The AMA, a Physician’s Rights, and the Radiologist

Nov RADlaw

The AMA is fighting for your rights and responsibilities as a radiologist and a physician within a practicing medical community. Will you join them in representing your interests?

Radiologists often ask why they should become members of the AMA in addition to the ACR®. After all, doesn’t the ACR represent their interests with state and local governments and regulators, while also providing voluminous materials on practice matters?

Well, yes, the ACR does all that, but there’s much more involved in organized medicine than just radiology.

Most U.S. physicians are aware that, one way or the other, their reimbursement is based on Medicare and Medicaid payment amounts. And those payment amounts are based on current procedural terminology or CPT® codes. The CPT codes are developed via the AMA/Specialty Society RVS Update Committee, known more widely as the RUC. The ACR represents radiology on the RUC. The level of radiology representation depends largely on the number of radiologists who are AMA members. So AMA membership has a direct impact on current and future reimbursement for radiologists.

The AMA Medical Staff Rights and Responsibilities covers professionalism, representation and voting rights, due process regarding revocation of privileges, and — most important — the right always to act in the best interests of patients.

 

However, the AMA does much more than just convene the RUC. It has a House of Delegates (HOD) that debates and adopts policy resolutions designed to guide medical practice and direct the AMA’s advocacy efforts. In fact, the ACR Council and its processes were originally modeled on the AMA HOD. Among the HOD’s key activities are development of the Code of Medical Ethics and issuance of ethics opinions in response to issues arising anywhere in U.S. medicine.

From a legal standpoint, one of the AMA’s most valuable resources is the Litigation Center. The Center analyzes potential and pending court cases involving issues of interest to organized medicine, provides those analyses to other organizations (like the ACR), and funds litigation either by filing cases directly or joining cases in progress at the appeals level. The Litigation Center has assisted the College in several cases involving radiologists and provided a steady stream of information that ACR simply does not have the resources to develop on its own.

In addition, the AMA develops materials designed to assist hospital-based physicians in their interactions with hospitals and payers. One such resource is the “Medical Staff Rights and Responsibilities,” which sets forth the basic rights and responsibilities physicians should demand and undertake as members of any medical staff (see page 27). The document covers self-governance, professionalism, privileging, representation and voting rights on various bodies, due process regarding revocation of privileges, and — most important — the right always to act in the best interests of patients. This document is an invaluable tool for all physicians seeking fair treatment for their patients and themselves.

To that end, the AMA has generously allowed ACR to share the document with our members.


Medical Staff Rights and Responsibilities

I. Our AMA recognizes the following fundamental responsibilities of the medical staff:

a.   The responsibility to provide for the delivery of high-quality and safe patient care, the provision of which relies on mutual accountability and interdependence with the health care organization’s governing body.

b.   The responsibility to provide leadership and work collaboratively with the health care organization’s administration and governing body to continuously improve patient care and outcomes.

c.   The responsibility to participate in the health care organization’s operational and strategic planning to safeguard the interest of patients, the community, the health care organization, and the medical staff and its members.

d.   The responsibility to establish qualifications for membership and fairly evaluate all members and candidates without the use of economic criteria unrelated to quality, and to identify and manage potential conflicts that could result in unfair evaluation.

e.   The responsibility to establish standards and hold members individually and collectively accountable for quality, safety, and professional conduct.

f.   The responsibility to make appropriate recommendations to the health care organization’s governing body regarding membership, privileging, patient care, and peer review.

II. Our AMA recognizes that the following fundamental rights of the medical staff are essential to the medical staff’s ability to fulfill its responsibilities:

a.   The right to be self-governed, which includes but is not limited to (i) initiating, developing, and approving or disapproving of medical staff bylaws, rules, and regulations (ii) selecting and removing medical staff leaders, (iii) controlling the use of medical staff funds, (iv) being advised by independent legal counsel, and (v) establishing and defining, in accordance with applicable law, medical staff membership categories, including categories for non-physician members.

b.   The right to advocate for its members and their patients without fear of retaliation by the health care organization’s administration or governing body.

c.   The right to be provided with the resources necessary to continuously improve patient care and outcomes.

d.  The right to be well informed and share in the decision-making of the health care organization’s operational and strategic planning, including involvement in decisions to grant exclusive contracts or close medical staff departments.

e.  The right to be represented and heard, with or without vote, at all meetings of the health care organization’s governing body.

f.  The right to engage the health care organization’s administration and governing body on professional matters involving their own interests.

III. Our AMA recognizes the following fundamental responsibilities of individual medical staff members, regardless of employment, contractual, or independent status:

a.  The responsibility to work collaboratively with other members and with the health care organization’s administration to improve quality and safety.

b.  The responsibility to provide patient care that meets the professional standards established by the medical staff.

c.  The responsibility to conduct all professional activities in accordance with the bylaws, rules, and regulations of the medical staff.

d.  The responsibility to advocate for the best interest of patients, even when such interest may conflict with the interests of other members, the medical staff, or the health care organization.

e.  The responsibility to participate and encourage others to play an active role in the governance and other activities of the medical staff.

f.  The responsibility to participate in peer review activities, including submitting to review, contributing as a reviewer, and supporting member improvement. 

 

IV. Our AMA recognizes that the following fundamental rights apply to individual medical staff members, regardless of employment, contractual, or independent status, and are essential to each member’s ability to fulfill the responsibilities owed to his or her patients, the medical staff, and the health care organization:

a.  The right to exercise fully the prerogatives of medical staff membership afforded by the medical staff bylaws.

b.  The right to make treatment decisions, including referrals, based on the best interest of the patient, subject only to review by peers.

c.  The right to exercise personal and professional judgment in voting, speaking, and advocating on any matter regarding patient care or medical staff matters, without fear of       retaliation by the medical staff or the health care organization’s administration or governing body.

d.  The right to be evaluated fairly, without the use of economic criteria, by unbiased peers who are actively practicing physicians in the community and in the same specialty.

e.  The right to full due process before the medical staff or health care organization takes adverse action affecting membership or privileges, including any attempt to abridge         membership or privileges through the granting of exclusive contracts or closing of medical staff departments.

f.   The right to immunity from civil damages, injunctive or equitable relief, and criminal liability when participating in good faith peer review activities.

©2017 American Medical Association. All Rights Reserved

 By Bill Shields, JD, LLM, CAE and Tom Hoffman, JD, CAE

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