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1 AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

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4 Resolution: 202
5 (A-09)
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7Introduced by: Florida Delegation
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9Subject: Federal EMR Incentive Program Is Non-Compliant With AMA’s Principles
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11Referred to: Reference Committee B
12 (Monica C. Wehby, MD, Chair)
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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
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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
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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
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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
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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
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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)
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47Fiscal Note: Implement accordingly at estimated staff cost of $4,580.
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49Received: 05/06/09
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 3 Resolution: 202 (A-09)
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1RELEVANT AMA POLICY
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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)
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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)
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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 H-
27450.947. 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-for-
32performance 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)
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