To Ensure Society a Seat on Highly Influential AMA Panels,
AGS Urges Its Physician Members to Join AMA

By Peter Hollmann, MD

AGS' seat in the American Medical Association's (AMA's) House of Delegates (HOD) -- the representative policy-setting body for America's broadest medical professional organization -- is in jeopardy. That threatens to weaken the ability of AGS to influence decisions regarding Medicare reimbursement, the development of clinical performance measures, and outcomes reporting tools for physicians.

At least 1,000 of AGS' physician members must belong to the AMA for the Society to retain its seat in the HOD. The Society just makes the cutoff for its HOD seat, which Charles Cefalu, MD, now holds. (See related story) The association will review the Society's eligibility for its HOD seat at its interim 2010 meeting and it is crucial that the AGS continue to have 1,000 AMA members.

The benefits of a seat in the HOD are tremendous. In a variety of ways, representation on the HOD enhances AGS' ability to advocate for policies and initiatives that support quality healthcare for older adults.

Why it matters:

HOD membership is required for a society to nominate members to the RUC and influence CPT
The Centers for Medicare and Medicaid Services (CMS) regularly considers recommendations from the AMA's Resource-Based Value Scale Update Committee (RUC) when creating the physician fee schedule for new and revised Current Procedural Terminology (CPT) codes. CMS has historically accepted 90% or more of the RUC's recommendations. CPT creates new and revised service descriptions, a process that is important in creating payment methodologies for the evolving healthcare system.

Our memberships have played important roles
Geriatrics has occupied a RUC rotating "medicine" seat in four of the last six years and will be eligible again in 2010. Meghan Gerety, MD, held the seat and also chaired the five-year review that resulted in the greatest boost in evaluation and management (E/M) code valuations since their creation. Dr Gerety is now the RUC advisor (a nonvoting position) and Alan Lazaroff, MD, is alternate advisor.

In 2003, I, became the first AGS nominee appointed to the CPT Editorial Panel. I was subsequently appointed the panel's Vice Chair. Thanks to AGS' seat on the HOD, the society also gets a spot on the CPT Advisory Committee, which supports and advises the Editorial Panel. Robert Zorowitz, MD, is a member of the CPT Advisory Committee. CPT recently revised the nursing facility codes to better recognize the work of caring for more complex nursing facility patients.

A seat on the HOD affords AGS yet another benefit -- a seat and a vote on the AMA's Physician Consortium for Performance Improvement (PCPI). The Consortium is charged with developing both clinical performance measures and outcomes reporting tools for physicians. The PCPI created geriatric measures with AGS leadership.

We need to be part of the process
By participating, AGS helps improve the processes involved in payment. We learn how to succeed and make important partnerships that increase the influence of our smaller specialty. AGS' work with the Academy of Homecare Physicians -- to understand how the CMS review processes could be used to improve payment to homecare -- provides a good example. Reforming payment is a long-term process and takes a long-term investment, which AGS and its volunteers are making. That investment is already paying off, with AGS members annually benefiting from these recent changes at a level that is far higher than the cost of their AGS memberships and the cost of an AMA membership.

Can we trust the AMA?

AGS is not asking members to trust anyone, but it is important to recognize how far the AMA has come in more recent years. The HOD has strong representation by women, young physicians and international medical graduates. Addressing the needs of an aging population is part of the AMA's strategic plan. AGS regularly partners with the AMA in efforts to prevent ill-advised regulation and to eliminate the Sustainable Growth Rate formula and continuous threats of Medicare fee cuts. AGS has achieved positions of influence in the AMA and will work with the AMA to promote the importance of all members of the healthcare team.

AGS' Board leads the way:

Many physician members of the AGS Board have shown their commitment by joining the AMA, some, for the first time.

"Having representation on the RUC and other AMA panels benefits our patients and our field," says AGS President John Murphy, MD. "So I urge our members who are physicians, and therefore eligible to join the AMA, to do so in order to ensure that AGS retains its seat in the House of Delegates and the many benefits that accompany it."

How Seats on the RUC Are Allocated
Twenty-three of the 29 members of the American Medical Association's (AMA's) Resource-Based Value Scale Update Committee (RUC) are appointed by major national medical specialty societies. These societies include: those recognized by the American Board of Medical Specialties; those with a high percentage of physicians in patient care; and those whose members provide services that account for a high percentage of Medicare expenditures. The remaining six seats are held by the RUC Chair, the Co-Chair of the RUC Health Care Professionals Advisory Committee Review Board, and representatives of the AMA, American Osteopathic Association, the Chair of the Practice Expense Review Committee and Current Procedural Terminology (CPT) Editorial Panel.

Of the 23 RUC seats to which major national medical specialties appoint representatives, three seats rotate every two years. Two of these three "rotating seats" are reserved for an internal medicine subspecialty, and the other is open to any other specialty. Geriatrics will next be eligible for a seat on the committee in 2010.

Cefalu Follows Keenan as AGS' Member of AMA House of Delegates
Charles Cefalu, MD, was appointed the AGS' representative to the American Medical Association's (AMA's) House of Delegates (HOD) in May. Dr. Cefalu took the reins from Joe Keenan, MD, who represented the Society on the highly influential panel for the preceding nine years.

On behalf of AGS, Dr. Cefalu presented a resolution during the HOD's June meeting calling on the AMA to join specialty societies in reviewing the recent Institute of Medicine (IOM) report recommending immediate action to prepare the US workforce for the coming Age Boom. The HOD approved the resolution, which also calls on the AMA to work with specialty societies to draft suggestions, this year, for supporting and implementing key recommendations in the IOM's Retooling for an Aging America: Rebuilding the Healthcare Workforce.

AGS thanks both Drs. Keenan and Cefalu for their time and efforts representing AGS on this important panel. We know the strong voice of Dr. Cefalu will help to positively shape the debate that occurs on issues of importance to us when they are discussed in the House.