by any individual who has not completed the state’s requirements for licensure to engage in the practice of medicine and surgery in all of its branches; and

Whereas, AMA Policy H-35.973 supports the formulation of clearer definitions of the scope of practice of physician extenders to include direct appropriate physician supervision and recommended guidelines for physician supervision to ensure quality patient care; and

Whereas, AMA Policy H-35.993 opposes any legislation or program that would provide for Medicare payments directly to physician extenders, or payment for physician extender services not provided under the supervision and direction of a physician; therefore be it

RESOLVED, That it shall be the policy of our AMA that the Medicare physician fee schedule compensate only authorized persons for the diagnostic interpretation of a specific patient and should not provide payments directly to non-physician personnel working under the supervision or in collaboration of a physician to perform a laboratory study or studies (New HOD Policy); and be it further

RELEVANT AMA POLICY

H-35.973 Scopes of Practice of Physician Extenders

Our AMA supports the formulation of clearer definitions of the scope of practice of physician extenders to include direct appropriate physician supervision and recommended guidelines for physician supervision to ensure quality patient care. (Res. 213, A-02)

H-35.988 Independent Practice of Medicine by “Nurse Practitioners”

The AMA, in the public interest, opposes enactment of legislation to authorize the independent practice of medicine by any individual who has not completed the state’s requirements for licensure to engage in the practice of medicine and surgery in all of its branches. (Sub. Res. 53, I-82; Reaffirmed: A-84; Reaffirmed: CLRPD Rep. A, I-92; Reaffirmed: BOT Rep. 28, A-03

H-35.993 Opposition to Direct Medicare Payments for Physician Extenders

Our AMA reaffirms its opposition to any legislation or program which would provide for Medicare payments directly to physician extenders, or payment for physician extender services not provided under the supervision and direction of a physician. (CMS Rep. N, I-77; Reaffirmed: CLRPD Rep. C, A-89; Reaffirmed: Sunset Report, A-00)

========= resolutions 204, 205, and 239 ====

resolution 204 – midwifery scope of practice and licensure
resolution 239 – midwifery scope of practice and licensure

Your Reference Committee heard testimony supporting increased regulation of home deliveries. Proponents provided important testimony discussing the many negative outcomes and mortality associated with inappropriate and/or unregulated home deliveries.

Your Reference Committee heard testimony in support of state legislation that helps ensure safe deliveries and healthy babies.  Your Reference Committee therefore recommends adoption of Resolution 205 as amended.

Your Reference Committee heard considerable testimony about regulation and limits on the scope of practice regarding midwives.

Your Reference Committee agrees with testimony supporting the need for a regulating body over midwives and believes that AMA resources would best be utilized by supporting state legislation reflecting the same.  After hearing the testimony and reviewing the resolution, your Reference Committee recommends adoption of Resolution 204, as amended, in lieu of Resolution 239.

RECOMMENDATION A:

Mr. Speaker, your Reference Committee recommends that the second resolve of Resolution 204 be amended by insertion and deletion on page 2, lines 1-2 to read as follows:

That our American Medical Association ~~develop model legislation~~ support state legislation regarding appropriate physician and regulatory oversight of midwifery practice, under the jurisdiction of ~~either~~ state nursing and/or medical boards.

RECOMMENDATION B:

Mr. Speaker, your Reference Committee recommends that Resolution 204 be adopted as amended in lieu of Resolution 239.

HOD ACTION: Resolution 204 adopted as amended in lieu of Resolution 239.

Resolution 204 asks

(1) that our American Medical Association only advocate in legislative and regulatory arenas for the licensing of midwives who are certified by the American College of Nurse-Midwives;

(2) our AMA develop model legislation regarding appropriate physician and regulatory oversight of midwifery practice, under the jurisdiction of either state nursing or medical boards;

(3) that our AMA continue to monitor state legislative activities regarding the licensure and scope of practice of midwives; and

(4) that our AMA work with state medical societies and interested specialty societies to advocate in the interest of safeguarding maternal and neonatal health regarding the licensure and the scope of practice of midwives.

Resolution 239 asks

(1) that our American Medical Association develop model legislation regarding appropriate physician and regulatory oversight of midwifery practice, under the jurisdiction of either state nursing or medical boards;

(2) that our AMA continue to monitor state legislation activities regarding the licensure and scope of practice of midwives and

(3) that our AMA work with state medical societies and interested specialty societies to advocate in the interest of safeguarding maternal and neonatal health regarding the licensure and the scope of practice of midwives.

(2) resolution 205 – home deliveries

RECOMMENDATION A:

Mr. Speaker, your Reference Committee recommends that the second resolve of Resolution 205 be amended by insertion and deletion on lines 24-28 to read as follows:

That our AMA ~~develop model state legislation in~~ support state legislation that helps ensure safe deliveries and healthy babies by acknowledging ~~of the concept~~ that the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.

RECOMMENDATION B:

Mr. Speaker, your Reference Committee recommends that Resolution 205 be adopted as amended.

HOD ACTION: Resolution 205 adopted as amended.

Resolution 205

(1) that our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that “the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers”; and

(2) that our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”