Medpagetoday.com reports on the AMA Delegates convention happening this week.

In a report FILED HERE the article reports that "it is unethical for physicians to self-refer to facilities where they have a financial stake unless they spell it all out to their patients, according to an opinion adopted this week by the American Medical Association's policy-making House of Delegates." Said the chair of the AMA Council on Ethical and Judicial Affairs "business arrangements among physicians can benefit patients, they also 'can be ethically challenging when they create opportunities for self-referral in which patients' medical interests can be in tension with the physicians' financial interests.'  Transparency is vital to keeping these relationships ethical..."

"The main thing when you talk about self-referral is that you're transparent. You let your patients know you have a financial interest. You also make sure the patient's interest is the first interest…and not your financial interest," said on doctor.

"By law, physicians cannot be a part of a self-referral agreement to a facility that requires the physician to refer patients as a condition of participation in the agreement, or one that prohibits the physician from referring patients to outside facilities."

The AMA report "instructs physicians to disclose to their patients any financial interest in the facility, product, or equipment, which is consistent with the law. The ethics guideline goes a bit further and advises physicians to 'assure [patients] that their ongoing care is not conditioned on accepting the recommending referral'."

"'This will protect patients from physicians who refer to only their self-owned facilities,' said one doctor. The 1972 federal Anti-Kickback Statute and the 1989 "Stark Law" prohibits physicians from receiving anything of value from referring patients to other facilities."

Another AMA opinion outlined an ethical manner in which to use secret shoppers, by making them "not-so-secret-shoppers". "It would have found the practice ethical if physicians were alerted in advance that their office or hospital would be "shopped," and if physicians were given a choice to opt out of the exercise. Physicians debating the issue at a reference committee hearing were largely critical of the practice of secret shoppers, and said that their use 'is a deceptive practice' and 'takes valuable resources away from patients, especially in emergency department settings'."

In another REPORT FILED HERE it is reported that "the American Medical Association wants third-party payers to put the brakes on pay-for-performance initiatives until there is evidence that such plans benefit patients.  Moreover, after five hours of debate -- often over the addition or deletion of a single word -- the AMA's House of Delegates said that it will "actively oppose" any pay-for-performance programs that do not meet the AMA's five pay-for-performance principles."

"Adopted in 2005, those principles specify that programs should ensure quality of care, foster the patient/physician relationship, offer voluntary physician participation, use accurate data and fair reporting, and provide fair and equitable program incentives."

"The number of pay-for-performance programs, which provide monetary bonuses to participating physicians who make progress in achieving specific quality or efficiency benchmarks, has increased significantly over the last four years -- from 35 plans in 2003, to 130, for a growth rate of 271%, according to one report. By 2008, it's estimated that there will be more than 160 pay-for-performance programs covering services provided to an estimated 85 million patients."

"…by adding the word "actively" the delegates authorized the AMA to mount opposition against any plan, anywhere that did not meet the standards."

"Typically, the national organization does not interfere in state issues unless invited to do so by the state society….the delegates' decision to ignore that tradition signals their frustration with the way in which pay for performance is being implemented by private insurers and concern that the Centers for Medicare and Medicaid Services (CMS) will also "use pay for performance to cut costs rather than improve quality."

One delegate "repeatedly urged the delegates to refrain from putting too many limits on what the AMA leadership could do in attempting to negotiate pay-for-performance plans with payers.  Too many restrictions, he said, would mean that the AMA would "lose our seat at the table" during crucial negotiations with CMS….'We don't want a seat at the table,' responded…a delegate from Los Alimitos, Calif. 'We want to stand on the table'."

The delegates also pledged the AMA to "an unshakable and uncompromising commitment to the welfare of our patients and the health of our nation and the primacy of the patient-physician relationship, free from intrusion by third parties."

In a related REPORT FILED HERE it is reported that "Senators left for the weekend without passing the so-called "doc fix" bill that would delay an impending 21% cut in Medicare reimbursement rates, as insurers gathered in Las Vegas for their annual conference….While doctors' groups were nervous over the Senate's lack of action [on the 21% Medicare cut], health insurers met in Sin City for their annual conference, which focused largely on the industry's role in a post-healthcare reform world."

"Sessions at the two-day meeting dealt with how the private insurance industry should begin to implement provisions of the Patient Protection and Affordable Care Act (PPACA).  Insurance industry workers heard from a number of big-name speakers, including former President Bill Clinton, who repeatedly thanked the insurance industry for their "support" of healthcare reform, and former Secretary of Health and Human Services Donna Shalala, who told the insurers that their actions will largely determine whether reform will work."

"The insurance industry holds much of the power to determine whether healthcare reform will work -- or the Patient Protection and Affordable Care Act (PPACA) will ultimately fail."

"Senators are expected to vote on the "doc fix," next week, with Sen. Debbie Stabenow (D-MI) expected to offer an amendment that would delay the 21% cut until 2014, which is a year longer than the bill passed by the House."