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1 1 AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES 2 3 4 Resolution: 202 5 (A-09) 6 7Introduced by: Florida Delegation 8 9Subject: Federal EMR Incentive Program Is Non-Compliant With AMA’s Principles 10 11Referred to: Reference Committee B 12 (Monica C. Wehby, MD, Chair) 13 14 15Whereas, Congress passed the American Recovery and Reinvestment Act in 2009 (ARRA) and 16the act includes “incentive payments” for physicians who “voluntarily” implement electronic 17medical records (EMR) in their medical practice as “meaningful users” defined by the Secretary 18of DHSS and would impose financial penalties on practices that do not comply; and 19 20Whereas, The ARRA EMR program is most properly classified as a Pay for Performance (PFP) 21program where an incentive/penalty model is used to increase compliance with a structural 22measure; and 23 24Whereas, Using AHRQ data, the independent consulting firm Avalere Health LLC estimated in 25March 2009 that the cost of implementation of EMR’s to a physician practice over five years 26exceed the incentive payment contemplated for physicians practices by up to $80,000 and 27estimated that operating under a penalty would result in a loss of $42,500 28http://www.avalerehealth.net/wm/show.php?c=1&id=808); and 29 30Whereas, The data from such EMR’s is planned to be used for performance measurement, 31public reporting and “value based purchasing programs” by third party payers including 32Medicare and the benefits to patients of widespread implementation of EMR’s has not been 33established and risks to patients and medical practices for participation do exist; therefore be it 34 35RESOLVED, That our American Medical Association finds that the Electronic Medical Record 36(EMR) incentive program passed in the American Recovery and Reinvestment Act of 2009 37undermines the economic viability of non-participating physicians by failing to provide payments 38to non-participating doctors, by financially penalizing non-participating doctors, and by providing 39inadequate funds to cover the costs of implementation in physician practices (Directive to Take 40Action); and be it further 41 42RESOLVED, That our AMA Board of Trustees communicate to the federal government that the 43Electronic Medical Record (EMR) incentive program should be made compliant with AMA 44principles by removing penalties for non-compliance and by providing inflation-adjusted funds to 45cover all costs of implementation and maintenance of EMR systems. (Directive to Take Action) 46 47Fiscal Note: Implement accordingly at estimated staff cost of $4,580. 48 49Received: 05/06/09 50

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3 Resolution: 202 (A-09) 4 Page 2 5 6 1RELEVANT AMA POLICY 2 3H-450.944 Protecting Patients Rights - Our AMA opposes Medicare pay-for-performance 4initiatives (such as value-based purchasing programs) that do not meet our AMA’s "Principles 5and Guidelines for Pay-for-Performance," which include the following five Principles: (1) ensure 6quality of care; (2) foster the patient/physician relationship; (3) offer voluntary physician 7participation; (4) use accurate data and fair reporting; and (5) provide fair and equitable program 8incentives. (Sub. Res. 902, I-05; Reaffirmation A-06; Reaffirmation I-06; Reaffirmation A-07) 9 10D-450.981 Protecting Patients Rights - Our AMA will: (1) continue to advocate for the repeal 11of the flawed sustainable growth rate formula without compromising our AMA’s principles for 12pay-for-performance; (2) develop a media campaign and public education materials to teach 13patients and other stakeholders about the potential risks and liabilities of pay-for-performance 14programs, especially those that are not consistent with AMA policies, principles, and guidelines; 15and (3) provide a report back to the House of Delegates at its 2006 Annual Meeting. (Sub. Res. 16902, I-05; Reaffirmation A-06; Reaffirmed per BOT Action in response to referred for decision 17Res. 236, A-06; Reaffirmation I-06; Reaffirmation A-07) 18 19H-450.941 Pay-For-Performance, Physician Economic Profiling, and Tiered and Narrow 20Networks - 1. Our AMA will collaborate with interested parties to develop quality initiatives that 21exclusively benefit patients, protect patient access, do not contain requirements that permit third 22party interference in the patient-physician relationship, and are consistent with AMA policy and 23Code of Medical Ethics, including Policy H-450.947, which establishes the AMA’s Principles and 24Guidelines for Pay-for-Performance and Policy H-406.994, which establishes principles for 25organizations to follow when developing physician profiles, and that our AMA actively oppose 26any pay-for-performance program that does not meet all the principles set forth in Policy H27450.947. 2. Our AMA strongly opposes the use of tiered and narrow physician networks that 28deny patient access to, or attempt to steer patients towards, certain physicians primarily based 29on cost of care factors. 3. Our AMA pledges an unshakable and uncompromising commitment 30to the welfare of our patients, the health of our nation and the primacy of the patient-physician 31relationship free from intrusion from third parties. 4. Because there are reports that pay-for32performance programs may pose more risks to patients than benefits, our AMA will prepare an 33annual report on the risks and benefits of pay-for-performance programs, in general and 34specifically the largest programs in the country including Medicare, for the House of Delegates 35over the next three years, beginning at the 2007 Interim Meeting. This report should shall clearly 36delineate between private pay-for-performance programs and voluntary public pay-for-reporting 37and other related quality initiatives. 5. Our AMA will continue to work with other medical and 38specialty associations to develop effective means of maintaining high quality medical care which 39may include physician accountability to robust, effective, fair peer review programs, and use of 40specialty-based clinical data registries. 6. As a step toward providing the Centers for Medicare 41and Medicaid Services (CMS) with data on special populations with higher health risk levels and 42developing variable incentives in achieving quality, our AMA will continue to work with CMS to 43encourage and support pilot projects, such as the Physician Quality Reporting Initiative (PQRI), 44by state and specialty medical societies that are developed collaboratively to demonstrate 45effective incentives for improving quality, cost-effectiveness, and appropriateness of care. 7. 46Our AMA will advocate that physicians be allowed to review and correct inaccuracies in their 47patient specific data well in advance of any public release, decreased payments, or forfeiture of 48opportunity for additional compensation. (BOT Rep. 18, A-07; Reaffirmed in lieu of Res. 729, 49A-08) 50 51 7