CONSENT CALENDAR Policies that are 5-years or older ...€¦ · CONSENT CALENDAR Policies that are 5-years or older reviewed for 1. Reaffirmation 2. Sunset 3. ... states without specific

CONSENT CALENDAR

Policies that are 5-years or older reviewed for

1. Reaffirmation

2. Sunset

3. Sunset with New Language

COMMITTEE ON ANNUAL SESSION

Special 04.12

SUBJECT: Policy Sunset and Reaffirmation Report

SUBMITTED BY: John S. Harvey, M.D., Speaker of the House of Delegates

REFERRED TO: Consent Calendar

The House of Delegates adopted policy which established a sunset mechanism for MAG policy. Under 1

the sunset mechanism, policies adopted are systematically reviewed after adoption to assess their 2

continuing timeliness and relevance. The MAG Board of Directors shall annually submit to the House of 3

Delegates, a list of MAG policy statements, which in the opinion of the Board no longer serve the best 4

interests of the Association. 5

6

At the October meeting, the Annual Session Committee will present a list of MAG policies five years old 7

which were reviewed by relevant committees and recommendations made for: 1) retention and 8

reaffirmation; 2) rescission and sunset; and 3) sunset with replacement by a new or revised policy. 9

10

The sunset mechanism for MAG policy was established to: 11

• Promote efficiency in House of Delegates deliberations; 12

• Identify and rescind outmoded, duplicative, or inconsistent policies; 13

• Update and/or modify policies which are still pertinent but for which change has occurred; and 14

• Facilitate development and maintenance of a MAG policy information base and Policy 15

Compendium. 16

17

A complete copy of the 2012 MAG Policy Compendium has been provided to members of the House of 18

Delegates. It is also posted on the MAG website. Of the 82 policies that were reviewed, 68 are being 19

recommended for retention/reaffirmation, 7 are being recommended for sunset and 7 are being 20

recommended for new language and replacement by a new or revised policy. Policies that have been 21

recommended for sunset will be retained in MAG’s historical records. 22

23

The Annual Session Committee expresses its appreciation to the MAG Board, councils, committees and 24

MAG staff for their continued assistance and cooperation in this activity, as well as MAG’s Department 25

of Health Policy which is in charge of maintaining the MAG Policy Compendium and organizes the Five 26

Year Reviews. The contributions and collective expertise of the councils and committees have ensured 27

the continued success of this project. 28

29

RECOMMENDATIONS: 30

31

1. That the policies set forth in Appendix I, be reaffirmed. 32

2. That the policies set forth in Appendix II, be sunset. 33

3. That the policies set forth in Appendix III, be sunset and replaced with new policy. 34

# # #

Appendix I

Special Report: 04.12

1

MAG HOUSE OF DELEGATES

Appendix I

MAG Policies for Reaffirmation

POLICY #

POLICY

15.988

Cell Phone Use

MAG supports legislation that prohibits the use of a cell phone while operating a vehicle for

drivers 18 years old and younger and allow only hands free use by drivers over 18 years old.

(Resolution 318C.07)

[Reviewed by the Council on Legislation that found this policy statement still relevant.]

35.982

Medical Assistants

MAG believes that the level of supervision in needed patient care should be based on the

medical judgment of the physician responsible for the care. (Resolution 216B.07)

[Reviewed by the Third Party Payer Committee that found this policy statement still relevant.

This policy was originally intended to clarify the definition of “direct supervision” in the

Georgia Code section, but the HOD believed it sufficient to state that the level of supervision

in needed patient care should be based on the medical judgment of the physician responsible

for the care.]

35.983

Disease Screening

by Non-physicians

MAG opposes pharmacists or other non-physicians offering screening for specific disease

states without specific physician involvement in, or supervision of, such screening. (Res:

107AB-07) (Reaffirmed 10/13/07)

[Reviewed by the Third Party Payer Committee that found this policy statement still relevant.]

55.998

Screening

MAG supports all efforts aimed at maintaining and increasing the rate of Pap Smears and

cervical cancer screenings completed in Georgia; and opposes initiatives that would decrease

access to and completion of Pap Smears. (Resolution 103A.07)


60.993

AMA Guidelines

for Adolescent

Prevention Services

MAG endorses the AMA Guidelines for Adolescent Prevention Services and encourages

physicians to provide services to adolescents in Georgia. (Reaffirmed 05/2002) (Reaffirmed

10/13/2007)

[Research conducted on the relevancy of this policy statement found it still relevant. AMA

continues to list these guidelines on its Web site as a useful resource of physicians.]

Appendix I


2

POLICY #

POLICY

85.993

Executions

MAG believes that physicians should be involved in the pronouncement of death at prison

executions. (Resolution 217B.07)


100.999

Direct Consumer

Advertising of

Prescriptions

MAG strongly objects to the marketing of pharmaceutical products through direct media

advertising to the general public. (Res: 102AB-02 and Res: 105AB-02) (Reaffirmed 10/13/07)


120.984

Step Therapy

MAG opposes any contractual requirement that requires the use of step therapy from any

public or private third party payer. (Appendix III - Committee 01.07)


120.988

Physician

Prescribing

Information

MAG opposes access to individual physician's prescribing data by pharmaceutical

manufacturers and their representatives. (Res. 305C-02) (Reaffirmed 10/13/07)

[This policy statement was thoroughly reviewed by physician members that found it still

relevant.]

130.972

Disaster Volunteers

MAG supports utilizing the Division of Public Health's Physician/Health Professional

Emergency Reserve Corps and the Georgia State Defense Reserve Corps, including qualified

retired physicians, as volunteers to hospitals, local health departments, or other medical

outpatient facilities in the event of a national disaster or any public health emergency

situation. All emergency programs such as these must have a system to assure that those who

are involved are legally certified and/or licensed and that the process can be implemented

expeditiously. (Appendix III - Committee 01.07)

[This policy statement was thoroughly reviewed and found still relevant.]

130.977

Chemical Attack

and EMS Personnel

MAG supports allowing EMS personnel to self-administer and administer to others the Mark

I kits in the event of an apparent chemical attack with nerve agents. EMS personnel should be

able to assist in setting up the "push packs" from the National Pharmaceutical Stockpile and

administer antibiotics, immunizations, and vaccinations at times of a declared disaster.

(Comm: 9-02, Rec. 3) (Reaffirmed 10/13/07)

[This policy statement was reviewed by members of MAG who are knowledgeable on this

issue and concluded the policy statement still relevant.]

Appendix I


3

POLICY #

POLICY

130.979

EMS Oversight

MAG supports the establishment of the EMS Medical Directors Advisory Council as the

physician advisory and oversight body for the state EMS Medical Director and for the Office

of EMS. (Comm: 9-02, Rec. 2) (Reaffirmed 10/13/07)

[This policy statement was reviewed by members of MAG who are knowledgeable on this

issue and concluded the policy statement still relevant.]

140.986

Declaration of

Professional

Responsibility

DECLARATION OF PROFESSIONAL RESPONSIBILITY: MEDICINE'S SOCIAL

CONTRACT WITH HUMANITY

Preamble

Never in the history of human civilization has the well-being of each individual been so

inextricably linked to that of every other. Plagues and pandemics respect no national borders

in a world of global commerce and travel. Wars and acts of terrorism enlist innocents as

combatants and mark civilians as targets. Advances in medical science and genetics, while

promising to do great good, may also be harnessed as agents of evil. The unprecedented scope

and immediacy of these universal challenges demand concerted action and response by all. As

physicians, we are bound in our response by a common heritage of caring for the sick and the

suffering. Through the centuries, individual physicians have fulfilled this obligation by

applying their skills and knowledge competently, selflessly and at times heroically. Today,

our profession must reaffirm its historical commitment to combat natural and man-made

assaults on the health and wellbeing of humankind. Only by acting together across geographic

and ideological divides can we overcome such powerful threats. Humanity is our patient.

Declaration

We, the members of the world community of physicians, solemnly commit ourselves to:

(1) Respect human life and the dignity of every individual.

(2) Refrain from supporting or committing crimes against humanity and condemn any such

acts.

(3) Treat the sick and injured with competence and compassion and without prejudice.

(4) Apply our knowledge and skills when needed, though doing so may put us at risk.

(5) Protect the privacy and confidentiality of those for whom we care and breach that

confidence only when keeping it would seriously threaten their health and safety or that of

others.

(6) Work freely with colleagues to discover, develop, and promote advances in medicine and

public health that ameliorate suffering and contribute to human well-being.

(7) Educate the public about present and future threats to the health of humanity.

(8) Advocate for social, economic, educational, and political changes that ameliorate suffering

and contribute to human well-being.

(9) Teach and mentor those who follow us for they are the future of our caring profession.

We make these promises solemnly, freely, and upon our personal and professional honor.


AMA continues to espouse this declaration which was prepared upon the requests by many

member physicians following the attack on the Twin Towers and New York City.]

Appendix I


4

POLICY #

POLICY

155.997

Translators

MAG should work with the appropriate government agency to eliminate the burden of

payment by physicians for translations services and other barriers to medical care. (Resolution

113A.07)


160.985

Access to Care

MAG encourages its members to provide medical services to active duty military families as

much as feasible. (Resolution 101A.07)


160.986

Physician-specific

Data

MAG supports the position that any physician-specific data which is published by health

plans or other entities be limited to appropriate data concerning quality of medical care, access

to care, and cost of care that is based on a full and complete understanding of the patient's

clinical record, their full diagnostic profile, their medical history, age and geographic and

social history; and MAG opposes the publication of physician-specific data that do not meet

these criteria. (Resolution 106A.07)


180.985

Health Insurance

Tax Preference

MAG supports legislation that gives individuals the same tax preference as job-based health

insurance when individuals purchase their own insurance plans. (Reaffirmed 05/2002)

(Reaffirmed again 10/2007)


180.986

Tax Equity

MAG supports tax equity of employer-based medical insurance, individual-paid medical

insurance, unreimbursed out-of-pocket medical care, and individual medical savings accounts.

(Reaffirmed by the Board of Directors on 4/14/07)


185.983

Peach Care

MAG supports eligibility for the provisions of Peach Care for Children at its current threshold

of 235% of the Federal Poverty Level. (Resolution 204B.07)


MAG staff confirms that 235% of the poverty level continues to be the Peachcare for Kids

eligibility level.]

Appendix I


5

POLICY #

POLICY

185.984

Indigent Care

MAG supports development of a statewide system for documenting uncompensated indigent

care provided by physicians similar to the Health Access Initiative created by the Hall County

Medical Society; and supports legislation which provides tax credits for uncompensated

indigent care provided by physicians. (Resolution 201B.07, Resolves 1 & 2)


185.985

Deductibles

MAG supports legislation and/or regulatory reform that require insurance companies to credit

deductibles only after fees are paid by the patient to their physician. (Resolution 212B.07)


185.986

Point of Service

MAG opposes health benefit plans that restrict access to physicians to annually offer

enrollees the opportunity to obtain coverage for out-of-network services through a point of

service option. (Appendix III - Committee 01.07)


190.983

National Provider

Identification

The Medical Association of Georgia supports legislation that would penalize Georgia

Medicaid for its failure to pay claims within 15 days and interest to physicians from the date

of the original clean claim regardless of NIP-related problems. The Medical Association of

Georgia supports federal legislation that reduces the compensation to Medicare carriers

administering government health plans for their failure to meet the NPI deadline. Resolution

205B.07 - resolves 1-3)


190.984

Universal Payment

Reporting Form

MAG supports the use of universal and uniform claims and payment reporting forms which

contain the same essential information used by all payers. (Appendix III - Committee 01.07)


205.988

Physicians Orders

MAG advocates that Physician Orders for Life Sustaining Treatment (POLST) be coordinated

with Advance Directives and/or a Durable Power of Attorney for healthcare. (Resolution

211B-07)

[Reviewed by administration that found this policy statement still relevant.]

205.990

Advance Directives

MAG supports federal financial incentives through use of a one-time refundable tax credit of

three hundred dollars ($300.00) to those individuals who prepare their Advance Directives

and Durable Power of Attorney for healthcare decisions. (Resolution 211.07, Resolve 2)


Appendix I


6

POLICY #

POLICY

215.991

Exclusive

Contracts

MAG is opposed to the use of exclusive contracts between insurance companies and hospitals

throughout the state, and supports legislation which prohibits it. (Res: 308C-02) (Reaffirmed

10/13/2007)


230.996

Physician

Licensure

MAG opposes any legislation, rule, or policy that requires hospital staff participation as a

condition of physician licensure. (Resolution 204C.07)


235.998

Physicians

Protections

MAG continues to advocate as a top tier priority for the protection of the rights of physicians

as allowed by the laws of the State of Georgia, including 1) the right to practice medicine

without usurpation in any way by hospital boards or any entity not licensed to practice

medicine; 2) the medical staff rights to self governance; and 3) MAG supports legislation to

prohibit economic credentialing by hospitals, insurance companies or other entities.


[This policy statement was reviewed by the Council on Legislation that found this policy still

relevant.]

270.980

Provider Tax

MAG opposes any new tax on physician practices or any new tax on any ancillary services

provided by physicians or their practice. (Resolution 314-07)


relevant.]

270.981

Present on

Admission

MAG supports efforts by the AMA to repeal the "Present on Admission Policy" as contained

in the Deficit Reduction Act. (Resolution 109A.07)

[Individual physician members reviewed this policy statement who found it still relevant. Also

the Council on Legislation reviewed the policy and it too found the policy statement still

relevant.]

270.982

Sales Tax

The Medical Association of Georgia opposes imposing a tax on professional services or alters

legislation to exclude physician services or, in the alternative, permitting physicians to pass

the cost of the tax on to their patients without violating their contractual obligations to insures.


[The Council on Legislation reviewed this policy statement and determined that it continues to

have relevancy in the current environment.]

Appendix I


7

POLICY #

POLICY

285.981

Prior Approval

MAG opposes the use of prior approval policies that are inappropriately based on economic

factors without the support of clinical evidence. MAG urges regulators, insurers, and others,

in both the public and private sector, to reduce and eliminate such policies; MAG urges

legislative or regulatory action, at the state level, to prevent the further utilization of

inappropriate prior approval of pharmaceuticals. (Res: 300C-02) (Reaffirmed 10/13/2007)


relevant.]

285.989

Financial

Incentives

MAG opposes the use of managed care techniques which adversely impact patient care and

the physician/patient relationship through the use of financial incentives designed to limit a

patient's choice of physician or patient's choice of services and recommends the continuation

of fee for service and a doctor/patient relationship. (Reaffirmed 05/2002; 10/13/2007)


285.992

Due Process

MAG supports legislation which requires managed care entities to hold a due process hearing

on any issue involving the appropriateness of medical care, before any sanction can be taken

against a physician for such action. (Reaffirmed 05/2002; 10/2007)


285.994

Managed Care -

Liability

MAG supports legislation that would require liability on the part of any managed care entity

for any decision it makes which breaches the acceptable standards for medical care.

(Reaffirmed 05/2002; 10/13/2007)


290.977

Dual Eligibility

The Medical Association of Georgia supports 1) legislation and/or use administrative change

in the Georgia Medicaid Program which allows payment levels for dual-eligible Medicare

patients to be reversed to the full 20% Medicare co-insurance and deductibles level; 2) The

Medical Association of Georgia supports legislation and/or administrative changes in the

Georgia Medicaid Program which requires Georgia Medicaid to accept paper claims for

secondary coverage on dual eligible Medicare claims without the 90-day holding period if the

Medicare EOB clearly shows no "cross over" occurred 3) The Medical Association of Georgia

supports legislation and/or administrative change in the Georgia Medicaid Program which

requires Georgia Medicaid to pay any secondary claim if the EOB from Medicare is attached

and no further extra information is needed on the CMS billing form and 4) The Medical

Association of Georgia supports legislation and/or administrative change in the Georgia

Medicaid Program which requires Georgia Medicaid to accept modifers on secondary claims

consistent with Medicare on duel eligible claims. Resolution 207B.07 Resolves 1-4)


Appendix I


8

POLICY #

POLICY

290.978

CMOs

MAG opposes continued implementation of Medicaid CMOs.


295.991

Medical Student

Training

MAG supports standardized Advanced Cardiac Life Support (ACLS) training for all medical

students prior to clinical clerkships and strongly encourages medical schools to fund ACLS

training for medical students. (Res: 113AB-02) (Reaffirmed 10/13/2007)


Furthermore, Staff checked with Georgia’s four medical schools concerning the status of

ACLS training and learned that only one medical school—Mercer University School of

Medicine requires the higher level of ACLS training as a part of the medical school

curriculum. The three other Georgia medical schools do not require the more advanced ACLS

training during medical school, but may offer it as an elective or post medical school

education, depending on its relevancy, prior to clerkship, i.e., Morehouse School of Medicine,

prior to a student’s clerkships. The other three medical schools all do require Basic Cardiac

Life Support training as a part of the medical school curriculum.]

330.980

Coverage

MAG supports legislation which requires a hospital to obtain prior authorizations required by

all health plans for inpatient services so as to insure proper reimbursement [payment] for

hospitals and physicians. (Res. 208B-07)


330.981

Physician Orders

MAG opposes Medicare's promotion with hospitals and state Quality Improvement agencies

allowing hospital administrations to set standing orders for influenza and pneumococcal

immunizations, in place of specific physician orders and directives. (Attachment III)


360.996

Prescriptive

Authority for

Advance Practice

Nurses

MAG fundamentally opposes independent prescriptive authority for advanced practice

nurses. Physician supervision and oversight for using "protocols" is essential. (Reaffirmed

05/1999 and 05/2002; 10/13/2007)


Appendix I


9

POLICY #

POLICY

385.997

Billing and

Payments

MAG opposes state legislation that dictates how a physician must bill for medical services,

that inhibits fair market contracting between physicians, and that inhibits physicians from

freely practicing medicine within acceptable professional standards. MAG opposes any state

legislation that limits billing and payment for a defined medical services or group of services

to a single medical specialty. (Resolution 215.C)


390.985

Payment Formula

MAG and the AMA will continue to work with the U.S. Department of Health and Human

Services, Centers for Medicaid and Medicare Services to insure the correctness of the formula

calculations for Medicare payment. (Attachment III - Committee 01.07)


405.991

Use of the Term

Physician

The Medical Association of Georgia supports legislation which limits the identification of a

person as a physician only to individuals licensed under the Medical Practice Act. The

Medical Association of Georgia urges the Composite State Board of Medical Examiners to

enjoin the unlawful use of the terms "physician" and/or "doctor" and will assist the Composite

State Board of Medical Examiners in its efforts to enjoin the unlawful uses of these terms.

(Res. 310C.07, Resolves 1-3)


415.997

Credentialing

MAG asserts that any physician meeting the overall credentialing criteria applied to all other

providers and agreeing to the same method of payment be accepted into any health plan

network to provide medical care. (Attachment III - Committee 01.07)


435.992

Tort Reform

MAG aggressively supports meaningful tort reform at the state and national levels. (App. III,

Comm. 01-07)


435.995

Collateral Source

MAG supports collateral source legislation that will enable the defendant to inform the jury

about the plaintiff's access to funds that will pay for the plaintiff's damages, such as his or her

health insurance or other insurance proceeds. (Special Report: 3-02) (Reaffirmed 10/2002;

10/2007)


Appendix I


10

POLICY #

POLICY

450.991

Clinical Practice

Guidelines

MAG believes that clinical guidelines are not a substitute for the experience and judgment of

the physician; MAG recommends to all specialty and subspecialty societies and others that

this reaffirmation be included as an addendum to each clinical guideline. (Attachment III –

Committee 01.07)

[This policy statement was thorough reviewed by physician members who determined this

statement still relevant.]

490.992

Smoking

MAG supports legislation which increases the legal age to buy tobacco in Georgia to twenty-

one and increases fines and enforcement efforts to prevent exposure of adolescents to

cigarettes. (Res. 310C-02) (Reaffirmed 10/13/2007)


525.997

Breastfeeding

MAG supports protection of a mother's right to breastfeed in public and encourages all states

to pass legislation which reaffirms the right to do so. (Attachment III - Committee 01.07)


530.893

Physician

Payments

MAG shall, in all of its communications and publications, use the term "physician payment"

in lieu of "physician reimbursement."


530.930

Stationary and

Logo - MSS and

YPS

The approved logo for the Medical Student Section and the Young Physician Section shall be

kept at MAG headquarters. Written communications from the Medical Student Section and

Young Physician Section shall be generated at MAG headquarters and such communications

shall include MAG's name on the letterhead. (Reaffirmed 10/13/2007)

[Reviewed administratively and found this policy statement relevant as section officers

change yearly and new officers look to MAG Headquarters for policy and procedures by

which is followed by the section leaders on an ongoing continuance. ]

530.932

MAG Directory

MAG supports development of usable, complete and accurate membership/resource

directories produced electronically. (Special Report: 3-02, Item 4) (Reaffirmed 10/13/2007)

[Reviewed administratively and found this policy statement still relevant. Maintaining an

electronic director not only allows physicians to view their fellow MAG members in their

area, but with MAG’s new “Find a Physician” feature on www.mag.org, it is also a valuable

resource for patients.]

Appendix I


11

POLICY #

POLICY

530.968

Policy Guidelines -

Distribution and

Modification

MAG directs that all policy statements be maintained in a manner which will allow for easy

distribution and modification to maintain a current reflection of MAG policy. (Reaffirmed

05/2002


530.963

Georgia Medical

Group Managers

Association

MAG agrees to the appointment, as ex-officio members of MAG committees, the names

submitted by the Georgia Medical Group Management Association, for a period of one year

and upon acceptance by the chairmen of the requested committees. (Reaffirmed

05/2002;10/2007)


530.970

Communication

MAG continues to encourage communication with component groups and allied organizations

in order to advance our common goals. (Reaffirmed 05/2002; 10/13/2007)


535.984

Component Society

Meetings

Members of the MAG Board of Directors should attend meetings of the component medical

societies and specialty medical societies in their areas, and promote MAG membership at

these meetings; members should work with MAG staff to obtain a pre-registration list of

attendees at specialty society meetings in order to target non-MAG members while attending

the meeting. [Reviewed by administration that found this policy statement still relevant.]

540.966

Continuing

Medical Education

Committee

The Continuing Medical Education Committee shall accredit organizations that desire to offer

CME activities to Georgia physicians. The CME Committee shall review and approve

applications for accreditation and reaccreditations, establish accreditations policies, provide

supervision and guidance to surveyors, hold training sessions for MAG-accredited sponsors

and keep all sponsors updated concerning MAG, ACCME and AMA policies related to CME.

(Reaffirmed 10/13/2007)

[Reviewed by the Committee on Continuing Medical Education that found this policy

statement still relevant.]

Appendix I


12

POLICY #

POLICY

540.989

Finance Committee

MAG authorizes the Chairman of the Board of Directors, in consultation with Treasurer, to

appoint Finance Committee members to staggered 2-year terms. (Reaffirmed 05/2002 and

10/2007)

[Reviewed by administration that found this policy statement still relevant and is the current

practice. These appointments are made each year at the Organizational Board of Directors

meeting.]

545.948

Meetings

Annual meetings of MAG should be held in late summer or early fall of each year.

(Attachment III - Committee 01.07)

[Reviewed by Annual Session Committee that found this policy statement still relevant.]

555.978

Recruitment

MAG asks that the student delegates to the MAG House of Delegates assume primary

responsibility for recruiting student colleagues to MAG and asks that they submit an annual

report on his/her progress in this area.

[Reviewed through our Membership Department that found this policy statement still relevant.

A peer-to-peer campaign is a valuable tool to recruit new students to MAG.]

555.980

Dues

Beginning in 2008, MAG's dues structure is revised to include first year free memberships for

newly licensed physicians excluding interns, residents and fellows; and group membership

discounts. (Officer 05.07)


Dues structure continues to designate first year free membership for newly licensed physicians

excluding interns, residents and fellows; and group member discounts are still and becoming a

high level recruitment tool for the association.]

555.988

Dues Billing

Procedure

MAG is the only entity that may bill MAG dues and MAG will offer to bill CMS dues for

those CMSs that request it. (Reaffirmed 10/2007)


MAG processes and updates its membership database hourly to maintain the most accurate

member listing possible. With new procedures developed between MAG and the bank

lockbox, we are able to process payments received through the lockbox within 24 hours.

Payments made directly to MAG are processed within an hour. In order to the membership

database to remain as accurate as possible for mailing and marketing purposes, it is best that

MAG continue to be the only entity that may bill MAG dues. MAG should continue to offer

to bill CMS dues for any CMS that request it. Its dues are processed on the same timetable as

MAG dues.]

Appendix I


13

POLICY #

POLICY

565.964

National Health

Care

MAG supports AMA policies which oppose a national health care system, and supports an

AMA national media campaign consistent with MAG's position.


565.968

Legislative

Grassroots

Program

MAG continues to emphasize expansion of the legislative grassroots programs of the Council

on Legislation. (Comm: 12-98 Recs. 2 3 4 6) (Comm. 01-05 Appendix III)


565.970

CMS Legislative

Meetings

Each component medical society should sponsor one function for its physicians and local

legislators before the convening of the session of the Georgia General Assembly for the

purpose of educating legislators on MAG priorities for the year and that the Legislative Team

continue assisting component medical societies in those endeavors. (Comm.: 12-02, Rec. 6)

(Reaffirmed 10/2007)


565.995

Continuing

Education of

Georgia's

Legislators

MAG urges the physicians of Georgia to actively involve themselves in the continuing

education of Georgia's legislators and other public officials on issues involved with health

care policy. MAG believes that NO citizen is better qualified to educate a public official on

complex medical issues. (Reaffirmed 05/2000 and 05/2002 and 10/2007)


# # #

Appendix II


1


Appendix II

MAG Policies for Sunset

POLICY #

POLICY

35.981

Employing physicians

MAG supports changes to the medical practice act which prohibits physicians assistants

from employing their supervising physician; MAG supports changes to AMA's Ethical

Opinions which would restrict physicians assistants and other allied health professionals

from employing their supervising physician; and MAG supports changes to MAG's Judicial

Council which would restrict physicians' assistants from employing their supervising

physician.

[This policy statement was reviewed administratively and found that in 2009 a provision

was incorporated into the Medical Practice Act which prohibit Pas from employing

supervising physicians. This eliminates the need for this policy statement.]

160.987

Pay-For-Performance

The Medical Association of Georgia opposes pay-for-performance programs as presently

designed because of their negative impact on patient care.

This policy statement was found to be a duplicate. Policy 185.977 adopted by the HOD in

2011 is more inclusive and renders this particular policy obsolete. It is recommended that

this policy become sunset.

270.983

General Surgery

MAG supports elimination of the single-specialty designation currently required by the state

as a requirement for exemption from CON or in its place CON Legislation that stipulates

any specialty and sub specialty including General Surgery, currently recognized by the

American Board of Medical Specialties as a specialty, be recognized as a single specialty

for purpose of LNR (Letter of Non-reviewability). (Resolution 201C.06, Certificate of

Need; Resolution 207C.06, Repeal of Certificate of Need; and Resolution 209C.06, Repeal

of Certificate of Need Laws, Reference Committee C) Reaffirmed 270.983 in lieu of

Resolution 305C.07 and 308C.07

[This policy statement was reviewed by the Council on Legislation. It was recommended for

sunset for two reasons. The first reason is that general surgery is now recognized as a single

specialty and the second is that MAG has a comprehensive Certificate of Need policy,

(Policy 205.989) adopted by the House of Delegates in 2009 that encompasses all of the

provisions outlined in this statement. ]

Appendix II


2

POLICY #

POLICY

360.990

Nursing Education

MAG supports state and federal legislative proposals to increase nursing education

opportunities and workforce incentives as well as public relations efforts to propose an

improved image for the nursing profession. (Res: 301C-02, Res.2) (Reaffirmed 10/13/2007)

[This policy statement was reviewed by the Council on Legislation. It determined that the

Institute of Medicine and the Robert Wood Foundation have already started a campaign to

increase workforce opportunities by expanding a nurse’s scope of practice.]

365.998

Injury Prevention

MAG supports the development of a worker’s injury prevention and safety project for

providers and industry. MAG supports continued development and distribution of a "Best

Practices" brochure for physicians providing workers' compensation services. (Reaffirmed

05/2002; 10/13/2007)

[This policy statement was reviewed to determine its continued relevancy. The State Board

of Workers’ Compensation underwent a major re-development in 2002. MAG has a seat on

the Medical Advisory Subcommittee to address issues related to workers’ compensation.]

535.986

Recruitment

MAG asks that members of the Board of Directors attend their specialty society meeting

and promote MAG membership at that meeting.

[This policy is duplicated in Policy #535.984 and should be sunset to remove duplicates

from the Policy Compendium.]

540.953

YPS Seat

MAG supports having the Membership Expansion & Involvement Committee include a

dedicated position for a Young Physician Section member. (Section Report 03.07 RC A)

[This policy statement was reviewed administratively and found no longer relevant since

MAG sunset this committee in 2010 by adoption of a Bylaws amendment to the House of

Delegates.]

# # #

Appendix III

Special Report: -04.12


Appendix III

MAG Policies Sunset with New Language

POLICY #

POLICY

55.997 Prevention

Current Language: MAG supports proven strategies and activities aimed at prevention of cervical cancer in

Georgia, such as education, regular health exams and the use of cervical cancer preventing

vaccines.(Resolution 102A.07) New Language with added portion:

MAG supports proven strategies and activities aimed at prevention of cervical

cancer in Georgia, such as education, regular health exams and the use of

cervical cancer preventing vaccines for all age groups.

[Reviewed by the Third Party Payer Committee that deemed the policy statement to be

relevant but recommended adding language to specify the intent of the action taken.]

120.990 Proton Pump

Inhibitors

Current Language: MAG opposes implementation of prior approval requirements for Proton Pump Inhibitors,

as harmful to patients and an ineffective cost saving measure, and asks the GA Department

of Community Health to reverse its policy on same.

New Language Proposed:

MAG opposes implementation of prior approval requirements for Proton Pump

Inhibitors, as harmful to patients and an ineffective cost saving measure, and

asks the GA Department of Community Health to reverse its policy on same.

[A review of this policy statement was reviewed by physician members and found still

relevant. However, it was recommended by MAG delete any reference to a state agency.]

130.971 Call Coverage

Current Language: MAG recognizes the crises in emergency department physicians' call coverage and offers

assistance and support to physicians as an information clearinghouse and monitor.

(Appendix III - Committee 01.07)

New Language Proposed:

MAG recognizes that access to specialists across the state’s hospital

emergency departments has deteriorated, particularly in rural areas, while at

the same time the number of patients accessing hospital emergency

departments has increased. An increasing number of specialties are no longer

Appendix III


2

POLICY #

POLICY

130.971 Call Coverage (Cont.)

aligned with specific hospitals or medical staffs making it more difficult to

gain traditional coverage from medical staffs. Although hospital payment for

emergency room coverage has improved, it is uneven throughout the state and

is non-exist in some hospitals. MAG will continue to serve as an information

clearing house for physicians in Georgia and to monitor emergency department

call coverage for the provision of emergency services and disaster

preparedness and for the adequacy of support of physicians providing this

critical service. MAG strongly encourages physicians and hospitals to work

collaboratively to develop solutions based on adequate compensation or other

appropriate incentives as the preferred method of ensuring on-call coverage.

[Physician members reviewed our policy statement and concluded that a more

comprehensive policy statement would clarify our position in regards to call coverage.]

230.997 Emergency

Department Training

Current Language: MAG supports ACEP policies and federal guidelines which dictate that each hospital have

written policies and procedures and/or medical staff bylaws that clearly state what their

requirements are regarding the training of emergency department physicians as published in

2007.

Proposed Language:

MAG supports the American College of Emergency Physicians (ACEP)

policies, (ACEP Policy Compendium, 2012 Edition) which, in part, recognizes

the roles of the American Board of Emergency Medicine (ABEM) and the

American Osteopathic Board of Emergency Medicine (AOBEM) to set and

approve the training standards, assess competency through board certification

processes and establish professional practice principles for emergency

physicians. Furthermore, MAG supports ACEP's assertion that the specific

process for physician credentialing and delineation of clinical privileges must

be defined by hospital or organized medical staff and department bylaws,

policy, rules, or regulations. These are also requirements of the Code of

Federal Regulations for Hospitals and the Georgia Department of Community

Health's, Office of Health Care Facility Regulation Hospital Rules and

Regulations. Each member of the medical staff must be subject to periodic

review as part of the performance improvement activities of the organization.

ACEP believes that the exercise of clinical privileges in the emergency

department is governed by the rules and regulations of the department. ACEP

policy also states that certificates of short course completion in various cored

content areas of emergency medicine, (i.e., Advanced Cardiac Life Support,

Advanced Trauma Life Support, etc.) may serve as evidence of focused

review; however, ABEM or AOBEM certification in emergency medicine

supersedes evidence of the completion of such courses. ACEP strongly

discourages the use of certificates of completion of such courses, or a specified

number of continuing medical education hours in a sub-area of emergency

medicine, as requirements for privileges or employment for physicians

certified by ABEM or AOBEM.

Appendix III


3

POLICY #

POLICY

230.997 Emergency

Department Training

(Cont.)

[Physician members gave careful review of MAG’s current policy statement and strongly

suggested that MAG’s policy should more fully address the topic and be clear on what

ACEP policy states on topics including the recognized accrediting bodies for emergency

room physicians, policies about the various educational tools on Advanced Cardiac Life

Support, and ACEP’s statement on the credentialing and delineation of clinical privileges.]

275.993 Non-physician

Personnel HD 10/13/2007

Current Language: MAG opposes the performance of medical procedures by non-physician personnel who are

inappropriately trained and unsupervised. (Appendix III - Committee 01.07)

Proposed Language:

As a matter of patient safety, MAG opposes the performance of medical

procedures by non-physician personnel who are not medically trained and

supervised. Actions such as the ordering of images, the administration of

vaccines and other injectibles should not be performed by non-physicians

unless administration is done pursuant to a physician protocol and in the case

of vaccine and injectible administration, a physician’s prescription.

The Council on Legislation reviewed current policy statement and concluded that a more

comprehensive statement better clarifies MAG’s position on patient safety measures .

305.994 Medical College of

Georgia

Current Language: MAG supports the position that the Medical College of Georgia in Augusta will continue to

be the sole public medical education institution in Georgia and will be allowed to continue

to expand its accreditation to qualified medical educational and residency programs in

Georgia to ensure the outcome of an appropriate supply of physicians to take care of

patients throughout the state. (Resolution 112A.07 Resolves 1 & 2)

Proposed Language with extracted portion:

MAG supports the position that the Medical College of Georgia in Augusta

will continue to be the sole public medical education institution in Georgia and

will be allowed to continue to expand its accreditation to qualified medical

educational and residency programs in Georgia to ensure the outcome of an

appropriate supply of physicians to take care of patients throughout the state.

(Resolution 112A.07 Resolves 1 & 2)

[This policy statement was reviewed by the Committee on Continuing Medical Education

that found the statement still relevant but recommended removing the reference to

accreditation. Committee members felt that this will in no way change the essence of the

policy.]

Appendix III


4

POLICY #

POLICY

535.985 Recruitment

Current Language: MAG's Board of Directors, as a condition of their position, are required to actively engage

in membership recruitment and other membership efforts adopted by the Board, such as

participating in a membership renewal phone drive at the annual House of Delegates

meeting.

New Language:

Members of MAG’s Board of Directors, as a condition of their position, are

required to actively engage in membership recruitment and other membership

efforts adopted by the Board.

[This was reviewed and determined that some of the language was outdated and limiting.

Also noted is that at the time of year the House of Delegates is held, it is the end of the dues

year and MAG is preparing for the next year’s billing.]

# # #

REFERENCE COMMITTEE A

All items of business referred to Reference Committee A

RESOLUTION

Resolution: 101A.12

SUBJECT: Bullet Tax

SUBMITTED BY: Rutledge Forney, M.D., Delegate

REFERRED TO: Reference Committee A

Whereas, the right to bear arms is protected by the United States Constitution; and 1

2

Whereas, bullets are the cause of injury and death from guns; and 3

4

Whereas, numerous injuries and deaths are caused by stray bullets shot into the sky in celebration, drive-5

by shootings, and other criminal or irresponsible use of firearms; and 6

7

Whereas, injuries from bullets are a significant cost to the health care system; and 8

9

Whereas, revenue from cigarette taxes are declining and new sources of tax revenue are needed by state 10

and federal governments; and 11

12

Whereas, legitimate users of firearms for protection and sports activities use bullets responsibly and in 13

limited supply; now therefore be it 14

15

RESOLVED, that the Medical Association of Georgia support legislation to put a $5 tax on each bullet 16

sold in the state of Georgia, notify all other state medical societies of this resolution and suggest they do 17

the same, and ask the American Medical Association to support federal legislation for a bullet tax. 18

# # #

RESOLUTION

Resolution: 102A.12

SUBJECT: Change Georgia’s Insurance Laws to Promote Greater Transparency for Patients

and Providers and Eliminate Insurance Practices that Limit Access To Providers

Based Solely on Costs

SUBMITTED BY: Medical Association of Atlanta


Whereas, health insurance companies often have payment policies that delay or deny payments to 1

physicians that ultimately add costs to the system and increase costs to patients; and 2

3

Whereas, changes should be made to state laws to expedite payments to physicians and other providers 4

through greater transparency; and 5

6

Whereas, many insurance companies are tiering and steering patients away from certain health providers 7

in their networks based solely on the cost of care; and 8

9

Whereas, insurance companies often give providers prior authorization for a medical service and after the 10

service is performed deny those claims; and 11

12

Whereas, Medicaid and Medicare payments pay less than the cost of care and many insurance companies 13

would like to tie the payments to providers based on those payment rates; now therefore be it 14

15

RESOLVED, that the Medical Association of Georgia (MAG) opposes the insurance industry’s practice 16

of prohibiting the authorization of payment for treatment and retrospectively denying those claims after 17

the services have been provided; and be it further 18

19

RESOLVED, that MAG supports requiring insurance companies to provide physicians and hospitals at 20

the time of a patient’s treatment the amount of the patient’s required co-pay and deductible, the patient’s 21

preventive care services that are not subject to a co-pay or deductible, the amount the patient owes at the 22

time of service, and provide payment of the amount owed by the insurance company to physicians and 23

hospitals at the time the service is provided; and be it further 24

25

RESOLVED, that MAG opposes insurance companies tiering physicians based on the contracted charge; 26

and be it further 27

28

RESOLVED, that MAG opposes insurance companies rescheduling studies and procedures without the 29

knowledge and permission of the original ordering physician. 30

# # #

RESOLUTION

Resolution: 103A.12

SUBJECT: Electronic Medical Record (EMR) Requirements

SUBMITTED BY: DeKalb Medical Society


Whereas, we recognize that Electronic Medical Records (EMR) may have great value in improving and 1

streamlining the practice of medicine, improving the quality of medical care, involving the patient in 2

medical decision making, communicating with physicians, patients and other stakeholders in health care; 3

and 4

5

Whereas, “Meaningful Use” (a set of criteria from the Centers for Medicare and Medicaid Services 6

(CMS) to define an EMR’s validity) has been defined by the federal government by fiat; and 7

8

Whereas, “Meaningful Use” criteria have never been validated to improve patient care or clinical 9

outcomes; and 10

11

Whereas, these criteria have been handed to practicing physicians, rather than created by practicing 12

physicians; and 13

14

Whereas, the current state of EMRs in medicine is a classical example of the “tail wagging the dog,” with 15

decisions, reporting and synthesis of data being made to follow the construction of the EMR, rather than 16

to assist physicians in improving the quality of medical care; and 17

18

Whereas, the onerous, time-consuming, one-size-fits-all, often irrelevant requirements of “Meaningful 19

Use,” represent a huge burden on the practicing physician; and 20

21

Whereas, most EMRs provide for and promote the use of “default values,” defaulting current evaluation 22

results with prior results, leading to misleading clinical data entry; and 23

24

Whereas, most practicing physicians cannot manage their current patient load without adding countless 25

hours of documentation; thereby, promoting and essentially requiring the use of input from clerical and 26

mid-level workers to complete much of these forms; and 27

28

Whereas, the accuracy of data collection by clerical and mid-level workers, who are not highly trained in 29

diagnosis and treatment of patients, and who may miss the subtleties and clinical relevance of this 30

information when obtained by a physician clinician; and 31

32

Whereas, the sheer volume of data collection requirement impairs the ability of the physician clinician to 33

find and use the clinically relevant data; and 34

35

Whereas, the driving market forces of all EMR companies is to construct an EMR with “Meaningful Use” 36

and “upcoding” as the primary element of marketability, not clinical relevance; and 37

Whereas, EMRs promote digitized data collection but deemphasize and minimize the primary goal of the 38

medical encounter — namely to synthesize data and create an IMPRESSION and PLAN; and 39

Resolution: 103A.12

2

Whereas, most practicing physicians intensely dislike their EMR and many feel that it impairs their ability 1

to practice quality medicine; and 2

3

Whereas, the quality and legibility of current EMR notes are notoriously inadequate (in spite of increased 4

volume); and 5

6

Whereas, new physicians beginning practice are being taught that good medicine means filling out the 7

boxes, not relating to the patient and not synthesizing the information into a differential diagnosis and 8

rational plan; now therefore be it 9

10

RESOLVED, that the Medical Association of Georgia (MAG) create a committee to outline EMR 11

requirements for “Medically Meaningful Use”— defined as elements of an EMR that PRIMARILY 12

promote and assure a high quality of medical care. This would not exclude other purposes such as data 13

collection for public health or governmental agencies or quality indicators, nor components of 14

“Meaningful Use.” (Note: Elements might include mechanisms of data collection, synthesis of 15

information, graphically presenting longitudinal data, creation of legible and relevant clinical notes for 16

communication with patients and physicians, avoidance of pharmacy and other errors…); and be it 17

further 18

19

RESOLVED, that such a document would be used to present to EMR vendors demanding that these 20

clinical requirements be included in all EMRs and the document would be presented to the AMA for 21

adoption nationwide at the AMA HOD making “Medically Meaningful Use” the driving force for all 22

future EMR development [recapture the role of the physician to direct patient care- with rational use of 23

the available literature, promotion of best practice guidelines, incorporation of flexibility that recognizes 24

patient variability…]. 25

26

Core Set: All 15 Measures Required 27

28

• Demographics (50 percent) 29

• Vitals: BP and BMI (50 percent) 30

• Problem list: 31

ICD-9-CM or SNOMED (80 percent) 32

• Active medication list (80 percent) 33

• Medication allergies (80 percent) 34

• Smoking status (50 percent) 35

• Patient clinical visit summary 36

(50 percent in 3 days) 37

• Hospital discharge instructions (50 percent) 38

-or- 39

Patient with electronic copy (50 percent in three days) 40

• e-Prescribing (40 percent) 41

• CPOE (30 percent including a med) 42

• Drug-drug and drug-allergy interactions (functionality enabled) 43

• Exchange critical information (perform test) 44

• Clinical decision support (one rule) 45

• Security risk analysis 46

• Report clinical quality (BP, BMI, smoke, plus three others) 47

Resolution: 103A.12

3

Menu Set: Select 5 of 10 1

2

• Drug-formulary checks (one report) 3

• Structured lab results (40 percent) 4

• Patients by conditions (one report) 5

• Send patient-specific education (10 percent) 6

• Medication reconciliation (50 percent) 7

• Summary care record at transitions (50 percent) 8

• Feed immunization registries (perform at least one test) 9

• Feed syndromic surveillance (perform at least one test) 10

• Send reminders to patients for preventative and follow-up care (20 percent > 65 yrs. <5 yrs.) 11

• Offer patient electronic access to labs, problems, medications and allergies (10 percent in four days) 12

Fiscal Note: Cost estimate $10–15K

# # #

RESOLUTION

Resolution: 104A.12

SUBJECT: EMR Stimulus Funds for Physician Assistants (PAs)

SUBMITTED BY: DeKalb Medical Society


Whereas, there is currently stimulus money available for nurse practitioners who use electronic medical 1

records (EMR) under the HITECH Act but no incentives for physician assistants (PAs); and 2

3

Whereas, many physicians, particularly those in primary care, are struggling to implement EMR in their 4

practices and depend heavily on PAs to meet the increasing demands of a larger patient load; now 5

therefore be it 6

7

RESOLVED, that the Medical Association of Georgia work through the American Medical Association 8

to gain stimulus funds for primary care practices using physician assistants. 9

# # #

RESOLUTION

Resolution: 105A.12

SUBJECT: High-Fructose Corn Syrup Sweetened Beverages in Hospitals

SUBMITTED BY: Bibb County Medical Society


Whereas, obesity now affects at least 30 percent of Americans, and 1

2

Whereas, obesity leads to metabolic syndrome and ultimately Type 2 Diabetes, and 3

4

Whereas, bottled drinks sweetened with high-fructose corn syrup contribute to obesity; and 5

6

Whereas, Georgia hospitals are an important interface between the community and physicians, and as 7

such are in a unique position to educate children and adults regarding the unnecessary abundance of 8

carbohydrates; now therefore be it 9

10

RESOLVED, that the Medical Association of Georgia work with the Georgia Hospital Association to 11

urge that hospitals not offer bottled drinks sweetened with high-fructose corn syrup in hospital vending 12

machines. 13

# # #

RESOLUTION

Resolution: 106A.12

SUBJECT: Insurance Companies Not Reading HCFA-1500 Forms

SUBMITTED BY: Ogeechee River Medical Society


Whereas, appropriate address information is listed on every claim made to insurance companies by 1

physicians; and 2

3

Whereas, insurance companies do not read these forms and mail payments to incorrect addresses that are 4

in their systems; and 5

6

Whereas, these errors are causing significant delays in payment to physicians; now therefore be it 7

8

RESOLVED, that the Medical Association of Georgia work with the insurance commissioner seeking 9

penalties for companies that fail to send payments to the addresses listed on the HCFA-1500 or electronic 10

media. 11

# # #

RESOLUTION

Resolution: 107A.12

SUBJECT: Laboratory Reports to Patients

SUBMITTED BY: John A. Goldman, M.D., Delegate


Whereas, the Georgia Composite Medical Board has decreed that patients should be informed of their 1

laboratory reports within two weeks; and 2

3

Whereas, these reports are sent to the physician who referred the patient for testing to discuss the results; 4

and 5

6

Whereas, to make it more efficient for patients and physicians, the laboratories should be required to send 7

the results to the patient as well as their physician; and 8

9

Whereas, this would facilitate accurate transmission of the results and allow an accurate discussion of the 10

results; and 11

12

Whereas, the results could be accessed by the patient online; now therefore be it 13

14

RESOLVED, that the Medical Association of Georgia supports laboratories making available a copy of 15

laboratory reports to the physician and the patient at the discretion of the ordering physician, within one 16

week of completing the study. 17

# # #

RESOLUTION

Resolution: 108A.12

SUBJECT: Medical Facility Regulations for Students Shadowing Physicians

SUBMITTED BY: Georgia Academy of Family Physicians


Whereas, students are now strongly encouraged by most medical school admissions committees to have 1

clinical shadowing experience; and 2

3

Whereas, students who shadow physicians receive a positive clinical and educational experience in 4

medicine, and 5

6

Whereas, many physicians fear problems with the Health Insurance Portability and Accountability Act 7

and other impediments to providing student shadowing experiences; and 8

9

Whereas, medical facilities have different regulations to allow for shadowing that impede physicians from 10

showing students the full range of a physician’s practice; now therefore be it 11

12

RESOLVED, that the Medical Association of Georgia work with state associations (i.e., hospitals, 13

nursing homes) to develop a standard criteria for students to shadow physicians in medical facilities. 14

# # #

RESOLUTION

Resolution: 109A.12

SUBJECT: Obesity Prevention

SUBMITTED BY: Georgia Obstetrical and Gynecological Society

Georgia Academy of Family Physicians


Whereas, the obesity rate in Georgia is more than 30 percent for adults and 17 percent for children; and 1

2

Whereas, obesity accounts for serious health problems in men, women and children; and 3

4

Whereas, the economic cost of obesity in this country has been estimated at $270 billion a year; and 5

6

Whereas, the cause of obesity is known to be taking in more calories than are expended, specifically 7

lifestyles that involve eating too much unhealthy food and lack adequate physical activity; now therefore 8

be it 9

10

RESOLVED, that the Medical Association of Georgia (MAG), and the physicians of Georgia support the 11

efforts of the Governor and the Department of Public Health in their campaign against obesity and the 12

adverse health consequences of obesity; and be it further 13

14

RESOLVED, that MAG encourage physicians to become educated about obesity prevention, nutrition 15

and safe methods of weight loss and address weight, healthy eating and physical activity with their 16

patients at least annually and more often when appropriate; and be it further 17

18

RESOLVED, that MAG encourage physicians to model healthy behavior of good nutrition and physical 19

activity; and be it further 20

21

RESOLVED, that MAG support third party payer reimbursement of anti-obesity counseling by 22

physicians; and be it further 23

24

RESOLVED, that MAG encourages development of community strategies to prevent and fight obesity 25

through involvement of county medical societies and local governments working with health departments 26

and the Centers for Disease Control and Prevention; and be it further 27

28

RESOLVED that MAG support policy requiring only healthy food and beverages be sold or served in 29

public institutions such as hospitals, schools and government institutions; and be it further 30

31

RESOLVED, that MAG support minimum requirements for physical activity for school children in 32

grades K through 12. 33

# # #

RESOLUTION

Resolution: 110A.12

SUBJECT: Office Care of Medicare Patients in Rehab Beds in Nursing Facilities



Whereas, many patients are in nursing facilities after illnesses requiring rehab services; and 1

2

Whereas, these patients have no notations in their records from these facilities, nor do the patients know 3

they are in rehab status; and 4

5

Whereas, when services rendered in the physician’s office are often paid by Medicare, but later Medicare 6

requests a refund; and 7

8

Whereas, the notifications from Medicare are negative and place blame on the physician who has no 9

possible knowledge of the patient’s status, and the rehab facility is then responsible for payment to the 10

physician in the event of refund and are very slow to pay; and 11

12

Whereas, the letter from Medicare has the following language: 13

“You are responsible for being aware of correct claim filing procedures, and must use care when billing 14

and accepting payment. In this situation you billed and/or received payment for services that you should 15

have known you were not entitled to. Therefore, you are not without fault and are responsible for 16

repaying the overpayment amount.”; now therefore be it 17

18

RESOLVED, that the Medical Association of Georgia should support a resolution to the AMA House of 19

Delegates in fall 2012 or summer 2013 to explore a method of education of Medicare officials of the 20

inability of physicians to determine this status and to ensure that physicians do not receive such 21

communications for situations that are out of their control and are paid promptly by the nursing facilities. 22

# # #

RESOLUTION

Resolution: 111A.12

SUBJECT: Opposition to Penalty for 30-day Hospital Readmissions in the Interest of

Patient Care



Whereas, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of 1

Health and Human Services (HHS) has targeted 30-day hospital readmissions with financial 2

penalties; and 3

4

Whereas, this penalty has placed financial pressure on hospitals and practitioners to decrease 5

their 30-day readmission rates, which may be deleterious to optimal patient care; and 6

7

Whereas, severely ill patients tend to require more frequent inpatient care for best outcomes; and 8

9

Whereas, several studies have documented decreased mortality rates among patients cared for in 10

hospitals with higher 30-day readmission rates; and 11

12

Whereas, as physicians, our duty is always first and foremost to provide the best possible 13

medical care for our patients and protect them from harm; now therefore be it 14

15

RESOLVED, that the Medical Association of Georgia (MAG) oppose penalties on the state and 16

federal levels imposed against physicians and other health care providers for restrictions on 30-17

day readmissions; and be it further 18

19

RESOLVED, that MAG work with the appropriate government agency to find meaningful ways 20

to reduce “inappropriate” hospital readmissions. 21

# # #

RESOLUTION

Resolution: 112A.12

SUBJECT: Parity in Insurance Contracting



Whereas, insurance plans limit the amount of time that providers can file claims; and 1

2

Whereas, plans can have an unlimited time period to recoup payments for claims that they have “paid in 3

error”; and 4

5

Whereas, most of these claims were verified at the time of service and found to be coverage in force 6

according to the plans website; now therefore be it 7

8

RESOLVED, that the Medical Association of Georgia (MAG) work with the insurance commissioner 9

requiring insurance plan websites be up to date and that statements of coverage verified by providers be 10

upheld for payment; and be it further 11

12

RESOLVED, that MAG support insurance companies acting as third party administrators require timely 13

removal of non-covered lives from their roster so that accurate verification of coverage can be made; and 14

be it further 15

16

RESOLVED, that MAG support the amount of time for post payment review for repayment be the same 17

time period as that required of the physician to make timely claims. 18

# # #

RESOLUTION

Resolution: 113A.12

SUBJECT: Preventing Penalties for Physicians who Provide Care to Military Patients



Whereas, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and 1

Human Services (HHS) through the Patient Protection and Affordable Care Act (PPACA) have instituted 2

incentive/penalty payment programs; and 3

4

Whereas, this practice in some cases penalizes physicians who care for a significant number of active 5

duty and/or retired military personnel, which may result in decreased access to care for these patriots 6

(e.g., e-prescribing which provides for financial incentives followed by penalties to promote the use of 7

electronic prescription and, for security reasons is not allowed in the VA clinics, bases and the U.S. 8

Department of Defense, thereby financially penalizing the physicians who treat these military patients); 9

and 10

11

Whereas, TRICARE and other military programs are actively moving more patients to care provided by 12

civilian practitioners; now therefore be it 13

14

RESOLVED, that the Medical Association of Georgia oppose programs that unfairly penalize or create 15

disincentives for physicians who provide care to military patients. 16

# # #

RESOLUTION

Resolution: 114A.12

SUBJECT: Promote Fair Payment for Best Care Practices



Whereas, the Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Health and 1

Human Services (HHS) has instituted an incentive/penalty program with quality outcomes reporting; and 2

3

Whereas, ample documentation demonstrates that less educated and poorer patients often fail to achieve 4

the outcome thresholds mandated by CMS due to many psychosocial and economic factors but still 5

clearly benefit with improved health outcomes through access to care and appropriate counseling; and 6

7

Whereas, implementation of the quality reporting payment system financially discourages physicians 8

from caring for these patients, likely causing their health outcomes to actually worsen; now therefore be it 9

10

RESOLVED, that the Medical Association of Georgia support legislation on the state and federal levels to 11

remove the criteria of quality outcomes reporting and replace it with reporting to ensure that appropriate 12

counseling and education is provided. 13

# # #

RESOLUTION

Resolution: 115A.12

SUBJECT: Revise MAG’s Position on Pay-for-Performance (PFP)



Whereas, an attempt to curb health care costs has resulted in modifications in the fee-for-service 1

compensation model. Examples include the establishment of pay-for-performance (PFP) and/or insurance 2

based tiered co-pay obligations tied to tiered physician “value” and “grading” scales; and 3

4

Whereas, there are published physician “grading” models that lack transparency; "grade" on unproven 5

metrics; and collectively, can result in a non-verifiable random performance penalty placed on the 6

physician; and 7

8

Whereas, in 2007, this caused the Medical Association of Georgia (MAG) to adopt a policy - 160.987 Pay 9

for Performance - stating that “The Medical Association of Georgia opposes pay-for-performance 10

programs, as presently designed because of their negative impact on patient care.”; and 11

12

Whereas, there are many studies that demonstrate high variance in medical treatment and outcome. This 13

has caused a growing volume of evidence-based studies aimed at reducing health care variance. One 14

source of variance is coordination of care among providers along the patient care continuum. This 15

element of variance is complicated by a fee-for-service remuneration based solely on Diagnosis Related 16

Groups and Current Procedural Terminology coding. This system fails to financially incentivize for the 17

time and resources necessary to create care coordination among providers; and 18

19

Whereas, both the government and the private marketplace has recognized reducing variance poses a 20

significant opportunity to reduce cost and improve quality. Organizations have incorporated these goals 21

into their design; and 22

23

Whereas, one example of an ACO-like model, is a seven-year old organization in Chicago called 24

Advocate Physician Partners (APP). They have within the organization 3,600 physicians who cover one 25

million patients. PFP measures at APP are transparent and include metrics for both the individual 26

physician and the organization as a whole. New measures are added each year to align with APP’s 27

strategic objectives and to keep pace with standards endorsed by national health policy agencies. There 28

were 147 measures as of November 2011. New measures, revisions to existing measures, and updated 29

performance goals are reviewed and approved by APP’s quality improvement (QI) committee and the 30

APP board of directors; and 31

32

Whereas, this structure allows the physicians in a PFP system to be compensated for those efforts that 33

bring quality to the patient that are not recognized in a traditional fee-for-service arrangement. This 34

arrangement has brought positive results that are documented in the 2011 APP report. 35

36

• APP’s generic prescribing initiative resulted in generic drug prescribing rates four to six percentage 37

points higher than the rates for two of the largest Chicago-area insurers. Using the lower percent 38

differential, the initiative resulted in savings of $26.5 million annually to Chicago-area payers, 39

employers and patients above the community performance. 40

Resolution: 115A.12

2

• APP’s comprehensive asthma outcomes initiative resulted in an asthma control rate 38 percentage 1

points better than the national average, saving nearly $13 million in direct and indirect medical costs 2

above national averages annually. These benefits include saving an additional 58,436 days from 3

reduced absenteeism and lost productivity; and 4

5

• APP’s diabetes care initiative resulted in savings of an additional 16,430 years of life, 26,288 years of 6

extended eyesight and 19,716 years free from kidney disease. Calculating savings from just one 7

measure – improving Hemoglobin A1c levels – resulted in more than $1.6 million in savings annually 8

above the community performance due to improved control of diabetes; and 9

10

• APP’s postpartum depression screening initiative resulted in screenings for 93 percent of new 11

mothers, exceeding the national screening rate of 50 percent. In addition, the initiative resulted in 12

savings of nearly $600,000 annually and more than 1,638 work days per year; and 13

14

• APP’s combination three immunization rate exceeded national averages by 16 percentage points for 15

HMO patients and 45 percentage points for PPO patients; now therefore be it 16

17

RESOLVED, that the Medical Association of Georgia (MAG) will revise its 160.987 Pay for 18

Performance position, and recognize the potential value to physicians and their patients that an 19

appropriate PFP incentive program can provide; and be it further 20

21

RESOLVED, that MAG will develop a statement or endorse a statement encompassing the principles 22

upon which an appropriate pay-for-performance metric is based. 23

# # #

RESOLUTION

Resolution: 116A.12

SUBJECT: Additional State Funding to Address the Shortage of Physicians and Nurses



Whereas, Georgia has fallen far behind in training physicians and will rank last in the United States in 1

physicians per capita by 2020 and the U.S. Health Resources and Services Administration forecasts a 2

shortage of 65,000 primary care physicians in the U.S. in 2020; and 3

4

Whereas, the nation is projected to be short 130,600 physicians by 2025 and Georgia’s per capita 5

physician workforce ranks 40 in the United States with 205 physicians per capita compared to the 255 per 6

capita nationally; 1 and 7

8

Whereas, Georgia faces a shortage of 38,000 nurses over the next 10 years, and falls below the national 9

per capita average for each profession; and 10

11

Whereas, a study conducted in 2006 showed that only 50 percent of medical school graduates with 12

confirmed practice plans remained in the state, down from 56 percent in 2002; 2

13

14

Whereas, Georgia Health Sciences University released a study calling for increased enrollment and 15

faculty, new classrooms, raising salaries for nursing professors and physician residents and adding 16

internships; and 17

18

Whereas, the passage of the Patient Protection and Affordable Care Act of 2010 could add 600,000 more 19

people to Georgia’s Medicaid roles at a time when there are not enough primary care physicians, nurse 20

practitioners and physician assistants available to meet the demand; and 21

22

Whereas, Georgia has one of the lowest number of RNs per capita in the U.S.; and 23

24

Whereas, the U.S. Health Resources and Services Administration projects there will be a 20 percent 25

shortage of nurses in 2015 due to an aging population, a lack of nursing faculty at colleges and technical 26

schools, and a high turnover rate in the profession; and 27

28

Whereas, nurses have significant delays and difficulty in obtaining a Georgia license when being 29

recruited from other states; now therefore be it 30

31

RESOLVED, that Georgia should provide financial resources and develop policies to increase the number 32

of physicians, physician assistants and registered nurses in the state; and be it further 33

34

RESOLVED, that the Medical Association of Georgia should support changes to nurse licensure laws to 35

expedite the issuance of Georgia licenses. 36

1 HPEC Recommendations. Board of Regents of the University System of Georgia

2 AAMC, Recent Studies and Reports on Physician Shortages in the US

REFERENCE COMMITTEE C

All items of business referred to Reference Committee C

RESOLUTION

Resolution: 301C.12

SUBJECT: Banning “All Product Clauses” for Physician Contracts with Insurance Companies

SUBMITTED BY: Georgia Academy of Family Physicians

REFERRED TO: Reference Committee C

Whereas, “All Product Clauses” in insurance programs can limit providers from negotiating with 1

insurance companies; and 2

3

Whereas, the American Academy of Family Physicians opposes “All Product Clauses;” and 4

5

Whereas, Georgia insurance companies, through a lawsuit agreement, agreed to refrain from “All Product 6

Clauses” for a period of five years which recently expired; now therefore be it 7

8

RESOLVED, that the Medical Association of Georgia lobby for legislation to make “All Product 9

Clauses” illegal in Georgia and thus excluded from any health insurance exchange product offered in the 10

state. 11

# # #

RESOLUTION

Resolution: 302C.12

SUBJECT: Diversity Training



Whereas, the population of Atlanta and the state of Georgia has changed dramatically; and 1

2

Whereas, Georgia physicians will be facing a patient who is different from them, be it gender, racial, 3

ethnic, primary language; and 4

5

Whereas, the Georgia Department of Health and Human Services has developed Culturally and Linguistic 6

Appropriate Standards (CLAS); and 7

8

Whereas, CLAS standards cover culturally competent care, language access services, organizational 9

supports for cultural competence; and 10

11

Whereas, CLAS standards are primarily directed at health care organizations; and 12

13

Whereas, the principles and activities of culturally and linguistically appropriate services should be 14

integrated throughout an organization and undertaken in partnership with the communities being served; 15

and 16

17

Whereas, the physician-patient relationship is critical for quality care; and 18

19

Whereas, New Jersey has added CLAS training for license renewal; now therefore be it 20

21

RESOLVED, that the Medical Association of Georgia support continuing medical education training in 22

diversity and cultural competence for all practicing physicians. 23

# # #

RESOLUTION

Resolution: 303C.12

SUBJECT: Support Physician Graduates Employment in the State of Georgia



Whereas, only 46 percent of Georgia medical school graduates were employed in state in 2010; and 1

2

Whereas, Georgia has an increasing need for new physicians to care for its increasing population; and 3

4

Whereas, there are no significant programs at Georgia’s medical schools to facilitate placement of 5

physician graduates in the state; now therefore be it 6

7

RESOLVED, that the Medical Association of Georgia support development of a program for physicians 8

trained in Georgia to seek employment in the state. 9

10

RESOLVED, that MAG conveys this support to the Georgia Board for Physician Workforce. 11

# # #

RESOLUTION

Resolution: 304C.12

SUBJECT: Georgia Composite Medical Board Pain Management Regulations

SUBMITTED BY: Colquitt County Medical Society


Whereas, the Georgia Composite Medical Board (GCMB) recently established new regulations for 1

physicians in relation to managing their patients with chronic pain (Rule 360-3-.06); and 2

3

Whereas, O.C.G.A 43-34-8 authorizes the GCMB to take disciplinary action against a physician's license 4

for unprofessional conduct, which includes "failure to practice at recommended minimal standards;" and 5

6

Whereas, many geriatric patients still residing at home take one or less Schedule III Narcotics daily along 7

with other medications for chronic pain management and would fall under this standard; and 8

9

Whereas, the standard requires monitoring for compliance (drug screens) every 90 days done at random 10

separate from the required clinical visits done every three months or more often (eight visits or more a 11

year in addition to other clinical visits to manage all their other multitude of health problems); and 12

13

Whereas, no "cost effective" method is available to confirm compliance of low dose narcotic use due to 14

required minimal detection levels on urine drug screens; and 15

16

Whereas, this standard creates undue hardships for primary care physicians and their patients, increases 17

the cost of health care, increases paperwork, and will probably force the referral of more patients to pain 18

clinics which will also have difficulty complying with this standard; now therefore be it 19

20

RESOLVED, that the Medical Association of Georgia work with the GCMB to revise this standard to 21

reduce the hardships it places on primary care physicians and their patients by reducing the frequency of 22

unnecessary drug monitoring, better define "hardship exceptions," and allow more "clinical judgment" 23

regarding patients at high risk of abuse and narcotic diversion. 24

# # #

RESOLUTION

Resolution: 305C.12

SUBJECT: Changes to Georgia’s Pharmacy Statute to Modify Changes in the

2011 Passage of Schedule II Security Paper



Whereas, Georgia passed a bill in 2011 that requires physicians to only use Georgia’s approved security 1

paper for Schedule II prescriptions; and 2

3

Whereas, this requirement is not only costly but is difficult to implement with existing computer software 4

programs; and 5

6

Whereas, the Centers for Medicare and Medicaid Services (CMS) already has a process in place to 7

provide for secure paper; and 8

9

Whereas, at the request of pharmacists and physicians, the Georgia Board of Pharmacy delayed 10

implementation of this law so long as “emergency” was written on the prescription; and 11

12

Whereas, the Georgia Board of Pharmacy, Georgia Pharmacy Association, and the Medical Association 13

of Georgia (MAG) agreed to a legislative change for the 2012 session, however the legislation failed to 14

pass due to unrelated issues; now therefore be it 15

16

RESOLVED, that MAG should support legislation in the 2013 legislative session to allow for physicians 17

to utilize the CMS-approved paper in addition to the current Georgia specifications. 18

# # #

RESOLUTION

Resolution: 306C.12

SUBJECT: International Board Certified Lactation Consultants (IBCLC)



Whereas, the American Academy of Pediatrics (AAP) recommends that babies have the exclusive 1

nourishment of breast milk for the first six months of lifei; and 2

3

Whereas, breast milk provides many health benefits to babies including reducing the risks of obesity, 4

Type II diabetes, ear infections, SIDS, leukemia, asthma, gastrointestinal disorders such as inflammatory 5

bowel disease and deadly necrotizing enterocolitisii; and 6

7

Whereas, nationally Georgia is in the top 20 percent for infant mortality rateiii

; and 8

9

Whereas, nationally Georgia is in the bottom 20 percent for its six-month breastfeeding rateiv; and 10

11

Whereas, 70 percent of Georgia’s moms are leaving the hospital breastfeeding their babies, but less than 12

10 percent are successful in meeting the AAP recommendation of providing exclusive breast milk for 13

their babies for the first six monthsv; and 14

15

Whereas, breastfeeding provides huge dollar savings for families, businesses and governmentvi with 16

Georgia’s WIC Department reporting that for each month an infant is breastfed, the state saves $160 17

dollars in direct Medicaid and WIC costsvii

; and 18

19

Whereas, research shows that mothers who have access to International Board Certified Lactation 20

Consultants (IBCLCs) have much higher initiation and duration rates of breastfeedingviii

; and 21

22

Whereas, IBCLCs are already certified by an international board with rigorous requirements of college-23

level health science courses, hundreds of hours of clinical training, certification testing and continuing 24

education requirementsix; and 25

26

Whereas, although many hospitals employ IBCLCs to assist new mothers while in the hospital, most 27

breastfeeding issues occur days and weeks after discharge; and 28

29

Whereas, state licensure of IBCLCs would provide avenues for physician practices to receive direct 30

reimbursement for the services of employed IBCLCs in their officesx and thus be able to offer in-house 31

clinical assistance to help mothers and babies work through breastfeeding problems; and 32

33

Whereas, the U.S. Surgeon General Regina Benjamin, M.D., supports the state licensing of IBCLCs and 34

she recognizes IBCLCs as the “only health care professionals certified in lactation care” and concludes 35

that “better access to the care provided by IBCLCs can be achieved by accepting them as core members 36

of the health care team…”xi; now therefore be it 37

38

RESOLVED, that the Medical Association of Georgia supports state legislation that would allow for the 39

state licensure of International Board Certified Lactation Consultants. 40

Resolution: 306C.12

2

i American Academy of Pediatrics, Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics.

2012;129:e827–e841. ii See, note 1.

iii See, http://www.statehealthfacts.org/comparemaptable.jsp?ind=47&cat=2.

iv Centers for Disease Control and Prevention, August, 2011. Breastfeeding Report Card- United States, 2011.

http://www.cdc.gov/breastfeeding/data/reportcard.htm. vSee, note 4.

vi A.M. Stuebe , E.B. Schwarz, “The Risks and Benefits of Infant Feeding Practices for Women and Their Children,”

Journal of Perinatology. 2010, Mar; 30(3):155-162; See also, M Bartick and A Reinhold, “The Burden of

Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis,” Pediatrics 125, no. 5 (2010): e1048-

e1056. Estimated savings if 90% of U.S. families complied with the medical recommendations to breastfeed

exclusively for 6 months.; See also, T.M. Ball, A.L. Wright, “Health Care Costs of Formula-Feeding in the First

Year of Life”, Pediatrics 1999; 103:870-876. vii

Georgia Department of Human Resources Division of Public Health, WIC FACT SHEET

http://www.health.state.ga.us/pdfs/wic/wic.faq.pdf. viii

Castrucci et al., “Availability of Lactation Counseling Services Influences Breastfeeding Among Infants

Admitted to Neonatal Intensive Care Units,” Am J Public Health 21, no. 5 (2007): 410-415; See also, Castrucci et

al., “A Comparison of Breastfeeding Rates in an Urban Birth Cohort,” Journal of Public Health Management 12, no.

6 (2006): 578-585; See also, Thurman SE, Allen PJ, “Integrating Lactation Consultants into Primary Health Care Services: Are Lactation Consultants Affecting Breastfeeding Success?,” Pediatric Nursing. 2008 Sep Oct;34

(5):419-425. ix See, http://americas.iblce.org/pathways-to-becoming-an-ibclc.

x Currently, IBCLC consults are not independently reimbursed by private or federal insurance in Georgia. See,

“Supporting Breastfeeding and Lactation: The Primary Care Pediatrician’s Guide to Getting Paid”,

http://www.aap.org/breastfeeding/files/pdf/coding.pdf. Georgia’s Medicaid program does not reimburse non-

licensed providers. xi U.S. Department of Health and Human Services, “The Surgeon General’s Call to Action to Support

Breastfeeding” Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General;

2011.

RESOLUTION

Resolution: 307C.12

SUBJECT: Legislation Supporting Licensure of Lactation Consultants

SUBMITTED BY: Georgia Chapter, American Academy of Pediatrics

Georgia Obstetrical and Gynecological Society



Whereas, extensive medical research has documented the many compelling health advantages 1

breastfeeding confers on infants and their mothers, among them that breast milk contains immune factors 2

and anti-infective properties that protect against several infections in infants, and is associated with the 3

reduction of other chronic conditions, such that the American Academy of Pediatrics recommends that 4

infants be fed exclusively with breast milk for the first six months of life; and 5

6

Whereas, lactation consultants are trained health professionals in the area of human lactation and provide 7

assistance and guidance to mothers of newborns; and that the most highly qualified lactation consultants 8

have achieved board certification conferred by the International Board of Lactation Consultant 9

Examiners; and 10

11

Whereas, the state of Georgia does not currently license lactation consultants and this lack of licensure 12

status impedes their ability and the pediatric practices they work with to receive appropriate payment for 13

these services; and 14

15

Whereas, licensure of board certified lactation consultants would significantly help promote breastfeeding 16

in our state; and further, provide avenues for physician practices to receive Medicaid or private insurance 17

reimbursement for these important services provided by lactation consultants in their offices and thus be 18

able to offer in-office clinical assistance to help mothers and their babies with breastfeeding issues, and 19

20

Whereas, such legislation on the licensure of board certified lactation consultants should describe their 21

scope of practice as limited to providing lactation counseling or lactation related services, for which 22

lactation consultants are uniquely qualified as a member of the health care team in caring for the 23

newborn; now therefore be it 24

25

RESOLVED, that the Medical Association of Georgia support appropriate state legislation that would 26

provide for the licensure of board certified lactation consultants. 27

# # #

RESOLUTION

Resolution: 308C.12

SUBJECT: Oppose Taxes on Health Care Providers as a Means to Fund Medicaid



Whereas, in 2010, the state legislature passed a law that imposed a $650 million annual tax over three 1

years on hospital revenues as a means to address a budget shortfall; and 2

3

Whereas, the leadership of the House and Senate agreed to a three-year tax with the promise that this tax 4

would sunset in July 2013; and 5

6

Whereas, the tax borne by hospitals contributes to the cost of medical care and is absorbed by the hospital 7

or is shifted onto the business community and patients through higher insurance and copayment costs; and 8

9

Whereas, while physicians are not directly impacted by the tax, the hospitals where they are employed or 10

have privileges are financially harmed by the tax and as such the hospitals have fewer dollars that can be 11

spent on patient care; and 12

13

Whereas, the burden of paying for the health care delivery system and Medicaid should be borne by the 14

state through sound public policy that promotes healthier lives and lowers health care costs; and 15

16

Whereas, the state should find creative ways to increase funding for health care services but not by taxing 17

the sick or health care providers; and 18

19

Whereas, Georgia’s annual health care expenditures due to tobacco use are $1.75 billion with Medicaid’s 20

portion consuming $419 million; and lost productivity in Georgia due to smoking related deaths is 21

estimated at $2.73 billion1; and

22

23

Whereas, Medicaid enrollees have nearly twice the smoking rates (37 percent) of the general adult 24

population (21 percent), and smoking-related medical costs are responsible for 11 percent of Medicaid 25

expenditures2; and 26

27

Whereas, it is proven that there is a direct correlation between the cost of cigarettes and its usage; and 28

29

Whereas, Georgia has one of the lowest tax rates on tobacco in the nation and the state should increase the 30

tax on tobacco products by $1 per pack to bring in an estimated $600 million to the state3; now therefore 31

be it 32

33

RESOLVED, that the Medical Association of Georgia (MAG) opposes hospital, physician or health care 34

provider taxes as a solution to state budget deficits; and be it further 35

1 Georgia Alliance for Tobacco Prevention, Resolution to Reduce Tobacco Use in Georgia

2 Centers for Disease Control and Prevention, State Medicaid Coverage for Tobacco-Dependence Treatments

3 UGA Today

Resolution: 308C.12

2

RESOLVED, that MAG supports alternate revenue sources to offset the cost of state provided health care 1

services, including a $1 per pack increase in tobacco taxes. 2

# # #

RESOLUTION

Resolution: 309C.12

SUBJECT: Opposing Expansion of CRNA Scope of Practice for

Chronic Pain Management

SUBMITTED BY: Georgia Society of Anesthesiologists


Whereas, the Centers for Medicare and Medicaid Services (CMS) has proposed to pay Certified 1

Registered Nurse Anesthetists (CRNA) for providing certain pain management procedures on a 2

nationwide basis; and 3

4

Whereas, the proposed rule would expand payment to CRNAs for services distinctively beyond the scope 5

as partially defined as “anesthesia services and related care” as delineated in section 1861(bb)(1) of the 6

Omnibus Budget Reconciliation Act (OBRA) of 1986; and 7

8

Whereas, CMS proposes to expand the statutory description of CRNA services by adding the following 9

language: “Anesthesia and related care includes medical and surgical services that are related to 10

anesthesia and a CRNA is legally authorized to perform by the State in which the services are furnished.”; 11

and 12

13

Whereas, chronic pain management is a complicated symptom complex requiring extensive diagnostic 14

skills to arrive at an often multi-modal treatment approach of physical therapy, behavioral therapy, and 15

various and specifically targeted interventional and pharmacologic therapies; and 16

17

Whereas, such necessary medically complex decisions demonstrate that chronic pain management is the 18

practice of medicine and is beyond CRNA scope of practice and training; and 19

20

Whereas, the state of Georgia description of CRNA scope of practice does not include chronic pain 21

management; now therefore be it 22

23

RESOLVED, that the Medical Association of Georgia shall oppose any state legislation or regulatory 24

board action to expand CRNA scope of practice to authorize the provision of chronic pain management. 25

# # #

RESOLUTION

Resolution: 310C.12

SUBJECT: Reducing the Projected 2020 Shortage of Georgia Physicians



Whereas, Georgia is the 9th most populous state but ranks 40th in physicians per capita with 1

approximately 18,500 physicians practicing in Georgia; and 2

3

Whereas, residents of rural counties in Georgia and poor Georgians suffer from a severe dearth of 4

physicians, making the need for primary care physicians most pressing; and 5

6

Whereas, physician-patient communication is important for good patient care but 18 percent of U.S. 7

certified physicians come from Asian medical schools (ECFMG), speaking English as either a second 8

language or with an accent that is difficult for most Americans to understand; and 9

10

Whereas, Georgia is estimated to lack 2,500 physicians as of 2020 despite expansion of Georgia’s 11

medical schools and the increase in Georgia post-graduate residencies (GA TREND, July 2008); and 12

13

Whereas, the cause of the physician shortage in Georgia includes the many out-of-state students in three 14

of five Georgia medical schools (Emory University School of Medicine, Philadelphia College of 15

Osteopathic Medicine - GA Campus, and Morehouse School of Medicine); and 16

17

Whereas, most medical students leave Georgia after graduation and 40 percent to 50 percent of those 18

doing residencies in Georgia do not plan to stay in the state to practice (GA Board of Physicians 19

Workforce 2006-2011) while the lack of physicians in Georgia is considered critical (Tripp Umbach Final 20

Executive Report 2008); and 21

22

Whereas, none of the seven residents in the 2011 Year 1 family practice residents at an Atlanta family 23

practice residency program plan to practice in Georgia (personal report); and 24

25

Whereas, non-U.S. citizens who apply for residency positions may have no commitment to the U.S. and 26

may even be hostile to it, preparing the ground for terrorist acts by foreign physicians in training in the 27

U.S. as the U.K. experienced in the 2007 bombings and as found in U.K.-trained doctors in Syria (2012); 28

and 29

30

Whereas, the lack of physicians in Georgia has led to the use of nurse practitioner extenders as physician 31

replacements, despite marked differences in the M.D./D.O. vs. N.P. training and qualifications; and 32

33

Whereas, the Georgia Composite Medical Board has recently made Caribbean graduates from “California 34

List” schools equivalent to U.S. medical school graduates1; and 35

Whereas all Caribbean medical students must pass USMLE 1 to advance to their clinical training in the 36

U.S. and must pass USMLE 2 within a year thereafter; and 37

1 Excepting those training US citizens, the California “Approval” of foreign medical schools is often unjustified as it

is unverified, because of distance, cost and language barriers.

Resolution: 310C.12

2

Whereas, all Caribbean students must be certified by the Educational Commission for Foreign Medical 1

Graduates (ECFMG) to be considered for U.S. residency programs and the quality of these graduates is 2

assessed when undergoing ECFMG certification; and 3

4

Whereas, almost all Georgia residents attending Caribbean medical schools want to return to Georgia to 5

live and practice, specializing in primary care, chiefly family practice; and 6

7

Whereas, Georgia residents/Caribbean students number approximately 50 a year, which over eight years 8

would alleviate 16 percent of the estimated physician shortage and provide Georgians with physicians 9

familiar with their language, culture and needs; and 10

11

Whereas, these Georgia resident/Caribbean students who pass the USMLE 1 are consistently evaluated by 12

U.S. physician/clerkship proctors to be as hard-working, motivated and able as U.S. students but the 13

Caribbean students face discrimination with respect to clinical and residency clerkship opportunities; and 14

15

Whereas, Caribbean students who are not so capable either do not pass the USMLE Step 1 or have scores 16

below those of U.S. medical school students and are not included in this RESOLUTION; and 17

18

Whereas, Georgia taxes fund residency training programs and also thereby indirectly fund all Georgia 19

medical schools since approved medical student clerkships are in hospitals with relevant residencies; and 20

21

Whereas, “Georgia resident” is herein defined as an adult residing in Georgia for three or more years; 22

now therefore be it 23

24

RESOLVED, that the Medical Association of Georgia support Georgia hospitals offering medical student 25

clerkships and residency programs and that directly or indirectly benefit from state funding should give 26

preference to Georgia residents who are U.S. citizens attending U.S. or Caribbean medical schools and 27

who have passed USMLE 1 with a score of 200 (1 standard deviation of the U.S. mean score). 28

# # #

RESOLUTION

Resolution: 311C.12

SUBJECT: Provision of Home Care Services for the Elderly through Medicaid



Whereas, many seniors and others with chronic health conditions lack support to allow their continued 1

independent living situation, leaving little option save admission to a skilled nursing facility; and 2

3

Whereas, significant numbers of these patients markedly prefer to maintain independence in their living 4

situation; and 5

6

Whereas, the nation is currently at the beginning of a large increase in our elderly population as “Baby 7

Boomers” age and further strain our state’s budget; and 8

9

Whereas, other states (e.g., Tennessee through TennCare) have shown increased patient satisfaction 10

coupled with markedly diminished costs by establishing Medicaid programs to provide care at home for 11

those patients who desire and are appropriate to continue to live independently; now therefore be it 12

13

RESOLVED, that the Medical Association of Georgia support legislative efforts on the state and federal 14

levels to establish programs that allow appropriate Medicaid patients the support needed to maintain 15

independence in their living situation. 16

# # #

RESOLUTION

Resolution: 312C.12

SUBJECT: Rule 360-3-.06. Pain Management



Whereas, physicians realize the enormous Schedule II and III controlled substance abuses that exist 1

among the daily delivery of acute and chronic care for painful conditions; and 2

3

Whereas, the Georgia Composite Medical Board (GCMB) and the Georgia Drugs and Narcotics Agency 4

have struggled with implementation of needed changes regarding identification of inappropriate narcotic 5

prescribing and usage; and 6

7

Whereas, GCMB Rule 360-3-.06 mandates “…a written treatment agreement with the patient and shall 8

require the patient to have a clinical visit at least once every three (3) months…” and “Monitoring must 9

include a urine, saliva, sweat, or serum test performed on a random basis”; and 10

11

Whereas, the Rule applies to non-terminal patients prescribed a narcotic for more than 90 days in one 12

year; and 13

14

Whereas, subsequently required chart documentation of such actions or hardship exemption thereof on 15

each patient represents undue additional administrative patient and physician legal requirements while 16

doing little to identify either narcotic abuse or safety issues; now therefore be it 17

18

RESOLVED, that the Medical Association of Georgia work with the legislature and/or the GCMB and/or 19

other appropriate state agencies to relax mandated pain management drug testing requirements rules on 20

physicians and instead concentrate on improving pharmacy identification and reporting of controlled 21

substance problems requiring possible investigation. 22

# # #

RESOLUTION

Resolution: 313C.12

SUBJECT: Return Pseudoephedrine to Prescription Status



Whereas, methamphetamine is a drug that can be manufactured in home labs if pseudoephedrine is 1

available; and 2

3

Whereas, methamphetamine is a terribly addictive and destructive drug; and 4

5

Whereas, an estimated $23 billion a year is spent on issues related to meth abuse; and 6

7

Whereas, home methamphetamine labs are highly flammable; and 8

9

Whereas, two-thirds of the patients in American burn units have been injured in methamphetamine related 10

fires; and 11

12

Whereas, methamphetamine is a terrible public health problem in the U.S.; and 13

14

Whereas, putting pseudoephedrine “behind” the counter at pharmacies has made it modestly harder to 15

obtain and has raised the street price of over-the-counter (otc) pseudoephedrine to $100 per package, 16

making it highly profitable for those who are willing to buy it and then sell to methamphetamine 17

producers; and 18

19

Whereas, pseudoephedrine was originally a prescription drug and made over-the-counter because it was 20

considered “safe,” but has proved to be unsafe to the public health; and 21

22

Whereas, Mississippi and Oregon have returned pseudoephedrine to prescription status; now therefore be 23

it 24

25

RESOLVED that the Medical Association of Georgia support legislation in Georgia and ask the 26

American Medical Association to support legislation at the federal level that would return 27

pseudoephedrine to prescription status. 28

# # #

RESOLUTION

Resolution: 314C.12

SUBJECT: Telehealth



Whereas, the Georgia Composite Medical Board (GCMB) has proposed defining treatment and/or 1

consultation via electronic or other means; and 2

3

Whereas, advances in technology, the proliferation of electronic devices such as smart phones, the 4

extensive implementation of Electronic Medical Records (EMRs), and advances in the availability, 5

security, and reliability of audio and video communication methods; and 6

7

Whereas, physicians are using electronic means to report lab/imaging and other testing results, follow-up 8

after procedures, evaluate and modify treatment plans, transmit orders to hospitals, pharmacies, offices 9

and other care venues; and 10

11

Whereas, Telehealth is a continuation and expansion of this practice and acknowledges the advancement 12

of technology in health care; and 13

14

Whereas, Telehealth offers the potential to improve quality of care, ease of care, access to care, and lower 15

costs to patients; and 16

17

Whereas, Telehealth may provide additional avenues of delivering care in areas that are underserved by 18

primary care and specialists, or areas where physicians require additional support for on-call coverage or 19

coverage while away from their practice; now therefore be it 20

21

RESOLVED, that the Medical Association of Georgia (MAG) urges the GCMB to develop rules that 22

ensure that Georgia licensed practitioners can broadly, appropriately, easily, and effectively use 23

Telehealth and other electronic means and devices to deliver care to their patients and consultation and 24

support to other physicians; and be it further 25

26

RESOLVED, that MAG urges the GCMB to review its rules on an annual basis to ensure that such rules 27

keep pace with the rapid use and implementation of Telehealth and other electronic means and devices 28

used in the delivery of quality health care. 29

# # #

RESOLUTION

Resolution: 315C.12

SUBJECT: Preservation of Women’s Health Care

SUBMITTED BY: Georgia Obstetrical and Gynecological Society


Whereas, the doctor-patient relationship is a critical component of quality health care; and 1

2

Whereas, women, just as all other patients, have the right to be counseled and made aware of the full 3

range of options, prescriptions and treatments available for their condition; and 4

5

Whereas, infertility treatment to achieve pregnancy may create special circumstances pertaining to 6

embryos where couples must be allowed to make decisions concerning embryos and the sanctity of the 7

family unit; and 8

9

Whereas, quality women’s health care requires access to the full range of birth control products available 10

in order to safely prescribe the appropriate method; and 11

12

Whereas, physicians should not be threatened with criminal prosecution for performing, prescribing, 13

diagnosing and treating medical conditions within their scope of practice; and 14

15

Whereas, women and families should have the ability to participate in health care decisions pertaining to 16

their families; now therefore be it 17

18

RESOLVED, that the Medical Association of Georgia (MAG) oppose legislation that violates the doctor- 19

patient relationship; and be it further 20

21

RESOLVED, that MAG oppose legislation that threatens criminal prosecution of physicians who are 22

diagnosing, prescribing and performing medical treatments within their scope of practice; and be it further 23

24

RESOLVED, that MAG oppose legislation that removes a woman’s and couples’ ability to seek and 25

receive infertility treatment and make decisions concerning embryos created as part of that treatment; and 26

be it further 27

28

RESOLVED, that MAG actively support policies and legislation that allow women and families to 29

maintain access to quality health care in Georgia. 30

# # #

REFERENCE COMMITTEE F

Only Resolutions referred to Reference Committee F

RESOLUTION

Resolution: 401F.12

SUBJECT: Resolution to Honor the Achievements and Service of E. M. Molnar Sr., M.D.

SUBMITTED BY: Muscogee County Medical Society

REFERRED TO: Reference Committee F

Whereas, Edmund MacDonald Molnar Sr., M.D., departed this life on February 27, 2012. To most in this 1

room, Dr. Molnar – “Mac” to all he knew – requires little in the way of introduction. A general surgeon, 2

from Columbus, Georgia, Mac was an active advocate for organized medicine throughout his career. Mac 3

towered above us; most obviously in stature, but more so by the example he set; and 4

5

Whereas, Dr. Molnar served our county and state societies in numerous capacities, as well has served for 6

many years as a member of our delegation to the AMA House of Delegates. His distinctive voice heard in 7

so many forums was always a voice of reason and of a calm and measured maturity. Mac was an 8

immediate friend to all whom he met. He was devoted to his patients, and yet balanced his life to be a 9

steadfast husband and father; and 10

11

Whereas, his lasting legacy, among so many he has left us, is his son, E. M. Molnar Jr., M.D., who carries 12

on as a general surgeon in Columbus, and is an active member of Muscogee County Medical Society, the 13

Medical Association of Georgia and MAG’s House of Delegates; and 14

15

Whereas, Mac was an inspiration to us all – a mentor and a friend. We know it would have pleased Mac 16

that this body devotes a moment of reflection of his life and career; now therefore be it 17

18

RESOLVED, that the Medical Association of Georgia (MAG) commends Dr. E.M. “Mac” Molnar Sr. for 19

a life of service to our profession. 20

# # #

REFERENCE COMMITTEE HC

All items of business referred to Reference Committee HC

RESOLUTION

Resolution: 601HC.12

SUBJECT: Accepting Medicaid Payments Under the Patient Protection and Affordable Care

Act (PPACA)


REFERRED TO: Reference Committee HC

Whereas, the Supreme Court has upheld most aspects of the Patient Protection and Affordable Care Act 1

(PPACA); and 2

3

Whereas, one provision of PPACA will give states 100 percent of their Medicaid expenses for the first 4

three years and 90 percent beginning in year four; and 5

6

Whereas, currently Georgia must fund 34 percent of its Medicaid expenses; and 7

8

Whereas, some states have decided to forgo the increased Medicaid funding despite the requirement that 9

the number of people eligible for Medicaid will expand significantly under PPACA; and 10

11

Whereas, the citizens of Georgia will benefit from increased eligibility and from the increased federal 12

funding; now therefore be it 13

14

RESOLVED, that the Medical Association of Georgia urges the governor and General Assembly to 15

accept the Medicaid expansion as proposed under the health care reform law. 16

# # #

RESOLUTION


SUBJECT: CMS Innovation Center



Whereas, the U.S. Congress created the Centers for Medicare and Medicaid Services (CMS) Innovation 1

Center under the 2010 Patient Protection and Affordable Care Act (PPACA); and 2

3

Whereas, the Innovation Center has the authority to test innovative payment and service delivery 4

models as they relate to Medicare, Medicaid and CHIP benefits; and 5

6

Whereas, Congress provided $10 billion in direct funding to support the Innovation Center and its 7

mission; and 8

9

Whereas, the State of Georgia faces substantial challenges in meeting the financial needs of its Medicaid 10

and CHIP programs; and 11

12

Whereas, the CMS Innovation Center has stated that its mission is “better health care, better health and 13

lower cost.”; now therefore be it 14

15

RESOLVED, that the Medical Association of Georgia (MAG) supports the stated goals of the CMS 16

Innovation Center; and be it further 17

18

RESOLVED, that MAG will work with the Georgia legislature and the appropriate Georgia 19

governmental agencies to ensure that Georgia and its citizens receive an appropriate portion of the 20

funding dollars from the Innovation Center to further the health and health care of Georgia citizens in 21

Medicaid and CHIP programs. 22

# # #

RESOLUTION


SUBJECT: Comparative Effectiveness Research



Whereas, the Patient Protection and Affordable Care Act (PPACA) instructs the Centers for Medicare and 1

Medicaid Services (CMS) to develop and implement payment programs that lower cost and improve 2

health care; and 3

4

Whereas, commercial insurers often base payment programs/reimbursement on policies developed by 5

federal agencies; and 6

7

Whereas, comparative effectiveness is likely to be a significant factor in developing reimbursement 8

amounts in payment programs by reimbursing the least costly treatment amongst equally or near equally 9

effective treatments; and 10

11

Whereas, patients increasingly wish to be informed and involved in treatment decisions where alternatives 12

exist amongst several different effective treatments and may have to bear a meaningful portion of the 13

cost; and 14

15

Whereas, comparative effectiveness may augment and assist clinician judgment in selecting treatment 16

plans from amongst several alternatives; and 17

18

Whereas, other methods to achieve payment reform and lower cost are likely to be less attractive to 19

physicians and patients (e.g., SGR); now therefore be it 20

21

RESOLVED, that the Medical Association of Georgia (MAG) urges the American Medical Association 22

to contact the appropriate government agencies to ensure that comparative effectiveness reviews are 23

scientifically valid, objective, clearly indicate the quality of the evidence, are applicable to current clinical 24

practice and specific patients, are reviewed on an annual basis, and that any reimbursement adequately 25

covers the cost of the treatment on a regional basis and is reviewed annually; and be it further 26

27

RESOLVED, that MAG propose legislation that physicians who treat patients based on published 28

comparative effectiveness research and/or those implemented by CMS that such treatment shall constitute 29

an affirmative defense in the event of medical malpractice claims. 30

# # #

RESOLUTION


SUBJECT: Dissolution of Meaningful Change of Independent Payment Advisory Board (IPAB)



Whereas, the provisions of the Patient Protection and Affordable Care Act (PPACA) create an 1

Independent Payment Advisory Board (IPAB) composed of 15 members – only one is designated to be a 2

health care provider (not necessarily a physician) –that shall determine which treatments (diagnostic tests, 3

drug therapies, procedures, surgeries, etc.) will be allowed under the Centers for Medicare and Medicaid 4

Services (CMS) guidelines; and 5

6

Whereas, CMS guidelines are likely to extend to private insurance plans; and 7

8

Whereas, the IPAB panel is authorized to “not cover” and to otherwise restrict access and payment for 9

medical therapies; and 10

11

Whereas, physicians have superior knowledge of these therapies and their benefits to patient care by 12

virtue of their experience with the use of these treatments, their superior knowledge base regarding the 13

conditions treated, and their training to interpret clinical trials and other studies regarding the safety and 14

efficacy of these therapies; and 15

16

Whereas, physicians’ first duty will always be to advocate for and ensure the ability to provide the best 17

care possible for our patients and protect them from harm; now therefore be it 18

19

RESOLVED, that the Medical Association of Georgia (MAG) support legislative efforts on the state and 20

federal levels to dissolve the Independent Payment Advisory Board and retain the right of physicians to 21

determine which therapies are in our patients’ best interests; and be it further 22

23

RESOVLED, that MAG support legislative efforts to ensure significant physician representation on any 24

board or panel given the power to make any determination on provision of patient care and the payment 25

for that care. 26

# # #

RESOLUTION


SUBJECT: Expansion of Medicaid Eligibility

SUBMITTED BY: Maurice Sholas, M.D., Delegate


Whereas, on March 23, 2010, President Barak Obama signed the Patient Protection and Affordable Care 1

Act (PPACA); and 2

3

Whereas, PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the 4

overall costs of health care. It provides a number of incentives, including subsidies, tax credits, and fees, 5

to employers and uninsured individuals in order to increase health insurance coverage. Additional reforms 6

are aimed at improving health care outcomes in the United States while updating and streamlining the 7

delivery of health care. PPACA requires insurance companies to cover all applicants and offer the same 8

rates regardless of pre-existing conditions or gender; and 9

10

Whereas, through PPACA Medicaid eligibility is expanded to include all individuals and families with 11

incomes up to 133 percent of the poverty level along with a simplified CHIP enrollment process; and 12

13

Whereas, the Supreme Court rejected PPACA's premise that the federal government could withhold 14

monies to states if they did not expand Medicaid as such; and 15

16

Whereas, in states that choose to reject the Medicaid expansion, individuals and families at or below 133 17

percent of the poverty line, but above their state's existing Medicaid threshold, will not be eligible for 18

coverage; additionally, subsidies are not available to those below 100 percent of the poverty line. As 19

many states have eligibility thresholds significantly below 133 percent of the poverty line, and many do 20

not provide any coverage for childless adults, this may create a coverage gap in those states; and 21

22

Whereas, as of July 10, 2012, the governors of six states: Georgia, Texas, Florida, Mississippi, Louisiana, 23

and South Carolina, had announced that they would decline to participate in the Medicaid expansion; now 24

therefore be it 25

26

RESOLVED, that the Medical Association of Georgia (MAG) support the expansion of Medicaid 27

eligibility in Georgia to include individuals and families with incomes at or below 133 percent of the 28

poverty level; and be it further 29

30

RESOLVED, that MAG advocate that the state of Georgia accept the federal money allocated for the 31

expansion of Medicaid; and be it further 32

33

RESOLVED, that MAG encourage the governor of Georgia, The Honorable Nathan Deal, to direct 34

appropriate officials to comply with the terms of the Medicaid expansion codified in the Patient 35

Protection and Affordable Care Act (PPACA) of 2010. 36

# # #

RESOLUTION


SUBJECT: Fair Payment to Hospitals for Outcomes



Whereas, the Centers for Medicare and Medicaid Services (CMS) and the United States Department of 1

Health and Human Services (HHS) has arbitrarily denied payment to hospitals for hospital outcomes they 2

have deemed “Never Events;” and 3

4

Whereas, documentation clearly demonstrates that with “Best Practices” care, there will be a certain non-5

zero event rate; and 6

7

Whereas, the patients who “fall out” of the optimal outcomes are often the sickest and medically 8

disadvantaged patients who could suffer decreased access to care due to the financial pressure this places 9

on hospitals that most often serve these patients; and 10

11

Whereas, this expectation of non-achievable outcomes clearly puts at a disadvantage the hospitals (and 12

possibly physicians in the future) by denying payment even when best practices medicine is practiced in 13

that facility and places an unfair and biasing perception to the patient that the physicians associated with 14

that event did not adhere to best practices; now therefore be it 15

16

RESOLVED, that the Medical Association of Georgia support legislation on the state and federal levels 17

that provides payment to hospitals up to the expected event rate that includes language acknowledging the 18

importance of adhering to best practices based upon evidence-based medicine as well as the impossibility 19

of achieving a zero event rate when complying with best practices. 20

# # #

RESOLUTION


SUBJECT: Georgia Health Insurance Exchanges

SUBMITTED BY: Maurice Sholas, M.D., Delegate


Whereas, on March 23, 2010, President Barak Obama signed the Patient Protection and Affordable Care 1

Act (PPACA); and 2

3

Whereas, PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the 4

overall costs of health care. It provides a number of incentives, including subsidies, tax credits, and fees, 5

to employers and uninsured individuals in order to increase insurance coverage. Additional reforms are 6

aimed at improving health care outcomes in the United States while updating and streamlining the 7

delivery of health care. PPACA requires insurance companies to cover all applicants and offer the same 8

rates regardless of pre-existing conditions or gender; and 9

10

Whereas, the Supreme Court upheld the individual mandate, perhaps the most controversial provision of 11

the law, but limited the expansion of Medicaid initially proposed under PPACA. All provisions of 12

PPACA will continue to be in effect, with some limits on the Medicaid expansion; and 13

14

Whereas, on May 23, 2012, the U.S. Department of Health and Human Services (HHS) and the Internal 15

Revenue Service (IRS) issued joint final rules regarding implementation of new state-based health 16

insurance exchanges to cover how the exchanges will determine eligibility for uninsured individuals and 17

employees of small businesses seeking to buy insurance on the exchanges, as well as how the exchanges 18

will handle eligibility determinations for low-income individuals applying for newly expanded Medicaid 19

benefits; and 20

21

Whereas, states must decide whether they’re going to establish their own health insurance exchanges, a 22

key part of PPACA, to give individuals and small businesses better coverage options; and 23

24

Whereas, states have until November 16, 2012 to notify the Centers for Medicare and Medicaid Services 25

(CMS) whether they plan to set up their own exchange. If states do not set up these exchanges, the federal 26

government will do it for them; now therefore be it 27

28

RESOLVED, that the Medical Association of Georgia (MAG) requests that the governor of Georgia, The 29

Honorable Nathan Deal, authorize the creation of a Georgia Health Insurance Exchange in compliance 30

with the Patient Protection and Affordable Care Act; and be it further 31

32

RESOLVED, that MAG requests that the Georgia Health Insurance Exchanges be created in a timely 33

fashion to prevent federal agencies from doing the creation in place of the state; and be it further 34

35

RESOLVED, that MAG directs its delegation to the American Medical Association to introduce or 36

support resolutions that see health insurance exchanges created for all citizens requiring such under the 37

Patient Protection and Affordable Care Act in all states. 38

# # #

RESOLUTION


SUBJECT: Medicaid Expansion

SUBMITTED BY: Troup County Medical Society


Whereas, the Supreme Court of the United States upheld the Patient Protection and Affordable Care Act 1

of 2010 (PPACA) on June 28, 2012; and 2

3

Whereas, the Supreme Court decision also made the expansion of Medicaid to 133 percent of the federal 4

poverty level as set forth by PPACA optional for the individual states (hereafter referred to as “Medicaid 5

expansion”); and 6

7

Whereas, the proposed Health Insurance Exchange will provide options for the purchase of insurance by 8

Georgia citizens who do not have coverage offered through their employer; and 9

10

Whereas, it is unclear whether the individuals targeted under the Medicaid expansion will have an option 11

to obtain health insurance under the potential Health Insurance Exchange; and 12

13

Whereas, the Medicaid expansion would be funded by taxes on corporations and individuals within the 14

state of Georgia, regardless of whether Georgia opts into the Medicaid expansion; and 15

16

Whereas, if Georgia chooses not to participate in the Medicaid expansion, the taxes of Georgia citizens 17

would still fund expansions in other states that chose to expand their state’s Medicaid programs; and 18

19

Whereas, uninsured care in doctor’s offices and in hospitals produces huge financial burdens on 20

Georgia’s health care providers who are already finding difficulty meeting increased expenses with 21

declining reimbursements; and 22

23

Whereas, indigent care funds from Federal revenues are directed to the hospitals to partially offset their 24

unreimbursed care but physicians have no similar offset and no tax breaks to help compensate this 25

overhead expense whatsoever; and 26

27

Whereas, in Troup County we have yearly unreimbursed care (mostly as a result of uninsured individuals 28

accessing our systems) that totals $24 million annually to our local hospital and more than $4 million 29

annually to the local physicians; and 30

31

Whereas, similar figures for unreimbursed care are commonly seen in each county each year throughout 32

the state of Georgia; and 33

34

Whereas, the current funding shortfall of the Georgia Medicaid program is of grave concern and 35

continues to be of concern with future increases in the budget shortfall projected; and 36

37

Whereas, MAG leadership has already been very involved with proposed changes to the state’s Medicaid 38

program to lessen and hopefully eliminate the budget shortfall projected; and 39


2

Whereas, the Medicaid expansion under PPACA will be funded initially100 percent by federal dollars, 1

gradually being reduced to 90 percent by 2020 with the state responsible for 10 percent; now therefore be 2

it 3

4

RESOLVED, that the Medical Association of Georgia (MAG) support the Medicaid expansion offered 5

through PPACA for individuals whose income level does not exceed 133 percent of the federal poverty 6

level; and be it further 7

8

RESOLVED, that MAG support Health Insurance Exchanges outlined in PPACA for low income 9

individuals purchasing health insurance; and be it further 10

11

RESOLVED, that MAG support innovations and modifications of our Georgia Medicaid program to 12

achieve a sustainable solution to the budget shortfalls and expected financial challenges in the years to 13

come. 14

# # #

RESOLUTION


SUBJECT: Reduce Fault Tort Reform



Whereas, the current tort system does not reach the necessary endpoint of properly compensating patients 1

for medical injuries and has not decreased the number of iatrogenic injuries; and 2

3

Whereas, the current tort system creates an environment that stifles reporting of medical errors and the 4

education and data collection needed for a strong quality and patient safety focus; and 5

6

Whereas, 80 percent of legitimate medical injuries are not properly compensated; and 7

8

Whereas, the poor, minorities and women are less likely to have access to the medical liability system; 9

and 10

11

Whereas, the current tort system is estimated to cost the health care system $650 billion in unnecessary 12

costs arising from the practice of defensive medicine; and 13

14

Whereas, patients only receive 35 percent of the premium with 40 percent going to attorney’s fees and 15

costs; and 16

17

Whereas, the current tort system is based upon a shame and blame system that pits patients against their 18

physician; and 19

20

Whereas, the current tort system takes two to five years to reach a conclusion; and 21

22

Whereas, while caps on damages have helped control medical malpractice insurance premiums, they do 23

not address physicians’ aversion to litigation nor have they proved very successful in controlling overall 24

health care costs; now therefore be it 25

26

RESOLVED, that the Medical Association of Georgia’s Board of Directors evaluate an alternative to the 27

current tort system – looking to the Patient Compensation System as a potential replacement, where 28

adjudication of medical malpractice claims are moved to an administrative system composed of an 29

independent medical review panel, a compensation department to determine actuarial-based 30

compensation packages, an administrative law judge ensuring fairness in the process and a quality 31

improvement department to consolidate data in order to better delineate correctable medical errors to 32

improve the practice of medicine – and bring a policy position resolution to the 2013 House of Delegates. 33

# # #

RESOLUTION


SUBJECT: State Health Insurance Exchange Reimbursement Rates



Whereas, the Patient Protection and Affordable Care Act (PPACA) of 2010 requires states to develop 1

insurance exchanges to provide uninsured patients with access to health care coverage through a sole 2

source or the U.S. Department of Health and Human Services (HHS) will develop an exchange for 3

Georgia residents; and 4

5

Whereas, Medicaid and Medicare payments pay less than the cost of care and many insurance companies 6

would like to tie the payments to providers based on those payment rates; and 7

8

Whereas, a federally established alternative exchange may set payment rates based on Medicaid and 9

Medicare rates; now therefore be it 10

11

RESOLVED, that the Medical Association of Georgia support a state-developed health care insurance 12

exchange that includes physicians and health systems in the development, execution, and governance of 13

the exchange and that insurance companies participating in the exchange reimburse physicians at their 14

normally contracted rate. 15

# # #

RESOLUTION


SUBJECT: Support for the Medicaid Expansion Under the Patient Protection and Affordable

Care Act (PPACA)

SUBMITTED BY: Georgia Chapter, American College of Physicians


Georgia Obstetrical and Gynecological Society

Georgia Chapter, American Academy of Pediatrics

Georgia Osteopathic Medical Association


Whereas, the 2012 federal poverty level for a family of four is $23,050 and the Department of 1

Community Health estimates that 600,000 additional Georgians would be eligible for Medicaid under the 2

expansion to cover 133 percent of the federal poverty level; and 3

4

Whereas, individuals below 100 percent of the Federal Poverty Level targeted under the Medicaid 5

expansion currently under the PPACA law will NOT have access to health insurance under the Health 6

Insurance Exchanges; and 7

8

Whereas, uninsured care in doctor's offices and in hospitals produce huge financial burdens on Georgia's 9

physicians and health care providers who are already finding difficulty meeting increased expenses with 10

declining reimbursements; and 11

12

Whereas, indigent care funds from the federal revenues are directed to the hospitals to offset their 13

unreimbursed care but physicians have no similar offset and no tax breaks to help compensate this 14

overhead expense whatsoever; and 15

16

Whereas, taxes will be levied on corporations and individuals within the state of Georgia to fund the 17

Medicaid expansion by federal law and these tax dollars will be sent to fund other states' Medicaid 18

expansion with NO benefit to the citizens of Georgia; now therefore be it 19

20

RESOLVED, that the Medical Association of Georgia support the Medicaid expansion in Georgia offered 21

through PPACA for the benefit of our patients, our member physicians, our hospitals, and our 22

communities in accordance with our MAG Mission to "Enhance patient care and the health of the public 23

by advancing the art and science of medicine and by representing physicians and patients in the policy-24

making process." 25

# # #

RESOLUTION


SUBJECT: MAG to Support Legislation to Adopt Clinical Algorithms

SUBMITTED BY: Charles Wilmer, M.D., Delegate


Whereas, the Science of Medicine is constantly changing; and 1

2

Whereas, the body of knowledge required to practice medicine has grown exponentially; and 3

4

Whereas, doctors may determine improved algorithms that lead to the enhancement of patient care, and 5

6

Whereas, the “standard of care” is not always clear to the active medical staff; and 7

8

Whereas, comparative effectiveness may augment and assist clinical judgment in selecting treatment 9

plans from amongst several alternatives; now therefore be it 10

11

RESOLVED, that the Medical Association of Georgia (MAG) support legislation that Clinical 12

Algorithms drawn up and agreed upon by the medical staff of a hospital may serve as the “standard of 13

care” for physicians of that hospital; and be it further resolved 14

15

RESOLVED, that MAG support legislation that use of an algorithm is one way to meet the “standard of 16

care” but not the only way; and be it further resolved 17

18

RESOLVED, that MAG support legislation that these agreed upon algorithms would stand the test of the 19

“community standard of care” in a legal malpractice suit. Doctors who follow these algorithms would be 20

innocent of malpractice and such treatment shall constitute as affirmative defense in the event of medical 21

malpractice claims; and be it further resolved 22

23

RESOLVED, that MAG support legislation that if a physician practices at a hospital without an adopted 24

algorithm for a disease process and uses an algorithm adopted at another hospital or clinical society for 25

that process that the above protection applies to that physician. 26

# # #

RESOLUTION


SUBJECT: Relax Criteria for Attainment of Meaningful Use

SUBMITTED BY: Richmond County Medical Society


Whereas, an April 2012 Health Affairs article indicated that about half of all eligible office-based 1

physicians intended to apply for either the Medicare or Medicaid meaningful use incentives, while only 2

11 percent of physicians surveyed intended to apply for incentives and had electronic health records 3

(EHR) capable of meeting all of the required meaningful use program measures; and 4

5

Whereas, physicians are facing technological and other challenges in meeting all of the required 6

meaningful use program measures; and 7

8

Whereas, EHRs have not improved efficiency, productivity, quality or communication; and 9

10

Whereas, this coupled with the fact that physicians are faced with an initial expense and a monthly fee in 11

the face of declining income, physicians spend more time on the record than on the patient, the record is 12

not user friendly and older physicians will be driven into retirement; now therefore be it 13

14

RESOLVED, that the Medical Association of Georgia encourage the American Medical Association to 15

continue its efforts in getting the Centers for Medicare and Medicaid Services to relax the criteria for 16

attainment of meaningful use. 17

# # #

Documents

CONSENT CALENDAR Policies that are 5-years or older ...€¦ · CONSENT CALENDAR Policies that are 5-years or older reviewed for 1. Reaffirmation 2. Sunset 3. ... states without specific