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 Battle Engaged: MD Specialists Promote Repeal of Non-Discrimination Toward Licensed Integrative Practitioners, Others, in Section 2706 of Reform Bill 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: The ink is hardly dry on the landmark Non-Discrimination in Health Care provision (Section 2706) of the Patient Protection and Healthcare Affordability Act, and MD specialists are pushing its repeal. Anesthesiologists and ophthalmologists have asked the AMA to initiate a major lobbying campaign at the executive, Congressional and grassroots levels. The request is framed as part of the AMA's ongoing Scope of practice partnership against other professions. Section 2706 is healthcare reform's most significant inclusiveness measure for DCs, NDs, LAcs, massage therapists and licensed midwives, potentially opening consumer choice to over 50-million more Americans. In the name of patient protection, the two AMA specialty societies are targeting their direct competitors, nurse anesthetists and optometrists. Here is the proposed Resolution as it will go to the AMA House of Delegates in June 2010.

See list below of related Integrator articles on the AMA's campaign
for discrimination against other professions.

Huge dollars at stake in campaign to repeal non-discrimination
The battle over the value of the Patient Protection and Affordable Healthcare Act (PPAHA) has quickly come home for licensed integrative practitioners and all other non-MD providers. Ophthalmologists and anesthesiologists have proposed a resolution to the House of Delegates of the American Medical Association to repeal
Section 2706: Non-Discrimination in Health Care of the PPAHA. The proposed resolution urges the AMA to:
" ... immediately condemn and work to repeal new Public Health Service Act Section 2706, the so-called provider 'Non-Discrimination in Health Care.'"
The means to this end recommended in the resolution include lobbying of members of Congress and leaders of federal agencies. The resolution also recommends a "grassroots lobbying" effort among its specialist members. (These "grassroots" anesthesiologists average $311,600 to $446,994 per year and "grassroots" ophthalmologists average $349,766.) Their pro-discrimination resolution is printed in full below and is available online here.

Section 2706 is a landmark law for chiropractors, naturopathic physicians, acupuncturists, massage therapists and midwives. Nurse anesthetists and optometrists, the targeted competitors of the two AMA specialties, are among the other allied health fields for whom the playing field would begin to be leveled by Section 2706. The section states, in part:
"A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law."
The full language is printed here under "Section 2706: Non-Discrimination in Health Care." An oral analysis of the meaning of this law's critical importance to consumers, chiropractors and other integrative practitioners is available here. In that short You Tube-available examination of PPAHA, the chiropractic lobbyist notes that over 50-million US employees in self-funded plans will be guaranteed the choice of chiropractors and other licensed integrative practitioners when (if) Section 2706 is implemented.

ImageThe anesthesiologists and ophthalmologists propose that leadership in this re-discrimination campaign come through the AMA Scope of Practice Partnership (AMA SOPP), a campaign that began in 2006 to ensure continuing discrimination against other providers. The AMA has engaged the campaign under the umbrella of patient protection. The AMA House of Delegates is expected to consider the proposal at their June 2010 regular meeting. A series of Integrator articles on the AMA SOPP are noted below.
Comment: First, the Resolution has not yet passed, though it is expected to be approved. Let hope spring eternal that the AMA will find other priorities. Perhaps the AMA's higher self will decide that the lack of harm from the non-MD practitioners means they needn't heed the worrying and whining from the anesthesiologists and ophthalmologists.
The good news is that two coalitions are in place that might lead the effort against re-segregation and continuing discrimination. These the Integrated Healthcare Policy Consortium and the Coalition for Patients Rights. As of yet however, neither has yet shown the horsepower, capital or commitment to take on this kind of sustained effort. In the case of CPR, tio do so would means a shift of focus away from states to the federal level. For IHPC, which is showing signs of ramping up its ability to lead such a campaign, the main issue is whether the professions, institutions, individuals and agencies from related fields will gather around and ante-in. IHPC's "grassroots" are not made of practitioners who average $350,000 of income a year.

An Integrator reader on the AMA's ongoing pro-discrimination campaign:



Resolution: ASA 1

Introduced by: American Society of Anesthesiologists

American Academy of Ophthalmology

Subject: Averting a Collision Course Between New Federal Law and Existing State Scope of Practice Laws

Referred to: Reference Committee __________
(__________, Chair)

Whereas, Scope of practice and regulation of medicine and paraprofessionals remains and should remain the purview of the individual states in keeping with our existing AMA policy; and

Whereas, The recent enactment of Federal health reform through the "Patient Protection and Affordable Care Act (PPACA)" contains troubling language that upsets this dynamic balance; and

Whereas, PPACA specifically contains language that amended the Public Health Service Act by addition of new Section 2706 that will prevent health plans in 2014 and thereafter from differentiating among licensed and certified health professionals with regard to health plan participation or coverage; and

Whereas, ASA, a large number of state medical and national medical specialty societies and our AMA opposed this language in various ways and its inclusion in PPACA, and despite our efforts and protests it was enacted; and

Whereas, Our AMA was the leading stakeholder in keeping this ill-advised language out of the "Patients' Bill of Rights" over a decade ago; and

Whereas, This new Federal law could trump existing state laws and create massive confusion, patient safety issues and waste scarce health care dollars by patients seeking and being subjected to inappropriate or unproven treatments; and

Whereas, The Department of Health and Human Services may or may not promulgate regulations on this matter based on the enactment of the new PPACA law; therefore be it

RESOLVED, That our American Medical Association immediately condemn and work to repeal new Public Health Service Act Section 2706, so-called provider "Non-Discrimination in Health Care," as enacted in PPACA, through active direct and grassroots lobbying of and formal AMA written communications and/or comment letters to the Secretary of Health and Human Services and Congressional leaders and the chairs and ranking members of the House Ways and Means and Energy and Commerce and Senate Finance Committees (Directive to Take Action); and be it further
Resolution: ASA 1

RESOLVED, That our AMA place repeal of new Public Health Services Act Section 2706 as an active agenda discussion and strategy item of each meeting or telephone conference of the Scope of Practice Partnership and provide regular updates to our AMA members on progress toward this end. (Directive to Take Action)
Fiscal Note:
Received: 5/13/10


H-35.973 Scopes of Practice of Physician Extenders - Our AMA supports the formulation of clearer definitions of the scope of practice of physician extenders to include direct appropriate physician supervision and recommended guidelines for physician supervision to ensure quality patient care. (Res. 213, A-02)

H-160.936 Comprehensive Physical Examinations by Appropriate Practitioners - AMA policy supports the position that performance of comprehensive physical examinations to diagnose medical conditions be limited to licensed MDs/DOs or those practitioners who are directly supervised by licensed MDs/DOs; and the AMA will actively work with state medical societies and medical specialty associations, both in the courts and in the legislative and regulatory spheres, to oppose any proposed or adopted law or policy that would inappropriately expand the scope of practice of practitioners other than MDs/DOs. (Sub. Res. 210, I-96; Reaffirmed: BOT Rep. 34, A-06; Reaffirmed in lieu of Res. 235, A-09)

H-275.973 State Control of Qualifications for Medical Licensure - (1) The AMA firmly opposes the imposition of federally mandated restrictions on the ability of individual states to determine the qualifications of physician candidates for licensure by endorsement. (2) The AMA actively opposes the enactment of any legislation introduced in Congress that promotes these objectives. (Res. 84, I-87; Reaffirmed: Sunset Report, I-97; Reaffirmed: CME Rep. 2, A-07)

H-275.975 Qualifications of Health Professionals - (1) Private certifying organizations should be encouraged to continue certification programs for all health professionals and to communicate to the public the qualifications and standards they require for certification. Decisions concerning recertification should be made by the certifying organizations. (2) Working with state licensing and certifying boards, health care professions should use the results of quality assurance activities to ensure that substandard practitioner behavior is dealt with in a professional and timely manner. Licensure and disciplinary boards, in cooperation with their respective professional and occupational associations, should be encouraged to work to identify "deficient" health care professionals. (BOT Rep. NN, A-87; Reaffirmed: Sunset Report, I-97; Reaffirmed: CME Rep. 2, A-07)

H-405.969 Definition of a Physician - 1. The AMA affirms that a physician is an individual who has received a "Doctor of Medicine" or a "Doctor of Osteopathic Medicine" degree or an equivalent degree following successful completion of a prescribed course of study from a school of medicine or osteopathic medicine. 2. AMA policy requires anyone in a hospital environment who has direct contact with a patient who presents himself or herself to the patient as a "doctor", and who is not a "physician" according to the AMA definition above, must specifically and simultaneously declare themselves a "non-physician" and define the nature of their doctorate degree. 3. Our AMA actively supports the Scope of Practice Partnership in the Truth in Advertising campaign. (CME Rep. 4-A-94; Reaffirmed by Sub. Res. 712, I-94; Reaffirmed and Modified: CME Rep. 2, A-04; Res. 846, I-08; Reaffirmed in lieu or Res. 235, A-09; Reaffirmed: Res. 821, I-09; Appended: BOT Rep. 9, I-09)

D-275.979 Non-Physician "Fellowship" Programs - Our AMA will (1) in collaboration with state and specialty societies, develop and disseminate informational materials directed at the public, state licensing boards, policymakers at the state and national levels, and payers about the educational preparation of physicians, including the meaning of fellowship training, as compared with the preparation of other health professionals; and (2) continue to work collaboratively with the Federation to ensure that decisions made at the state and national levels on scope of practice issues are informed by accurate information and reflect the best interests of patients. (CME Rep. 4, I-04)

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Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
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