Representation of the ASNR in the AMA House of Delegates at Risk

Arliss Pollack; Pat Turski

Beginning in 1993, the ASNR worked aggressively to gain a seat in the AMA House of Delegates. The process was arduous and was only successful after 3 years of data collection, reapplications, membership recruitment, and debate. Fortunately, persistence was rewarded and in 1996 the ASNR gained a seat in the AMA House of Delegates and access to several key committees of the AMA such as the Current Procedural Terminology editorial panel (CPT), the Practice Expense Advisory Committee (PEAC), and the Resource-based Relative Value System Update Committee (RUC). Over the years access to these committees has allowed the ASNR to comment on CMS decisions, advocate for new CPT codes, develop and participate in RUC surveys, and testify at RUC committee deliberations.

In many instances, this advocacy has resulted in a positive outcome. For example, when the MRA head and neck codes were revised, the ASNR played a key role in the development of the codes, conducted surveys, and represented neuroradiology during the deliberations at the RUC committee. When confronted with the requirement to divide this code into 6 codes, we faced the possibility of having the one code for head and neck simply divided by 6 to satisfy the CMS goal of revenue neutrality. This would have devastated reimbursement for MRA, and we fought vigorously to get it classified as new work so it would not have to be revenue neutral. In another instance when the MR codes were divided into without, with, and without/with contrast, society representatives at the RUC worked tirelessly to assure proper valuation. The ASNR contributes to the development of many codes and provides much needed perspective regarding the importance and complexity of imaging procedures. The fMRI codes are currently under development and will be considered at the February 2006 RUC committee. Without the society’s input, there is significant risk that new procedures such as fMRI could be undervalued.

In 2006, the ASNR will need to recertify with the AMA to retain its seat in the AMA House of Delegates. One of the key elements in the AMA recertification process is the requirement that 35% of a specialty society’s senior members hold membership in the AMA. Currently, only 25% of ASNR senior members are members of the AMA, thus placing the society at significant risk of losing representation on important committees. This is a real threat and at least one society has lost its seat in the last year. There are many specialty societies that would like to have a seat in the AMA House of Delegates and are waiting for an opportunity to fill a vacant seat. The original ASNR approval occurred during a time when the AMA was receptive to expanding seats to accommodate specialty societies—this may not be the case in the future. If the ASNR seat is lost, it will be very difficult, if not impossible, to regain the level of representation and advocacy that we currently have within the large economic landscape of organized medicine. If our representation is lost, who will advocate for new codes that impact the practice of neuroradiology?

The need for representative advocacy has never been greater. A current example is the across-the-board 4.4% reduction in 2006 and a potential 26% reduction over the next 5 years in physician Medicare payments unless new legislation is approved overriding this reduction. The AMA, in concert with state chapters and specialty societies, leads the process and has worked with Congress to introduce new legislation to modify the current law and reduce or eliminate the reduction. The AMA is pursuing a series of regulatory changes that will also reduce the effects of the proposed cuts in physician payments. The AMA is aggressively pressing Congress and the Administration to reduce costly and counterproductive regulatory burdens and halt unfunded mandates. Your membership in the AMA will add support to these important economic initiatives.

Another of the AMA top priorities is medical liability reform. Many states are facing a malpractice crisis and the AMA has worked closely with state chapters to develop a rational approach to medical liability reform. A recent example is the December 1, 2005 meeting of the AMA with the Washington, DC, city council in which testimony clearly showed that the growing medical liability problem threatens patients’ access to health care due to the relocation of physicians outside of the city. The AMA assisted local physicians in staging a rally on the steps of the John Wilson Building. Meaningful liability reform will require major effects at the state and national levels. The AMA is the only organization with the resources to advocate for new legislation and change.

The ASNR needs a close relationship with the AMA to maintain socio-economic collaborations. Negotiations regarding codes and relative value units are conducted through AMA committees. Issues of safety, quality, and utilization are now being addressed within the AMA. Without the participation of ASNR representatives there is a risk that neuroradiology procedures will be undervalued, misrepresented, or inappropriately categorized. The AMA is working to enact legislation to promote voluntary reporting systems for improving patient care with effective confidentiality protections. It is also advocating for a fair and balanced framework for implementation of public and private quality improvement initiatives and developing clinical performance measures for treating disease. The ASNR needs to be a part of these discussions and provide leadership in how imaging procedures are integrated into these programs.

Other AMA initiatives include building public support for tax credits and insurance market reforms that move toward a system of personalized health insurance. The AMA has called for a number of managed care reforms to restore balance and fairness to the system, including strengthening state-managed care laws.

The ASNR clinical practice committees are organized to interface with many national initiatives. Committees for Standards and Guidelines, Coding and Reimbursement, Credentials and Contracts, Government Relations, and Utilization have been developed to support the society in socio-economic issues such as quality, safety, and Medicare coverage. Recently, the ASNR established a closer relationship with the ACR Commission for Neuroradiology, thus enhancing access to advocacy activities sponsored by the ACR. The impact of the ASNR efforts is greatly amplified by collaborations with partners such as the ACR and AMA.

We strongly encourage you to maintain, renew or initiate membership in the AMA to provide the ASNR with the broadest possible options for collaboration and advocacy on socio-economic issues. For AMA membership information you can go directly to https://membership.ama-assn.org/JoinRenew/ or call 800-262-3211.