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					                          AMERICAN MEDICAL ASSOCIATION
                               BOARD OF TRUSTEES
                                    MINUTES


AMA Headquarters                                                        April 10 – 13, 2008
Chicago, IL


Members of the Board Present
Edward L. Langston, MD, Chair
Joseph M. Heyman, MD, Chair-Elect
Cecil B. Wilson, MD, Immediate Past Chair
Ronald M. Davis, MD, President
Nancy H. Nielsen, MD, PhD, President-Elect
William G. Plested, III, MD, Immediate Past President
William A. Hazel, Jr., MD, Secretary
Jeremy A. Lazarus, MD, Speaker, House of Delegates
Joseph P. Annis, MD
Peter W. Carmel, MD
Chris DeRienzo
William A. Dolan, MD
Andrew W. Gurman, MD, Vice Speaker, House of Delegates
Cyril M. Hetsko, MD
Ardis D. Hoven, MD
Robert R. McMillan
Rebecca J. Patchin, MD
J. James Rohack, MD
Samantha L. Rosman, MD
Steven J. Stack, MD
Robert M. Wah, MD

Trustees-Elect Present
Kendall S. Allred
Christopher K. Kay

Staff
Michael D. Maves, MD, MBA, EVP, CEO
Bernard L. Hengesbaugh, Chief Operating Officer
Jon Ekdahl, General Counsel
Richard A. Deem, Senior Vice President, Advocacy
Marietta L. Parenti, Senior Vice President and Chief Marketing Officer
Modena H. Wilson, MD, MPH, Senior Vice President, Professional Standards
Jon Burkhart, Chief of Staff, Vice President, Executive Offices
Robin J. Menes, CAE, Vice President, Governance and Program Support

The meeting was called to order at 8:00am (Central Time) on Saturday, April 12, 2008 by the
Chair, Edward L. Langston, MD. Intra-Board Committees and Task Forces met prior to the start of
the meeting.
                                                                     American Medical Association
                                                                        Board of Trustees Minutes
                                                                              April 10 – 13, 2008
                                                                                     Page 2 of 32
1.   LEADERSHIP REPORTS TO THE BOARD

     President
     The President commented on his recent representational visits including the: University of
     Toledo; American College of Preventative Medicine; American College of Medical Genetics;
     and the Wayne County Medical Society. The President also commented on his participation
     in a National Business Group on Health press conference and a presentation he delivered at a
     meeting of Amigos de las Americas.

     President-Elect
     The President-Elect commented on her recent representational visits including the: Institute of
     Medicine Drug Forum; Integrated Healthcare Association; and the Denver Rotary Club. The
     President-Elect also commented on her participation in a New York Attorney General’s Press
     Conference; Mayo Clinic’s symposium on healthcare reform; and her meeting with a Senator
     McCain healthcare advisor.

     Immediate Past President
     The Immediate Past President commented on his recent representational visits including the:
     Pacific Coast Surgical Association; Las Vegas Chamber of Commerce; Economic Roundtable
     of Jacksonville; and the Rotary Club of Palm Springs. The Immediate Past President also
     commented on his participation in the Irish Medical Association meeting.

     Chair
     The Chair welcomed Richard Stennes, MD, Member, AMA House Compensation
     Committee, who will attend the meeting as an observer.

     The Chair commented on his recent meeting with Doug Henley, MD, Executive Vice
     President, American Academy of Family Physicians, regarding principles related to the
     patient-centered medical home.

     Executive Vice President/Chief Executive Officer (EVP/CEO)
     The Board received a report from the EVP/CEO including: (1) 2008 year-to-date AMA
     membership figures; (2) consolidated AMA financials; (3) a list of recent meetings he
     attended; and (4) a list of meetings he is currently scheduled to attend through December
     2008.

     The EVP also presented a slideshow which contained the EVP’s observations related to AMA
     development and growth. The EVP commented on the Chicago Specialty Society CEO dinner
     scheduled for April 30, 2008 and plans for an October 2008 state society executive session at
     Kellogg School of Management.


2.   AMA ALLIANCE (ALLIANCE) UPDATE

     The Board heard an update from Dianne Fenyk, President, Alliance, including information
     regarding the Alliance’s: Screen Out Campaign; continued research regarding expansion of
     membership categories to include friends of medicine and domestic partners; and a new
     relationship with the Partnership for a Drug-Free America.
                                                                   American Medical Association
                                                                      Board of Trustees Minutes
                                                                            April 10 – 13, 2008
                                                                                   Page 3 of 32

3.   AMA FOUNDATION (FOUNDATION) UPDATE

     The Board heard a report from Steven Churchill, Executive Director, Foundation, regarding
     the information presented in the “Findings and Recommendations for the Foundation” report.
     The report includes a historical perspective on the Foundation, and recommendations for
     future Foundation growth and development.


4.   APPROVAL OF BOARD MINUTES

     The Board voted to approve the following minutes:
        (a) November 2007 Board Meeting;
        (b) February 2008 Board Meeting;
        (c) February 26, 2008 Board Conference Call; and
        (d) February 28, 2008 Board Conference Call.

     The Executive Committee voted to approve the following Executive Committee minutes:
        (a) November 27, 2007 Conference Call; and
        (b) January 15, 2008 Conference Call.

     The Board confirmed the actions taken by the Executive Committee on the November 27,
     2007 and January 15, 2008 conference calls.


5.   APPROVAL OF FOREIGN TRAVEL

     The Board voted to approve foreign travel as follows:
        (a) May 15 – 17, 2008, Divonne, France – The three Presidents serve as the delegation to
            the World Medical Association (WMA) and will represent the AMA at the WMA
            Council Meeting. Travel expenses will be reimbursed by the AMA Office of
            International Medicine.
        (b) May 17 – 20, 2008, Geneva, Switzerland – Dr. Nielsen will be the AMA
            representative at the World Health Organization Assembly meeting. Travel expenses
            will be reimbursed by the AMA Office of International Medicine.
        (c) May 20 – 23, 2008, Ulm, Germany – Dr. Nielsen will serve as the AMA
            representative at the German Medical Association (GMA) Annual Meeting. Hotel
            expenses will be paid by GMA.
        (d) November 17 – 19, 2008, London, England – Dr. Nielsen will speak at the opening
            session of the International Physician Health Conference. She will also be a panelist
            along with the Canadian Medical Association (CMA) and British Medical Association
            (BMA) presidents. This conference is jointly sponsored by AMA, CMA and BMA.
            Travel expenses will not be reimbursed, as the AMA is one of the sponsors of the
            conference.
                                                                    American Medical Association
                                                                       Board of Trustees Minutes
                                                                             April 10 – 13, 2008
                                                                                    Page 4 of 32

6.   LITIGATION UPDATE

     The Board heard a privileged and confidential status report regarding pending litigation and
     significant administrative actions in which the AMA is a party, an affiliate of the AMA is a
     party, or the AMA or Litigation Center is an amicus curiae.


7.   BOARD REPORTS TO THE HOUSE OF DELEGATES

     The Board considered, approved, and authorized transmittal of the following Reports of
     the Board of Trustees to the House of Delegates for consideration at the 2008 Annual Meeting,
     as amended where indicated:

         (a) Pharmacists’ Refusal to Fill Legally Valid Prescriptions – Resolution 13 (A-07)
         (b) Prescription Drug Monitoring to Prevent Abuse of Controlled Substances –
              Resolution 218 (A-07)
         (c) Increasing Minority Participation in Clinical Research – Resolution 912 (I-07)
         (d) Council on Legislation Sunset Review of 1998 House Policies
         (e) Health Care for Veterans and Their Families – Resolution 434 (A-07)
         (f) Direct to Consumer Advertising and Provision of Genetic Testing – Resolution 522
              (A-07) – As amended
         (g) Curing the Addiction to Tobacco Profits – Resolution 439 (A-07)
         (h) Surrogate Requirement for Nursing Home Residents – Resolution (216 A-07)
         (i) Council of Medical Specialty Societies (CMSS) Official Observer Status in the
              House of Delegates
         (j) Tiering Systems for Third Party Payers – Resolution 816 (I-07)
         (k) Work of the Task Force on the Release of Physician Data
         (l) Ethical Procurement of Organs for Transplantation – Resolution 8 (A-07)
         (m) The RUC: Recent Activities to Improve the Valuation of Primary Care Services –
              Resolution 124 (A-07)
         (n) Personal Medication Supply in Times of Disaster – Resolutions 433 and 437 (A-07)
              – As amended
         (o) Designation of Specialty Societies for Representation in the House of Delegates –
              Board of Trustees Report 17 (A-07)
         (p) Centers for Medicare and Medicaid Services Policy on Hospital Acquired Conditions
              – Present on Admission – Resolution 919 (I-07) – As amended
         (q) Legal Protections for Medical Peer Review – Resolution 914 (I-06)
         (r) Gender Disparities in Physician Income and Advancement – Resolution 306 (A-07)
         (s) Protection of Medical Staff Members’ Personal Proprietary Financial Information –
              Resolution 22 (A-07)
         (t) Update on the AMA Women Physicians Congress
         (u) National Provider Identification (NPI) Implementation – Resolution 923 (I-07)
         (v) Annual Update on Activities and Progress in Tobacco Control
         (w) Inappropriate Peer Review – Resolution 18 (A-07)
         (x) Auditor’s Report
         (y) 2007 Grants and Donations
         (z) Leadership for Patient Safety: Reducing the Hospital Registered Nurse Shortage –
              Resolution 534 (A-07) – As amended
         (aa) Reauthorization of the Indian Health Care Improvement Act – Resolution 221 (A-07)
                                                                     American Medical Association
                                                                        Board of Trustees Minutes
                                                                              April 10 – 13, 2008
                                                                                     Page 5 of 32

     BOARD REPORTS TO THE HOUSE OF DELEGATES (continued)

         (bb) AMA Performance, Activities, and Status in 2007
         (cc) Update on Corporate Relationships
         (dd) AMA Dues – 2009


8.   ITEMS REFERRED TO THE BOARD FOR DECISION FROM THE HOUSE OF
     DELEGATES

     The Board considered the following items referred from the House of Delegates at the 2007
     Annual Meeting and 2007 Interim Meeting, with actions taken as indicated:

     Maintaining the Physician Consortium for Performance Improvement (PCPI) as
     Physician-Led - Resolution 609 (I-07)
     Resolution 609 asks that: (1) the PCPI continue to be a physician-led organization; (2) the
     AMA support voting rights for participants of the PCPI only for those who meet the criteria of
     a “physician” as defined by AMA Policy H-405.969; (3) non-physicians continue to
     participate in the development of appropriate performance measures at the workgroup level;
     and (4) the AMA work to make the definition of “physician” under Medicare law consistent
     with H-405.969 by defining chiropractors, optometrists, and podiatrists eligible for payment
     under their own titles.

     The Board considered a report related to this issue and voted to consider the requests of Resolution
     609 (I-07) after the PCPI has had an opportunity to review and respond to the proposed
     recommendations.

     U.S. Presidential Candidates’ Views on Health System Reform – Resolution 603 (I-07)
     Resolution 603 (I-07) was introduced by the Florida Delegation for consideration at the 2007
     Interim Meeting. The resolution called for the AMA to host the leading U.S. Presidential
     candidates from the major political parties at a candidate forum during the 2008 Annual
     Meeting with adequate time for questions and answers directly from the AMA delegates. The
     Reference Committee noted positive testimony on the resolution’s goal of making the views of
     presidential candidates on health system reform available to physicians. Concerns were
     raised, however, about using the House of Delegates as the venue to accomplish that goal.
     The resolution was referred to the Board of Trustees for decision to allow for research on legal
     issues, security requirements and other logistical concerns as well as give the Board the
     opportunity to identify other ways to assist the efforts of physicians to understand the
     candidates’ positions on health care issues.

     The Board considered a report related to this issue and voted that in lieu of Resolution 603 (I-
     07), the AMA use its communications vehicles such as AMNews, AMA Voice and the AMA
     web site, to publicize the health care positions of the major U.S. Presidential candidates and
     encourage physicians to become more informed voters.
                                          American Medical Association
                                             Board of Trustees Minutes
                                                   April 10 – 13, 2008
                                                          Page 6 of 32
ITEMS REFERRED TO THE BOARD FOR DECISION FROM THE HOUSE OF
DELEGATES (continued)
National Diabetes Education Program - Resolution 604(I-07)
Resolution 604 (1-07) asks that the AMA: (1) formally endorse the work of the National
Diabetes Education Program (NDEP), a joint venture of the National Institutes of Health, the
Centers of Disease Control and Prevention, and over 200 other organizations; and (2) seek
inclusion in the NDEP Steering Committee to help guide the development of diabetes
educational materials in line with existing AMA policy. Existing AMA policy supports efforts
to develop national-level data that would provide monitoring of diabetes among youth by type;
encourage greater awareness by physicians of Type 2 diabetes and its complications in
children; and promote the availability of resources and information about the prevention and
treatment of this growing public health threat. AMA staff currently serve on the NDEP
Steering Committee.
The Board considered a report related to this issue and voted to adopt Resolution 604 (I-07).
Patients Admitted for Observation - Resolution 715 (I-07)
At the 2007 Interim Meeting, the House of Delegates referred for decision Resolution 715,
“Patients Admitted for Observation.” Reference Committee testimony was mixed, with
supporters noting the need for guidelines that could be used by physicians and third party
payers to assist in determining varying levels of observation or admission status. Testimony
from the Council on Medical Service (CMS) noted previous studies, questioned whether
additional studies would yield substantially different results, and supported the third resolve of
the resolution. The Reference Committee expressed the view that additional study might be
desirable, but that a study could also be too expensive and time consuming.
The Reference Committee also noted that the issues raised in Resolution 715 are addressed in
AMA Policy H-160.944, Defining “Observation Care,” and Directive D-190.995, Uniform
Clinical Criteria for Level of Care Status (AMA Policy Database). The Reference Committee
recommended referral for decision so that the Board of Trustees could assess the implementation
of AMA Policy H-160.994 and Directive D-190.995.
The Board considered a report related to this issue and voted to:
   (a) Reaffirm AMA Policy H-160.944, Defining “Observation Care,” in lieu of Resolves 1 and 2
       of Resolution 715 (I-07); and
   (b) Adopt Resolve 3 of Resolution 715 (I-07).
Improving Affordability of Childhood Vaccines - Resolution 904 (I-07)
Resolution 904 (I-07), introduced by the Colorado Delegation and referred for decision, asks
that the AMA actively encourage the U.S. Congress to develop legislation aimed at allowing
states to purchase vaccines at the Vaccines For Children rate even when private funding is
included in the financing of a state’s Universal Status Immunization Initiative.
This resolution attempts to address a problem, which affects the financing of vaccine programs
for children in the United States. This problem began to escalate in the past few years, as an
increasing number of new, and more expensive vaccines were added to the childhood
immunization schedule, thereby limiting the ability of state immunization programs and
private providers to deliver vaccines to all children in the state.
The Board considered a report related to this issue and voted to not adopt Resolution 904 (I-07).
                                                                  American Medical Association
                                                                     Board of Trustees Minutes
                                                                           April 10 – 13, 2008
                                                                                  Page 7 of 32

ITEMS REFERRED TO THE BOARD FOR DECISION FROM THE HOUSE OF
DELEGATES (continued)

Confidentiality of Medical Staff Members’ Personal Proprietary Financial Information -
Resolution 826 (I-07)
Resolution 826 (I-07) originated with the AMA Organized Medical Staff Section (AMA-
OMSS), following the Section’s consideration of an update to AMA-OMSS Governing
Council Report A (I-05). The resolution was subsequently referred for decision by the House
of Delegates at the 2007 Interim Meeting.

Joint Commission Standards do not specifically address the confidentiality of the personal
proprietary financial information of medical staff members nor do they specifically address the
need to protect medical staff information.

The Medicare/Medicaid Conditions of Participation for Hospitals do not address the
confidentiality of medical staff information. The Conditions of Participation defer to and
require compliance with federal, state, and local law. States have their own licensing
requirements and act as inspectors in the place of Centers for Medicare and Medicaid Services
(CMS). CMS accepts compliance with accrediting agency standards such as The Joint
Commission and American Osteopathic Association in lieu of their inspection.

There is no apparent federal or state law or regulation that specifically addresses the
confidentiality of personal proprietary financial information. There is some state law that
requires notification of individuals when select information (Social Security number, driver’s
license number, etc.) is inadvertently released.

The Board considered a report related to this issue and voted to:
   (a) Seek the insertion of the term “medical staff” into the list of types of information referenced in
       the first sentence of the Rationale for Standard IM.2.10 in the current Joint Commission
       Management of Information Chapter, or other appropriate language changes to provide
       medical staff information the same level of protection as other sensitive hospital information;
   (b) Seek the development and adoption by the American Osteopathic Association – Health
       Facilities Accreditation Program (HFAP) of an accreditation standard that specifically requires
       policies and procedures to protect the confidentiality of personal proprietary financial
       information of medical staff members and other medical staff information; and
   (c) Develop and promote model state legislation that will provide legal safeguards to protect the
       confidentiality of the personal proprietary financial information of medical staff members.

FDA Regulations of Stereotactic Breast Biopsy - Resolution 513 (A-07)
Resolution 513 (A-07), submitted by the American Society of General Surgeons and referred
to the Board for decision, asked that the AMA: (1) oppose the U.S. Food and Drug
Administration’s (FDA) proposed regulation of stereotactic breast biopsy; and (2) promote
accreditation and certification by members of the house of medicine as the preferred method
for raising standards and improving the quality of care. Although the first resolve refers to a
proposed regulation, no specific proposals for regulating stereotactic breast biopsy exist at this
time. However, an FDA advisory committee has recommended such an action be considered.

At issue is the ability of non-radiologists to perform stereotactic breast biopsy independently,
the type of oversight and accreditation standards that might be applied to this procedure, and
quality of care for patients with breast cancer. An emerging controversy exists between two
                                                                      American Medical Association
                                                                         Board of Trustees Minutes
                                                                               April 10 – 13, 2008
                                                                                      Page 8 of 32

     ITEMS REFERRED TO THE BOARD FOR DECISION FROM THE HOUSE OF
     DELEGATES (continued)

     FDA Regulations of Stereotactic Breast Biopsy - Resolution 513 (A-07) (continued)

     large medical specialty contingents (radiology and surgery) regarding the clinical use of this
     procedure and physician autonomy.

     The Board considered a report related to this issue and voted that the following substitute be adopted
     in lieu of Resolution 513 (A-07):
          (a) That the AMA monitor the activities and recommendations of the National Mammography
              Quality Assurance Advisory Committee and the Food and Drug Administration pertaining to
              interventional mammography procedures and respond as appropriate; and
          (b) That the AMA reaffirm Policy D-385.974, “Freedom of Practice in Medical Imaging.”

     Marketing Low Cost Internet-Based Education Programs for Medical Staff Leadership –
     Resolution 602 (A-07)
     Resolution 602 (A-07), introduced by the OMSS and referred for decision to the Board, asks
     that the AMA feature prominently and incorporate aggressively in its new marketing
     campaign distance education programs on medical staff self-governance and to make these
     programs available to AMA members at a steep discount to the actual cost.

     The Board considered a report related to this issue and voted that:
        (a) The AMA-OMSS, as appropriate, selectively offer and promote internet-based education
            programs on medical staff self-governance;
        (b) Program pricing be determined by its cost, market place considerations and the objectives of
            the program (e.g., education with or without CME, promotion of AMA positions and/or
            policy, etc.); and
        (c) Programs be offered at no cost or at a discount to members.


9.   BYLAWS AND PROCEDURES FOR THE PHYSICIANS CONSORTIUM FOR
     PERFORMANCE IMPROVEMENT

     The Board considered and took action regarding this item as a part of the Report of the Task
     Force on Quality, Safety and E.H.R., Item 15 of these minutes.


10. GROUP PRACTICE ADVISORY COMMITTEE CHARTER RENEWAL

     The Board considered a report regarding the renewal of the charter for the Advisory
     Committee on Group Practice Physicians. The Committee was established by the Board in
     1989 with an initial charter approved for a two-year period commencing in January 1990. The
     Committee is made up of 11 physicians, each of whom holds an executive or senior position
     within his/her group. The Board has renewed the Committee’s charter every two years since
     its inception.
                                                                     American Medical Association
                                                                        Board of Trustees Minutes
                                                                              April 10 – 13, 2008
                                                                                     Page 9 of 32

   GROUP PRACTICE ADVISORY COMMITTEE CHARTER RENEWAL (continued)

   The Board voted to:
      (a) Approve the amended language regarding Committee member attendance requirements; and
      (b) Renew the charter of the Advisory Committee on Group Practice Physicians for a two-year
          term commencing July 1, 2008 and concluding June 30, 2010.


11. SENIOR PHYSICIANS GROUP (SPG) CHARTER RENEWAL

   The Board considered a report regarding the renewal of the charter for the SPG. Beginning in
   2008 the SPG is funded similarly to other AMA Special Groups, not through dues paid by
   SPG members in addition to their AMA dues. The SPG Governing Council has proposed a
   change to SPG eligibility criteria that would allow all physician members age 65 and over,
   retired or working, to be members of the SPG. The revised charter closely resembles those of
   other AMA Special Groups.

   The Board voted to:
      (a) Approve the new eligibility criteria for involvement in the SPG; and
      (b) Approve the revised SPG charter commencing July 1, 2008 through June 30, 2010.


12. AMA E-PRESCRIBING WORKPLAN AND PENDING FEDERAL LEGISLATION

   The Board discussed an April 2008 memo regarding an AMA e-prescribing work plan and
   pending federal legislation. The memo included information regarding AMA plans to address
   current barriers for effective e-prescribing through: (1) qualitative and quantitative research of
   physicians’ e-prescribing habits; and (2) engaging key stakeholders to create an efficient e-
   prescribing process. In addition, the memo included: (1) background on the current legislative
   environment; (2) the Council on Legislation’s recommendations regarding e-prescribing
   principles that are to be considered in pending federal legislative proposals; (3) possible
   legislative negotiating positions; and (4) a copy of the Chair’s April 7, 2008 AMNews column
   titled “Consider E-Prescribing as One Step in Climb to Health IT.” The Board also discussed
   the importance of not supporting mandates in e-prescribing legislation.


13. QUARTER ONE REPORT – 2008 OPERATING PLAN

   The Board received the Quarter One Report - 2008 Operating Plan including: (1) status for the
   first quarter of 2008 of the ten strategic issue teams; and (2) a financial summary for the first
   two months of 2008 vs. 2007.

   The Board heard that: (1) the reporting format has been modified to focus on achievement of
   results in a concise manner; and (2) that the second quarter report will include progress made
   within the Centers of Expertise.
                                                                     American Medical Association
                                                                        Board of Trustees Minutes
                                                                              April 10 – 13, 2008
                                                                                    Page 10 of 32



14. REPORT OF THE COUNCIL ON LEGISLATION (COL)

   The Board welcomed Barney R. Maynard, MD, Chair, COL. The Board considered the
   Reports of the February 1-2, 2008 and March 29-30, 2008 COL meetings, with actions taken
   as indicated below:

   Resolution 806 (I-06)—Tiered, Narrow or Restricted Physician Networks
   AMA Advocacy staff requested that the COL submit to the Board a revised model physician
   profiling bill because a number of state medical societies are eager to have legislation
   introduced on this issue during the 2008 legislative session. In April of 2007, the Board
   approved draft model state legislation based on Resolution 806 (I-06) that would prohibit the
   formation of networks based solely on economic criteria, and would ensure that, before health
   plans can establish new panel networks, physicians are informed of the criteria for
   participating in those networks, with sufficient advance time to permit them to satisfy the
   criteria.

   Since the time that the original model bill was adopted, there have been significant
   developments that warrant revisions that more thoroughly address the issue of health insurers
   profiling their network physicians. Recently, this issue has garnered national attention as a
   result of the agreements reached between the New York Attorney General Andrew Cuomo
   and seven large health insurers regarding the insurers physician profiling programs. The
   Council believes that the terms of the agreements (e.g., rankings not based solely on cost, use
   established standards, risk adjust, etc.) should be brought into the legislative arena through this
   revised model bill. The Council determined that the attached model bill would appropriately
   respond to these recent developments and more effectively meet the requirements of
   Resolution 806. The Council believes that the Board’s approval of this revised bill would be a
   timely way of providing the states with model state legislation.

   The Board voted that the AMA adopt revised state model legislation entitled “An Act Relative
   to Physician Profiling Programs.”
                                           American Medical Association
                                               Board of Trustees Minutes
                                                     April 10 – 13, 2008
                                                           Page 11 of 32
REPORT OF THE COUNCIL ON LEGISLATION (COL) (continued)

Resolution 808 (I-07)—Tax Credit for Health Information Technology
The Council considered draft model federal legislation that would allow for a full refundable
tax credit for physicians for the cost of purchasing and implementing clinical information
technology, including electronic medical record systems, e-prescribing, and other clinical
information technology tools. The Council determined that, in addition to this resolution,
AMA policy supports legislation that provides positive incentives for physicians to acquire
and maintain health information technology (HIT) and seeks changes to obtain an exception to
any and all laws that would otherwise prohibit financial assistance to physicians purchasing
HIT. There has been a significant amount of legislative activity on HIT during the first
session of the 110th Congress. A number of bills have included provisions on the use of
federal grants, as well as other financial incentives, including tax credits, to encourage HIT
adoption, as well as relaxation of anti-kickback laws and safe harbor provisions to assist
physicians in acquiring HIT. The Council determined that the attached draft model federal
legislation would meet the intent of Resolution 808 and recommends adoption.

The Board voted that the AMA adopt model federal legislation that amends the Internal
Revenue Code to allow for a full refundable tax credit for physicians for the cost of purchasing
and implementing clinical information technology, including electronic medical record
systems, e-prescribing, and other clinical information technology tools.

Resolution 907 (I-07)—Medicare Advantage
The Council considered draft model federal legislation that would mandate that any Medicare
Advantage policy sold to a Medicare patient must include a seven-day waiting period that
allows cancellation without penalty, as well as an unambiguous disclaimer that, the patient’s
physician potentially may not accept Medicare Advantage. The Council agrees that there is a
need to include a disclaimer in contracts for patients who have been in traditional Medicare.
The Council discussed that the language in the resolution’s disclaimer assumes that the patient
is already enrolled in traditional Medicare and would apply only in cases where such
enrollment in cancelled. There are situations, however, where the patient may contract with a
Medicare Advantage plan upon first becoming Medicare eligible, and thus technically does
not cancel his or her traditional Medicare coverage. The Council determined that the
resolution did not make such a distinction and neither should the model bill. The Council
determined that the attached draft model federal bill would satisfy Resolution 907 and
recommends adoption.

The Board voted that the AMA adopt draft model federal legislation entitled “An Act to
Improve the Medicare Advantage Program to Safeguard Patient Choice and Access.”

Resolution 914 (I-07)—Establishment of Model Legislation to Develop State
Commissions/Taskforces to Eliminate Racial and Ethnic Health Care Disparities
The Council considered draft model federal legislation that would create state commissions or
taskforces to eliminate racial and ethnic health care disparities. One of sponsors of this
resolution (Massachusetts) created such a commission to examine the racial, ethnic, and
linguistic disparities in health care and provide for an action plan for the state to address these
disparities. The attached model federal legislation is based on a Massachusetts statute. The
Council noted that the Massachusetts law succeeded in raising awareness about health
                                           American Medical Association
                                               Board of Trustees Minutes
                                                     April 10 – 13, 2008
                                                           Page 12 of 32
REPORT OF THE COUNCIL ON LEGISLATION (COL) (continued)

Resolution 914 (I-07)—Establishment of Model Legislation to Develop State
Commissions/Taskforces to Eliminate Racial and Ethnic Health Care Disparities
(continued)

disparities in the state and led to the creation of a standing state health disparities council. The
Council determined that the attached model federal bill would meet the criteria of Resolution
914 and recommends its adoption.

The Board voted that the AMA adopt draft model federal legislation to create state
commissions or taskforces to eliminate racial and ethnic health care disparities.

Resolution 922 (I-07)—Advance Directive
The Council considered a resolution that, as amended by the House of Delegates, calls on the
AMA to work with members of Congress to develop incentives to individuals who prepare
advance directives consistent with current AMA policies and legislative priorities on advance
directives. The Council determined that there are several bills pending in the 110th Congress
that address the issue of advance directives and advance care planning. However, these bills
do not include financial incentives to encourage individuals to engage in such planning.
While the Council agrees that it is important to encourage individuals to prepare advance
directives and durable powers of attorney, there would be some challenges to implementing
effective financial incentives. For example, an individual’s claim for a tax credit would need
to be verified through some type of system, such as a registry. Due to privacy concerns,
however, individuals might be reluctant to submit their advance directives to a registry.

An alternative incentive that might be considered to encourage individuals and physicians to
discuss advance care planning is to provide for Medicare coverage of end-of-life planning and
consultations as part of an initial preventive physical examination. The AMA supports
reimbursing physicians for medical conferences with patients and/or their relatives and
guardians regarding advance directives and advance care planning (H-390.916). Another
incentive, also supported by AMA policy, includes education campaigns to raise awareness of
the importance of planning for care near the end of life (D-140.976). The Council determined
that these incentives are included in S. 465, the “Advance Directives Improvement and
Education Act of 2007” [Senator Bill Nelson (D-FL)].

The AMA supported a similar version of Senator Nelson’s legislation in 2005. The Council
believes that supporting S. 465 is consistent with AMA policy and would be consistent with
the intent behind Resolution 922.

The Board voted that the AMA support S. 465 as consistent with AMA policy and to
implement Resolution 922.
                                           American Medical Association
                                               Board of Trustees Minutes
                                                     April 10 – 13, 2008
                                                           Page 13 of 32
REPORT OF THE COUNCIL ON LEGISLATION (COL) (continued)
S. 866, “Health Promotion Funding Integrated Research, Synthesis, and Training Act”
or “Health Promotion FIRST Act” [Senators Richard Lugar (R-IN) and Jeff Bingaman
(D-NM)]
The Council considered federal legislation on health promotion. The intent of S. 866 is to help
people stay healthy and encourage the federal government to build a more comprehensive and
coordinated plan and strategy to develop the basic and applied science of health promotion,
synthesize research results into practical guidelines, and disseminate findings to researchers,
practitioners, and policy makers. The Council determined that the bill is consistent with AMA
policy that strongly supports health promotion and disease prevention initiatives, including
research. The AMA has several policies supporting research on health promotion and
prevention (D-425.999, H-460.926, H-425,984, H-170.986, and H-460.943). The Council
believes that the bill would be a step forward in helping to implement the AMA’s Healthy
Lifestyles campaign. Also, the Council noted that AMA policy strongly advocates intensified
leadership by the medical profession to promote better health through disease prevention and
through support for preventive medicine residency training programs, as well as continuing
education programs for health professionals at all levels (H-425.993, H-425.988, H-425.989,
H-425.982, H-425.984, H-425.991, and H-170.986). For these reasons, the Council
recommends support for S. 866.
The Board voted that the AMA support S. 866 as consistent with AMA policy on health
promotion and disease prevention.
S. 1471, “Improved Medical Decision Incentive Act of 2007” [Senator Sheldon
Whitehouse (D-RI)]
At the request of Senator Whitehouse, the Council considered legislation that would allow
states to develop voluntary health care best practices. S. 1471 would allow state medical
societies or medical specialties to initiate a process to establish a state best practice for a
particular condition, illness, or procedure with the state health department. If the best practice
lowers system costs and improves the quality of care, a state health department may approve
it, after notice and a hearing, for a given condition, illness, or procedure. In general, health
insurers would be required to pay all provider claims for any service rendered in accordance
with best practices not later than 30 days after the date of service and regardless of an insurer’s
utilization review process. The Secretary of HHS would establish procedures to provide
differential Medicare and (after consultation with the state) Medicaid payments for items and
services covered under the program that favor treatment consistent with qualifying best
practices approved by a state. Also, national best practice standards may be adopted in cases
the Secretary deems to be appropriate.
The Council determined that, while the focus of S. 1471 is to contain costs while ensuring the
delivery of quality health care by improving access to health care best practices, there are
several areas of concern. First, the development of quality of care standards at the state level
would duplicate and possibly conflict with existing national efforts (Consortium). Also, a
prompt-pay provision in the bill could undermine more stringent state prompt pay laws.
Further, the Council determined that the bill would open the door to the federal regulation of
the practice of medicine, through a state process, and would financially penalize physicians
who deviated from “best practices” even when the specific needs of a patient dictated an
alternate course of treatment. Given these concerns, the Council does not recommend support
for the legislation, but does encourage continued discussions with the Bill’s sponsor on
                                           American Medical Association
                                               Board of Trustees Minutes
                                                     April 10 – 13, 2008
                                                           Page 14 of 32
REPORT OF THE COUNCIL ON LEGISLATION (COL) (continued)

S. 1471, “Improved Medical Decision Incentive Act of 2007” [Senator Sheldon
Whitehouse (D-RI)] (continued)

seeking ways to reduce claims paperwork and improving dissemination of, and access to,
information on best practices.

The Board voted that the AMA not support S. 1471 as introduced and work with the bill
sponsor to develop legislation that would reduce the documentation physicians must submit to
secure payment and improve the access physicians have to information on health care best
practices.

Regulation of Rental Network PPO Market Model State Legislation
The Council considered draft revised model state legislation on rental network PPOs. Rental
network PPOs are entities whose business practices focus on brokering physician discounted
rates. Increasingly, these discounts are being applied without prior approval from the
physician and often without notice. In 2005, the Council approved a model bill that the
Advocacy Resource Center (ARC) used to advance state advocacy campaigns. Several states
have advanced similar legislation and the ARC has worked closely to provide technical
support. After receiving a report from staff on the AMA’s work with a national coalition of
health insurers, the Council determined the model bill should be updated to reflect agreements
with the coalition on several items, including: transparency of information for the purpose of
determining the contractual network relationship; terms and conditions of the underlying
contract; restricting who is allowed to apply or transfer a physician’s discounted rate; the
effect of terminating the underlying contract; and access to network providers. The Council
concluded that the draft model bill reflects this work at the national level as well as makes
technical adjustments that reflect information learned from states.

The Board voted that the AMA adopt revised model state legislation on rental network PPO
regulation.

Physician Complaint Form and Process
The Council considered draft model state legislation that would mandate implementation of a
complaint form and process for physicians to use against third-party payers. Staff reported on
the status of the multi-state settlement between United Health Care and 37 different states to
resolve aberrant payment practices. Our AMA is working with many state medical
associations and other parties to ensure that patients and physicians actually receive the
restitution stipulated in the settlement. An issue of the settlement that requires improvement is
a complaint process for physicians to use when settlement terms are not properly followed.
While most states have patient complaint processes, many states have no adequate process for
physicians to submit complaints regarding the settlement, nor is there a process for physicians
to submit general complaints about other issues involving a third-party payer. The Council
determined that the attached model state legislation and complaint form would address this
void.

The Board voted that the AMA adopt model state legislation that would mandate
implementation of a complaint form and process for physicians to use against third-party
payers.
                                           American Medical Association
                                               Board of Trustees Minutes
                                                     April 10 – 13, 2008
                                                           Page 15 of 32
REPORT OF THE COUNCIL ON LEGISLATION (COL) (continued)

AMA Antitrust Reform Legislation
The Council considered draft model federal antitrust reform legislation. At its September
2007 meeting, the Board adopted the recommendation in a staff report to, in lieu of
Resolutions 209 and 232 (A-07) on antitrust and collective bargaining, continue pursuing an
antitrust advocacy strategy in collaboration with the medical specialty stakeholders in the
Antitrust Steering Committee to urge the Department of Justice (DOJ) and Federal Trade
Commission (FTC) to amend the “Statements of Antitrust Enforcement Policy in Health Care”
(also known as Guidelines) and adopt new policy statements regarding market concentration.
The recommendation also calls for a legislative strategy.

The Steering Committee is comprised of AMA and several national medical specialty
associations that have lobbyists with expertise in antitrust reform issues. Since early 2007, the
Steering Committee has comprehensively reviewed and considered draft federal legislation
and an antitrust reform advocacy strategy. The Steering Committee also has held several
meetings with, and has received suggestions from, key Senate staff regarding the most
effective approach to garner support for the introduction of federal antitrust legislation. Senate
staff initially urged the Steering Committee to pursue a strategy to modify the existing
DOJ/FTC Guidelines prior to seeking the introduction of a federal antitrust reform bill. To
this end, our AMA has developed and will be submitting a proposal to the FTC with
recommendations for changing the Guidelines to make it easier for physicians to financially
and clinically integrate, as well as to provide new guidelines on regulating health plan
mergers.

The AMA has also been engaged in pursuing a legislative strategy. The Council has
considered during its past few meetings the prospects for introducing a bill that would create a
general antitrust exemption for physicians to act jointly to negotiate and enter contracts with
health plans when the share of the relevant market served by the health professionals is
smaller than the share of the relevant market of purchasers of such services comprised by the
health plans. However, the Council concurs with a report from our Advocacy staff that the
political climate is not ripe for introduction of legislation that provides a straight antitrust
exemption for physicians.

As an alternative, the attached draft legislation provides a more modest, but effective, antitrust
exemption. Under the draft legislation, physicians would be able to negotiate with health
plans if: (1) the share of the relevant market served by the health professionals is smaller than
the share of the relevant market of purchasers of such services comprised by the health plans;
and (2) they are part of “Health Care Cooperatives”—groups of 2 or more physicians that are
engaged in “Clinical Improvement Activities.” These activities include: investment in
equipment, staff, overhead, and other administrative aspects of medical practice to improve
clinical performance; health information technology; or participation in clinical quality
programs. In addition, the draft legislation would protect good faith actions and limit damages
and recovery to actual damages. The Council believes that this approach would provide
effective relief for physicians and has greater potential to attract broader support in Congress.

The Board voted that the AMA adopt draft model federal antitrust reform legislation entitled,
“Health Care Cooperation and Quality Improvement Act of 2008.”
                                           American Medical Association
                                               Board of Trustees Minutes
                                                     April 10 – 13, 2008
                                                           Page 16 of 32
REPORT OF THE COUNCIL ON LEGISLATION (COL) (continued)

Biological Similars (Generic) Abbreviated FDA Approval Process—H.R. 5629, “Pathway
for Biosimilars Act” [Representatives Anna Eshoo (D-CA) and Joe Barton (R-TX)]
The Council considered federal legislation that would establish an abbreviated Food and Drug
Administration (FDA) market approval pathway for generic biologicals (biosimilars or
biogenerics). In doing so, the Council utilized a set of principles on biogenerics that the Board
adopted last November. H.R. 5629 was introduced shortly after the Medicare Payment
Advisory Commission (MedPAC) reported that an abbreviated biogenerics approval process is
urgently needed because many of the most innovative and costly products entering the market
are biologics. The Council agrees with MedPAC’s statement. However, H.R. 5629 is
inconsistent with at least one of our AMA’s principles and should be modified.

H.R. 5629 would confer FDA with the discretion to deem biogenerics as interchangeable with
the innovator biologic. In contrast, our principles provide that legislation should not include
provisions that would compel physicians to treat biogenerics as “interchangeable” and/or
therapeutically equivalent with brand biologicals. In addition, a provision in H.R. 5629 would
mandate that FDA issue guidance identifying classes of biologics that could be safely copied
within two years of an application for guidance being submitted on a specific biologic.
However, the bill specifically blocks the FDA from stating that recombinant proteins cannot
be safely copied. The two provisions could be combined to tie FDA's hands and legally
obligate FDA to issue a guidance document that prevents the agency from indicating that it
does not have the scientific know-how to license a generic recombinant protein. In contrast,
our principles provide that legislation must not allow FDA to approve biogenerics with
differences in efficacy and safety from the innovator biological. Without modification, H.R.
5629 could result in approval of recombinant protein biogenerics that are not safe.

The Board voted that the AMA not support H.R. 5629 as introduced and work with the bill
sponsor to develop legislation that is consistent with our AMA Biological Similars Principles.

S. 334, the “Healthy Americans Act,” (Wyden, D-OR/Bennett, R-UT)
Over the past year, given the AMA’s focus on expanding coverage for the uninsured, the
Council on Legislation has reviewed several comprehensive health system reform proposals,
including S. 334, the “Healthy Americans Act,” introduced by Senator Ron Wyden (D-OR).
The Council first considered S. 334 at its February 2007 meeting, and recommended to the
Board that the AMA support the bill’s overall goal of ensuring that every American has access
to affordable, high quality, private health coverage, and work with Senator Wyden and his
staff to advocate changes to the legislation consistent with AMA policy. The Board adopted
this recommendation.

At the request of the Board Chair and as a continued effort to work with Senator Wyden, the
Council invited Senator Wyden to discuss his legislation at its February 2008 meeting. Since
it was introduced last year, Senator Wyden’s legislation has attracted a significant number of
bipartisan cosponsors, including Senator Robert Bennett of Utah as the main Republican
cosponsor, as well as Senators Lamar Alexander (R-TN), Thomas Carper (D-DE), Norm
Coleman (R-MN), Bob Corker (R-TN), Mike Crapo (R-ID), Chuck Grassley (R-IA), Judd
Gregg (R-NH), Daniel Inouye (D-HI), Joe Lieberman (I-CT), Bill Nelson (D-FL), Mary
Landrieu (D-LA), and Debbie Stabenow (D-MI). The Healthy Americans Act is unique
because it is the only comprehensive health system reform bill with broad bipartisan support.
In addition, a similar bill, H.R. 3163, has been introduced in the House of Representatives by
                                                                 American Medical Association
                                                                    Board of Trustees Minutes
                                                                          April 10 – 13, 2008
                                                                                Page 17 of 32

REPORT OF THE COUNCIL ON LEGISLATION (COL) (continued)
S. 334, the “Healthy Americans Act,” (Wyden, D-OR/Bennett, R-UT)
Representatives Brian Baird (D-WA), Jo Ann Emerson (R-MO), Earl Blumenauer (D-OR),
and Jim Cooper (D-TN).

The Healthy Americans Act is a comprehensive proposal aimed at providing affordable, high
quality, private health coverage for all Americans regardless of where they work or live.
Under the proposal, all Americans would be guaranteed private coverage that is at least as
comprehensive as the Blue Cross/Blue Shield (BCBS) standard option offered to members of
Congress and federal workers through the Federal Employees Health Benefits Program
(FEHBP). Employer-sponsored health coverage for employees would be substantially
transformed in favor of individually selected and purchased coverage. All Americans, with
some exceptions, would choose from private plans offered through newly created state Health
Help Agencies (HHAs). Adults would be required to enroll themselves and their dependent
children in a Healthy Americans Private Insurance (HAPI) plan unless they provide proof of
coverage under Medicare, existing retiree health plans, existing collective bargaining
agreements, the Indian Health Service, the Department of Defense, or the Veterans
Administration. Income-related premium assistance subsidies would be provided to low-
income individuals and families to help them purchase private health insurance.

The main goals and broad components of the Healthy Americans Act are consistent with the
AMA’s proposal for expanding health insurance coverage such as: individual ownership,
choice, and responsibility; subsidies to help low-income individuals purchase health insurance
and for cost-sharing obligations; private market offerings and market competition; tax
incentives to remove the tax bias favoring employer-sponsored health benefits; and disease
prevention and wellness programs. In addition, the Healthy Americans Act addresses rising
health care costs through savings in administrative costs, increased price competition for
insurance, and making better use of government resources devoted to health care and health
care coverage.

During Senator Wyden’s presentation to the Council and the ensuing discussion, he indicated
his commitment to working with stakeholders such as our AMA to make the overall goal of
the Act, ensuring that every American has access to affordable, high quality health care
coverage, a reality. He acknowledged that, while the goals and broad components of his bill
are consistent with AMA policy, there are many provisions where we have differences in
policy or approach, and he sought our AMA’s input and recommendations to refine his bill.
Senator Wyden expects to introduce a revised version of S. 334 as a result of such input later
this year, and plans to use the rest of 2008 to work out the issues and concerns raised by his
bill so that a fully developed proposal can be presented to the next President in January 2009.
He believes that his plan is achievable because Republicans are moving away from opposing
universal health coverage and Democrats are moving away from opposing private insurance
coverage and tax credits or subsidies.

Senator Wyden is seeking the AMA’s eventual endorsement of his legislation. The Council
believes that this is a serious, bipartisan effort that could achieve one of our AMA’s top
strategic and legislative priorities in 2009. Working with Senator Wyden to refine his bill
presents a critical opportunity for our AMA to shape health reform legislation that would
comport more fully with AMA policy. To this end, the Council has developed the attached
recommendations to guide staff in their discussions with Senator Wyden to modify S. 334 to
                                              American Medical Association
                                                  Board of Trustees Minutes
                                                        April 10 – 13, 2008
                                                              Page 18 of 32
   REPORT OF THE COUNCIL ON LEGISLATION (COL) (continued)
   S. 334, the “Healthy Americans Act,” (Wyden, D-OR/Bennett, R-UT)
   comport with our AMA policy. The recommendations are divided into three categories:
   provisions that are consistent with AMA policy and can be supported without changes;
   provisions that are not consistent and will need to be modified; and issues that were discussed
   during the Council’s meeting with Senator Wyden that he expressed interest in further
   exploring outside the scope of his bill.

   The Board voted that the AMA support provisions in S. 334 that comport with AMA policy,
   seek changes to provisions that do not comport with AMA policy, and urge Senator Wyden’s
   support on issues regarding comparative effectiveness, physician workforce, and
   antitrust/managed care reform.


15. REPORT OF THE TASK FORCE ON QUALITY, SAFETY, AND E.H.R.

   The Board considered the reports of the April 7, 2008 conference call and the April 11, 2008
   meeting of the Task Force on Quality, Safety, and E.H.R. (Drs. Lazarus, Chair; Dolan;
   Hetsko; Hoven; Rohack; Stack/ex-officio; Mukkamala, Council on Legislation Liaison; and
   Mr. McMillan) with actions taken as indicated below:

   Physician Consortium for Performance Improvement (PCPI)
   National Committee for Quality Assurance (NCQA)/AMA/PCPI Agreement
   The Task Force discussed the final draft NCQA/AMA/PCPI agreement that would formalize
   the collaboration between the PCPI and NCQA to develop and test new physician-level
   performance measures and to harmonize existing measures where practicable. The Task Force
   considered this agreement, which is based on a previous Board approved Letter of Intent and
   Term Sheet (April 2007). An updated risk/benefit analysis was also provided by staff.

   The Board voted to approve the NCQA/AMA/PCPI agreement.

   PCPI Bylaws and Rules and Procedures
   During its February 9, 2008, meeting, the AMA Board deferred action on proposed
   amendments to the PCPI Bylaws and Rules and Procedures. The Board recommended that the
   PCPI Executive Committee consider additional language to the Rules and Procedures that
   would explicitly ensure that all work groups include a doctor(s) of medicine and/or
   osteopathy. The PCPI Executive Committee agreed to the AMA Board request and revised
   the Rules and Procedures accordingly. The amended PCPI Rules and Procedures, which
   reflect the request made by the AMA Board to the PCPI, and Bylaws, were presented to the
   Board for reconsideration.

   The Board voted to approve the amended PCPI Bylaws and Rules and Procedures.
                                          American Medical Association
                                              Board of Trustees Minutes
                                                    April 10 – 13, 2008
                                                          Page 19 of 32
REPORT OF THE TASK FORCE ON QUALITY, SAFETY, AND E.H.R. (continued)

Expanding the Involvement of Non-MDs in the Consortium Update
During its February 2008 meeting, PCPI members were invited to comment on the draft
document, “Expanding the Involvement of Health Care Professional Organizations in the
Physician Consortium for Performance Improvement (PCPI) – An Alternative Approach,” that
proposes the establishment of a new membership category, “Health Care Professional”
member with specified rights. PCPI members were also invited to submit written comments
on the document during a comment period that ended on March 31, 2008. The comments
received on this document will be reviewed by the PCPI Executive Committee for possible
revision. The Executive Committee will then determine if the document will be forwarded to
PCPI voting member organizations for a vote.

As indicated in the Management Report for Board Action regarding the referred for Decision
Resolution 609 (I-07) “Maintaining the Physician Consortium for Performance Improvement
as Physician-Led,” staff recommends that the Board consider Resolution 609 after the PCPI
has completed its process.

The Board voted to accept this item as information.
(Secretary’s Note: For additional information regarding Resolution 609 (I-07), refer to Page
5 of these minutes.)

Health Information Technology (HIT) Update
The HIT Advisory Group developed with staff a set of draft electronic prescribing principles
and prerequisites to guide physicians and policy makers on the use of electronic prescribing
technology in clinical practice. The principles are based on the qualitative research conducted
by the AMA that studied physicians’ attitudes and perceptions on and barriers to the adoption
of electronic prescribing systems. The AMA HIT Advisory Group plans to pilot test a web-
based educational platform to identify short- and long-term solutions to the adoption of
electronic prescribing systems for small physician group practices.

The Board voted to accept this item as information.

Patient Safety
An update on the status of AMA’s review of the Patient Safety and Quality Improvement Act
of 2005 Proposed Rule was provided; comments are due to the Agency for Healthcare
Research and Quality by April 14, 2008. The Board Task Force will receive copies of the
final comments.

The Board voted to accept this item as information.

Task Force on the Release of Physician Information
April 7, 2008 Conference Call of the Task Force on Quality, Safety, and E.H.R.
The Task Force discussed the principles and recommendations outlined in the Task Force on
the Release of Physician Information’s draft Board Report for A-08, which are intended for
use by physicians to address the public release of physician specific data and commercial
products recommending specific physicians. The principles focus on patient privacy, data
accuracy and security, transparency, physician appeals, physician profiling, quality
measurement, and patient satisfaction. The Task Force on Release of Physician Information
recommends that the AMA develop new policy calling for the release of claims and payment
                                          American Medical Association
                                              Board of Trustees Minutes
                                                    April 10 – 13, 2008
                                                          Page 20 of 32
REPORT OF THE TASK FORCE ON QUALITY, SAFETY, AND E.H.R. (continued)

data from governmental programs only in specified instances, develop model legislation,
create tools for physicians, monitor relevant legislation, and educate employers, coalitions,
and the public about physician profiling concerns. Members of the Board Task Force on
Quality suggested amendments to the principles.

The Board voted to accept this item as information.

April 11, 2008 Meeting of the Task Force on Quality, Safety, and E.H.R.
The Task Force reviewed a revised version of Board Report 12 (A-08), “Work of the Task
Force on the Release of Physician Data,” which reflected edits recommended by the Task
Force during its April 7, 2008 call. The Task Force recommends Board approval of revised
Board Report 12 (A-08), “Work of the Task Force on the Release of Physician Data.”

The Board voted to accept this item as information.

AMA Strategy on Quality
The Task Force will engage in a discussion on the overall AMA quality agenda. This will
address current AMA efforts in quality, patient safety, and HIT. Potential strategies for
collaboration and maximization of the AMA’s leadership role in quality and patient safety will
be considered.

The Board voted to accept this item as information.

AMA Strategy on Quality, Patient Safety, and Health Information Technology (HIT)
The Task Force discussed key environmental forces that impact the quality of patient care and
identified opportunities for the AMA to maximize its leadership role in the quality arena. The
Task Force acknowledged that the quality agenda will need to reflect the economic reality of
unsustainable growth in health care expenditures. The Task Force supported the development
of a paper that defines the role of the profession in addressing health care reform in
preparation for the change in administration and the Congress next year. The Task Force
identified professionalism as an area that would provide opportunities to lead, and to
collaborate, in defining the role of physicians in the debate.

The Board voted to accept this item as information.

Strategies for Collaboration
The Task Force emphasized the need to further collaborate with the Federation as broadly as
possible, including through the Physician Consortium for Performance Improvement (PCPI).
Through enhanced communications and education, the AMA has an opportunity to better
engage its members, non-member practicing physicians, employers, health plans, and policy
makers in its quality initiatives. The AMA’s continued support of the PCPI and promotion of
transparency with the PCPI leadership are recognized as essential. Identifying and influencing
other relevant stakeholders is critical. Creating an overall AMA vision on quality of care
should create opportunities for strengthening the AMA’s potential relationships with various
organizations.

The Board voted to accept this item as information.
                                             American Medical Association
                                                 Board of Trustees Minutes
                                                       April 10 – 13, 2008
                                                             Page 21 of 32
   REPORT OF THE TASK FORCE ON QUALITY, SAFETY, AND E.H.R. (continued)

   Next Steps
   The Task Force will continue its discussion of the AMA’s overall quality agenda, as well as
   review strategies for internal and external communications, and identify potential “thought”
   leaders on quality that could be engaged in dialogue to inform the development of the agenda.
   A draft quality agenda with recommendations for full Board discussion and action is planned
   for its September 2008 meeting.

   The Board voted to accept this item as information.

16. REPORT OF THE TASK FORCE ON HEALTH SYSTEM REFORM

   The Board considered the report of the April 11, 2008 meeting of the Task Force on Health
   System Reform (Drs. Rosman, Chair; Dolan; Hoven; Patchin; Rohack; Wah; Maynard,
   Council on Legislation Liaison; and Mr. DeRienzo) with actions taken as indicated below:

   AMA “Voice for the Uninsured” Campaign
   Staff provided an update on the current and future activities of the AMA’s “Voice for the
   Uninsured” campaign. As follow-up to the recent Board Executive Committee conference
   call, staff reported that negotiations with Vince Gill over the “Voice for the Uninsured”
   sponsorship of his 42-city tour (July-November 2008) have been productive. Mr. Gill may
   sing at the opening session of the 2008 Annual Meeting of the House of Delegates, as well as
   a Chicago White Sox game the day preceding the opening of the House. Staff also reported on
   the status of several “out-of-home” initiatives in which “Voice” advertising will be highly
   visible in Denver and Minneapolis at the time of the Democratic and Republican conventions,
   respectively, as well as around the Hyatt Regency Chicago during the Annual Meeting. In
   addition, staff reported that work is underway to revise the “Voice” web site to make it more
   appealing and interactive. The “Voice” web site should be revised by the end of May.

   The Board voted to accept this item as information.

   Legislative Update
   Staff provided an update on the status of developments related to Medicaid and Medicare.
   The AMA has been working with members of the House of Representatives regarding
   Medicaid regulations proposed by the Administration that would have the net effect of
   potentially decreasing money to the states, increasing the number of uninsured, and decreasing
   payment levels for physicians and other health care providers. Staff also discussed the status
   and likely timetable of legislation to address the pending SGR cuts. The likely Senate
   Medicare payment package will be for 18 months, but may include a 2010 payment cut of up
   to 22%, as well as other provisions related to electronic prescribing and an extension of the
   quality reporting bonus.

   The Board voted to accept this item as information.
                                         American Medical Association
                                            Board of Trustees Minutes
                                                  April 10 – 13, 2008
                                                        Page 22 of 32
REPORT OF THE TASK FORCE ON HEALTH SYSTEM REFORM (continued)

AMA Questions for U.S. Presidential Candidates
Staff provided an update on the submission of questions, previously approved by the Task
Force, to the U.S. Presidential candidates regarding their health system reform proposals. To
date, responses to the questions have been received by representatives of Senators Hillary
Clinton and Barack Obama. Representatives of Senator McCain’s campaign have indicated
that they intend to submit his responses in the near future. AMA staff have already formatted
the responses from Senators Clinton and Obama into a combined document, to which Senator
McCain’s responses will be added when they are received.

The Board voted to accept this item as information.

“Healthy Americans Act” (S. 334)
Dr. Maynard highlighted the Council on Legislation’s February 2008 meeting with Senator
Ron Wyden (D-OR) and presented recommendations on S. 334, the “Healthy Americans Act.”
As Senator Wyden conveyed at the National Advocacy Conference, S. 334 is a comprehensive
health system reform bill that has attracted significant number of bipartisan sponsors.
Working with Senator Wyden to refine his bill will provide a critical opportunity for the AMA
to shape the legislation to make it more consistent with AMA policy. The Council’s
recommendations are divided into three categories: provisions that are consistent with AMA
policy and can be supported without changes; provisions that are not consistent and will need
to be modified; and issues that were discussed during the Council’s meeting with Senator
Wyden that he expressed interest in further exploring outside the scope of his bill. The Task
Force discussed the Wyden bill and commended the Council on its efforts.

The Board voted to support provisions in S.334 that comport with AMA policy, seek changes
to provisions that do not comport with AMA policy, and urge Senator Wyden’s support on
issues regarding comparative effectiveness, physician workforce, and antitrust/managed care
reform.

(Secretary’s Note: Additional material related to S.334 can be found on page 17 of these
minutes.)

Principles for Comparative Effectiveness Research
Staff and Dr. Maynard summarized the development of the principles presented in Attachment
N of these minutes for comparative effectiveness research (CER) that were developed by staff
and modified and approved by the Councils on Legislation and Medical Service. The
principal impetus for the development of the principles is the possible inclusion of a provision
in the Medicare physician payment reform package this summer that would establish a
federally supported entity charged with CER. Most notably, in March 2008, Senators Max
Baucus (D-MT) and Kent Conrad (D-ND) introduced and then withdrew the “Comparative
Effectiveness Research Act of 2008,” which would establish an independent Health Care
Comparative Effectiveness Research Institute. It is anticipated that a very similar bill will be
re-introduced soon. Adoption of the attached principles will position the AMA to advocate
proactively on legislation this spring concerning a federally supported CER entity.
                                            American Medical Association
                                               Board of Trustees Minutes
                                                     April 10 – 13, 2008
                                                           Page 23 of 32
   REPORT OF THE TASK FORCE ON HEALTH SYSTEM REFORM (continued)

   The Board voted to adopt the “Comparative Effectiveness Research” principles as presented
   in Attachment N of these minutes for use internally to evaluate and advocate for legislation
   concerning a federally supported comparative effectiveness research entity.


17. REPORT OF THE TASK FORCE ON MEDICAL LIABILITY REFORM (MLR)

   The Board considered a report of the April 11, 2008 meeting of the Task Force on MLR (Drs.
   Wah, Chair; Carmel; Gurman; Van Etta, Council on Legislation Liaison; and Mr. McMillan)
   with actions taken as indicated below:

   Medical Liability Reform Research Update
   The Task Force received an update from the AMA Health Policy Group on a recent case study
   that investigated the effect of Texas’ tort reform statutes. The case study, “Impact of the 2003
   Texas Medical Liability Reforms,” was written by Jim Hurley, ACAS, MAAA and Jason
   Martin, FCAS, MAAA of Towers Perrin. Mr. Hurley is one of the most expert and well
   respected actuaries in the area of professional medical liability, and the AMA and several state
   medical associations have worked with him on prior occasions. The AMA requested an
   objective and informed analysis of the impact of the 2003 Texas tort reforms. The report will
   only be made available on a strictly confidential basis. Before completing the case study, Mr.
   Hurley indicated that there are some signs of a positive impact on some components of the
   liability market, but he also forewarned the AMA that on a number of areas, it is too early to
   say with credibility that the tort reforms are having an impact. Staff will strongly consider
   asking Mr. Hurley to revisit the issue after more years of post-reform data are available. Here
   is a top level summary of the results:

    Variable                                      Impact of 2003 Reforms
    Frequency of paid claims                      Decrease
    Losses                                        Early indications of a decrease
    ALAE                                          No evidence of a change
    Premiums                                      Decrease
    Insurer profitability                         Early indications of greater profitability
    Physician supply                              Early indications of an increase in supply
    Note: ALAE is allocated loss adjustment expenses – the amounts spent by insurers to defend claims.

   The Task Force also discussed staff’s plans for the next case study, “The Structure and Impact
   of Two Tort Reforms: (1) Pre-trial Screening Panels; and (2) Early Disclosure and
   Compensation Programs.” The case study will be completed by the end of Q3, and it will be
   used to expand AMA knowledge about alternatives to MICRA-like reforms.

   The Board voted to accept this item as information.
                                          American Medical Association
                                             Board of Trustees Minutes
                                                   April 10 – 13, 2008
                                                         Page 24 of 32
REPORT OF THE TASK FORCE ON MEDICAL LIABILITY REFORM (MLR)
(continued)

Litigation Center Update
Staff from the Litigation Center provided an update for the Task Force on litigation involving
medical liability reform. In Oregon, the Supreme Court upheld the state’s cap on non-
economic damages in wrongful death actions (Hughes v. Peacehealth). In Illinois, the
Litigation Center is preparing an amicus curiae brief asking the Illinois Supreme Court to
reinstate the state’s cap on non-economic damages in medical liability actions (Lebron v.
Gottlieb Memorial Hospital). The Litigation Center continues to reach out to state medical
associations facing challenges to their medical liability reforms.

The Board voted to accept this item as information.

MLR State Update
The Task Force discussed recent state actions on medical liability. The AMA continues to
work with the Colorado Medical Society to defeat an effort to increase Colorado’s cap on non-
economic damages. Tennessee is poised to pass a compromise bill that will require a
certificate of good faith and 60 days notice to a defendant in a medical liability action. After a
rancorous 2007 legislative session in Tennessee on this issue, this is a step forward on the
issue. TMA is very appreciative of the AMA’s support of their efforts. The Hawaii Medical
Association (HMA) effort to enact a cap appears headed for defeat, but HMA is already
working on its strategy for 2009. The Illinois State Medical Society has been able to prevent a
joint and several liability bill that would be harmful to physicians. Washington State was able
to defeat a bill that would expand recovery in wrongful death actions.

The Board voted to accept this item as information.

MLR Federal Update
The Task Force discussed recent federal legislation introduced on MLR. H.R. 5480/S. 2662,
the "Medicare Funding Warning Response Act of 2008" was introduced on February 25th.
The bill includes medical liability reform provisions consistent with H.R. 2580 (HEALTH
Act of 2007) (Gingrey R-GA) and MICRA-like reforms which the AMA supports, but
prospects for passage of either bill remain dim. The Task Force received an update on the
Federal Rules initiative that the AMA is pursuing. Under the initiative, the AMA is working
with two litigation experts to amend the Federal Rules of Civil Procedure and the Federal
Rules of Evidence to make the legal system more equitable for physicians. On February 25th,
the AMA along with several specialty groups, the Physician Insurers Association of America,
and the Association of American Medical Colleges issued a letter to the Federal Rules
Advisory Committee on proposed amendments to Federal Rule 56 to allow for early motions
to dismiss meritless cases.

The Board voted to accept this item as information.
                                             American Medical Association
                                                Board of Trustees Minutes
                                                      April 10 – 13, 2008
                                                            Page 25 of 32
   REPORT OF THE TASK FORCE ON MEDICAL LIABILITY REFORM (MLR)
   (continued)

   MLR Visibility and Task Force Activity
   The Task Force asked staff to continue to promote MLR as an issue at AMA meetings. The
   Task Force also discussed ways to keep MLR visible in the media. Staff will provide the Task
   Force with a list of suggestions at the next Task Force meeting. The Task Force agreed that
   coupling MLR with other practice viability issues such as reimbursement, managed care
   contracting issues, and physician profiling, is a good strategy to pursue.

   The Board voted to accept this item as information.


18. REPORT OF THE COMMITTEE ON THE ORGANIZATION AND OPERATION OF
    THE BOARD (ORGANOP)

   The Board considered the report of the April 11, 2008 meeting of ORGANOP (Drs. Hoven,
   Chair; Annis; Rohack; Rosman; Stack; Wah; Heyman/ex-officio; Wilson/ex-officio; and Mr.
   DeRienzo) with actions taken as indicated below:

   Spouse Travel
   In response to tightening of reporting requirements by the IRS and the newly released draft
   IRS schedule J (Form 990) instructions covering the reporting requirements for 2008 spousal
   travel, the Committee reviewed the current Board spousal travel policy. The Committee
   acknowledged the importance of spouse travel and the amount of travel Trustees undertake as
   part of their AMA responsibilities. The Committee also respects the need to be consistent
   with other organizations in reporting requirements to the IRS.

   Options discussed included AMA reporting of spousal travel amounts as taxable income and
   the individual Trustee taking the deduction on their personal or corporate tax returns. The
   option the Committee supports is to have the Board consider an increase in Trustee
   honorarium and then ask Trustees to bear any cost of companion travel. All Trustees would
   be able to deduct spousal travel from their personal or corporate tax returns if there is a bona
   fide business purpose, at their discretion, without AMA involvement.

   The Board voted to request that the House Compensation Committee of the Officers consider
   an increase in honorarium to replace the current Spousal Travel Amounts:
                                        American Medical Association
                                           Board of Trustees Minutes
                                                 April 10 – 13, 2008
                                                       Page 26 of 32
REPORT OF THE COMMITTEE ON THE ORGANIZATION AND OPERATION OF
THE BOARD (ORGANOP) (continued)

Amended Audit Committee Charter in the Operational Standing Rules Of The Board
At the request of the Board, the Committee will include in the Operational Standing Rules of
the Board, amended language to the Audit Committee charter as presented below. The
amended language had been reviewed by the Audit Committee at their February 2008
meeting. The amended language clarifies the Audit Committee’s responsibilities to oversee
the risk management program of the AMA. The language defines what is encompassed within
this oversight to include “financial risk, strategic risk, operational risk, compliance risk, and
reputational risk to the AMA.” The amendment also includes language to cover oversight of
how AMA affiliates using AMA’s name manage their risk.

   Rule 9: Intra-Board Committees
           (E) Audit Committee
                   (7) Specific Duties
                           (e) Additional Audit Committee Action
                               9. [i] Oversee the risk management program of the
                                    AMA, which should include financial risk,
                                    strategic risk, operational risk, compliance risk,
                                    and reputational risk to the AMA, with any clear
                                    business risk to be reviewed by the Chair of the
                                    Audit Committee with the Chair of the Board of
                                    Trustees to determine what action, if any, should
                                    be taken in the best interests of the American
                                    Medical Association and [ii] review how AMA
                                    affiliates using the AMA name or derivatives of
                                    the AMA logo manage risk to their organizations
                                    which might also impact the AMA’s reputation.

The Board voted to accept this item as information.

Annual Review/Approval of 2009 Proposed Board Meeting Dates
In accordance with the charter of the Committee on Organization and Operation of the Board,
the Committee reviewed a list of proposed meeting dates and scheduled assignment days for
2009. The scheduled assignment days historically include:
    • Board meetings;
    • Strategic Planning meeting;
    • One travel day for each Board meeting; and
    • Annual, Interim, and Special Meetings of the House of Delegates.

The Board voted to approve the 2009 meeting/honorarium schedule.
                                        American Medical Association
                                           Board of Trustees Minutes
                                                 April 10 – 13, 2008
                                                       Page 27 of 32
REPORT OF THE COMMITTEE ON THE ORGANIZATION AND OPERATION OF
THE BOARD (ORGANOP) (continued)

Annual Review of Intra-Board Committees
The Standing Rules of the Board stipulate that the Committee annually, prior to the
reorganization meeting of the Board, consider continuation, discharge or reconstitution of the
Intra-Board Committees for recommendation to the Board. The Committee considered a list
of the current Intra-Board Committees of the Board as chartered in the Standing Rules of the
Board and the current number of members assigned to each Committee.

The Board voted to continue the following current Intra-Board Committees for 2009 as
chartered in the Standing Rules of the Board: Audit Committee; Compensation Committee;
Awards/Nominations Committee; Committee on the Organization and Operation of the Board;
Finance Committee; Membership Committee, and the Executive Committee.

Annual Review of Spokesperson Guidelines
Annually, the Committee conducts a review of the Spokesperson Guidelines and makes
recommendations to the Board if changes are necessary. The Committee received and
discussed the Spokesperson Guidelines. The Committee made no recommendations for
change.

The Board voted to accept this item as information.

Routine Review of Board of Trustees Conflict of Interest Forms
The Committee reviewed updated Disclosure of Affiliation forms submitted by Edward L.
Langston, MD, and Cecil B. Wilson, MD. Disclosures are intended to provide notice of each
affiliation, so that Board members may evaluate the options and recommendations of Trustees
and staff, in light of the interests they hold. In addition, the disclosures are reviewed to
identify any affiliation that causes a conflict between the interests of the AMA and the
interests of another organization with which a Trustee or staff member is affiliated.

The Committee found no affiliations with issue.

The Board voted to accept this item as information.

Routine Audit of Random Trustees’ Expense Vouchers / Amex Reports
The Committee conducted a routine audit of random expense vouchers and American Express
reports completed by Trustees. The Committee found no irregularities.

The Board voted to accept this item as information.
                                                                 American Medical Association
                                                                    Board of Trustees Minutes
                                                                          April 10 – 13, 2008
                                                                                Page 28 of 32

19. REPORT OF THE AWARDS AND NOMINATIONS COMMITTEE

   The Board considered the report of the April 11, 2008 meeting of Awards and Nominations
   Committee (Drs. Stack, Chair; Annis; Carmel; Dolan; Gurman; Hazel; Wah; Heyman/ex-
   officio; and Wilson/ex-officio) with actions taken as indicated below:

   The Committee was impressed with the qualifications of all the nominees presented and feels
   that the AMA is fortunate as an organization to have so many qualified candidates willing to
   serve

   Awards
     Distinguished Service Award
     The Board voted to select and present James F. Arens, MD, (Bayfield, CO) to the House of
     Delegates for confirmation at the 2008 Annual Meeting as the recipient of the 2008
     Distinguished Service Award. The award will be presented at the 2008 Interim Meeting of
     the House of Delegates.

      Citation for Distinguished Service
      The Board voted that the Citation for Distinguished Service not be awarded in 2008.

      Benjamin Rush Award for Citizenship and Community Service
      The Board voted that the Benjamin Rush Award for Citizenship and Community Service
      not be awarded in 2008.

      Isaac Hays, MD and John Bell, MD Award for Leadership in Medical Ethics and
      Professionalism
      The Board voted not to submit a nomination to the AMA Foundation Board the 2008 Isaac
      Hays, MD and John Bell, MD Award for Leadership in Medical Ethics and
      Professionalism.

      Medical Executive Lifetime Achievement Award
      The Board voted to select Mr. D. Brent Mulgrew (Hilliard, OH) as the recipient of the
      2008 Medical Executive Lifetime Achievement Award to be presented at the 2008 Interim
      Meeting of the House of Delegates.

   NOMINATIONS
   Appointed Councils of the AMA

      Council on Legislation
      (one-year term ending June 30, 2009)
      The Board voted to reappoint the following incumbents:
          Randolph J. Gould, MD, (Norfolk, VA);
          David T. Hannan, MD, (Newark, NY);
          Patrice A. Harris, MD, (Atlanta, GA);
          Philip E. McCarthy, MD, (Norwood, MA);
          Jack S. Resneck, Jr., MD, (San Anselmo, CA); and
          Rowen K. Zetterman, MD, (Omaha, NE)
                                        American Medical Association
                                           Board of Trustees Minutes
                                                 April 10 – 13, 2008
                                                       Page 29 of 32
REPORT OF THE AWARDS AND NOMINATIONS COMMITTEE (continued)
  Council on Legislation (continued)

  The Board voted to appoint Kathleen Fitzgerald, MD, (Providence, RI) to succeed Barney
  Maynard, MD, who has reached maximum tenure.

  The Board voted to appoint David E. Winchester, MD, as the Resident member to succeed
  Charles Mashek, MD, who did not seek reappointment.

  The Board welcomed Mary Shuman as the Alliance representative to the Council on
  Legislation for the 2008-2009 year. Mrs. Shuman’s appointment is effective June, 2008.

  Council on Long Range Planning and Development
  The Board voted to reappoint Saul M. Levin, MD, (Chestertown, MD) to a second four-
  year term to end June 2012.

  The Board voted to appoint Marilyn K. Laughead, MD, (Scottsdale, AZ) to succeed
  Carolyn Evans, MD, who has reached maximum tenure.

Appointment of Medical Student Members to AMA Councils/Committees
The Board voted to concur the appointments or reappointments to the following
councils/committees: (for a one-year term ending June 2009)

  Council on Legislation
  Jessica Nguyen-Trong, University of Texas Southwestern Medical School

  Council on Constitution and Bylaws
  Trace Fender, Northeastern Ohio Universities College of Medicine

  Council on Long Range Planning and Development
  Justin Mahida, The Ohio State University College of Medicine

  Council on Medical Education
  Timothy Craft, University of Virginia School of Medicine

  Council on Medical Service
  Rachelle Klammer, University of Colorado School of Medicine

  Council on Science and Public Health
  Aaron Kithcart, The Ohio State University College of Medicine

Liaison Committee on Medical Education
The Board voted to concur the appointment of Cathleen Greenzang, Columbia University
College of Physicians and Surgeons, to the Liaison Committee on Medical Education (one-
year term)

AMA Foundation
The Board voted to ratify the election of Edmond B. Cabbabe, MD, as a Director of the AMA
Foundation for a three-year term effective June 1, 2008.
                                        American Medical Association
                                           Board of Trustees Minutes
                                                 April 10 – 13, 2008
                                                       Page 30 of 32
REPORT OF THE AWARDS AND NOMINATIONS COMMITTEE (continued)
Advisory Committee on Group Practice Physicians
The Board voted to reappoint Michael Kitchell, MD, (Ames, IA) for a three-year term to
begin July 1, 2008.

The Board voted to appoint Jeffrey W. Bailet, MD, (Milwaukee, WI) for a three-year term to
succeed Kathryn Leonhart, MD, who is not seeking reappointment.

The Board voted to appoint Peter C. Amadio, MD, (Rochester, MN) for a three-year term to
succeed Jasper Daube, MD, who has resigned.
Gay, Lesbian, Bisexual and Transgender Advisory Committee
  Student Representative
  The Board voted to appoint Jesse A. Levin (New York Medical College) as the Student
  representative for a one-year term to end May 31, 2009.

   GLMA Representative
   The Board voted to appoint Gal Mayer, MD, (New York, NY) as the GLMA
   representatives for a two-year term, ending May 31, 2010.

   At-Large Member
   The Board voted to reappoint Paul A. Wertsch, MD, (Madison, WI) as the At-Large
   representatives for a two-year term, ending May 31, 2010.

Senior Physicians Group
The Board voted to: (1) appoint Claire V. Wolfe, MD, (Dublin, OH) for a three-year term to
begin immediately and end in June 2010, to succeed Harrison Rogers, Jr., MD, who has
resigned; and (2) waive the newly instated minimum age eligibility requirement for the Senior
Physician Group for Dr. Wolfe.

The Board voted to appoint Joseph L. Murphy, MD, (Chicago, IL) for a three-year term
effective July 1, 2008 to succeed Irwin K. Kline, MD who was not reappointed to the Senior
Physicians Group.

Utilization Review Accreditation Committee (URAC)
The Board voted to reappoint David Barbe, MD, (Mountain Grove, MO) as a representative
on URAC for a second three-year term to end April 30, 2011

Residence Review Committees - Reappointments
The Board voted to reappoint the following incumbents for terms to be determined by the
Accreditation Council on Graduate Medical Education:
  Anesthesiology – Rita M. Patel, MD, (Pittsburgh, PA);
  Dermatology – Maria K. Hordinsky, MD, (Minneapolis, MN);
  Family Medicine – Richard A. Neill, MD, (Narberth, PA);
  Medical Genetics – Mira B. Irons, MD, (Milton, MA);
  Neurological Surgery – Arthur L. Day, MD, (Boston, MA);
  Pathology – Mark D. Brissette, MD, (Denver, CO);
  Preventive Medicine – Timothy J. Key, MD, (Homewood, AL);
  Psychiatry – Michael J. Vergare, MD, (Philadelphia, PA); and
  Surgery – Peter J. Fabri, MD, (Tampa, FL).
REPORT OF THE AWARDS AND NOMINATIONS COMMITTEE (continued)
                                                                    American Medical Association
                                                                       Board of Trustees Minutes
                                                                             April 10 – 13, 2008
                                                                                   Page 31 of 32

    External Awards
    The Board voted to nominate Joseph V. Messer, MD, MACC, (Chicago, IL) for The Joint
    Commission 2008 Ernest Amory Codman Individual Award.

    The Board voted to nominate Dennis S. O’Leary, MD, (Oakbrook Terrace, IL) for The Joint
    Commission 2008 John M. Eisenberg Award for Patient Safety and Quality.

    Nominations Board Report to The House Of Delegates
    The Committee considered a draft informational Board of Trustees report titled “Nominations
    for Election to AMA Councils.” The Committee felt the report would be more effective with
    recommendations for the House to consider. Based on the discussion, the report is being
    referred back to staff for revision. The Committee provided direction on the development of
    appropriate recommendations to seek a bylaws change regarding the requirement that the
    Board of Trustees submit two names per vacancy on the AMA councils elected by the House
    of Delegates. The Committee will review the revised report at the June meeting with possible
    transmission to the House of Delegates for the 2008 Annual Meeting.

    The Board voted to accept this item as information.


20. REPORT OF THE MEMBERSHIP COMMITTEE
    The Board considered the report of the April 10 and April 11, 2008 meetings of the
    Membership Committee (Drs. Patchin, Chair; Hetsko; Lazarus; Stack; Heyman/ex-officio;
    Wilson/ex-officio; and Mr. DeRienzo) with actions taken as indicated below:

    REPORT OF THE MEMBERSHIP COMMITTEE (continued)

    Military Dues Waivers
    The Committee heard and discussed the report on Military Physicians. The focus of the report
    was to provide clarity on three main points: an accurate roster of military physicians, offering
    gratis versus further discount of dues to military physicians and examining the implications to
    the AMA in exchange for creating a special offer. In summary, existing Department of
    Defense (DOD) and Privacy Act rules prevent the obtaining of lists from the military and use
    of the lists for solicitation of AMA membership. There are significant and complex rules
    surrounding gifts to military members. With respect to “free” membership, the DOD
    Standards of Conduct prohibit the acceptance of any gift valued at over $50. Any gratis
    membership offer from AMA would require DOD approval.

    There was considerable discussion on ways for the AMA to express appreciation to those
    serving in all branches of the military. Management had presented information related to
    previous discussions and offered clarity on how to pursue a gratis and/or reduced dues for
    military physicians.

    Utilization of an electronic peer-to-peer marketing tactic was suggested by the Membership
    Committee to engage military physicians who are current AMA members to recruit other
    military physicians. This opportunity will allow the AMA to make contact and get the
    membership message to the military physicians in a way that does not violate or interfere with
    any government rules and regulations. Management will follow-up on this suggestion and
    report back to the committee.
                                                                 American Medical Association
                                                                    Board of Trustees Minutes
                                                                          April 10 – 13, 2008
                                                                                Page 32 of 32
It was suggested that management and the Membership Committee Chair explore with the
Board Chair the opportunity to convene a meeting of AMA Executive Committee members
and high ranking military leaders to discuss issues related to AMA membership and ways the
AMA could honor those physicians who are serving in the military.

The Board voted to accept this item as information.

Criteria for Handling Hardship Dues Waivers in the Event of a National Disaster
The Committee heard an update on the background and existing protocols for handling
hardship dues waivers due to natural disasters. The evaluation process includes a risk
assessment of estimated dues revenue loss and other costs. The assessment and staff
recommendation is reviewed by Membership, Finance and Legal areas and then sent to the
EVP for review and approval. The EVP then forwards the recommendation to the
Membership Committee and Board of Trustees for consideration and action. The current
protocol of approving financial hardships as natural disasters arise is satisfactory with the
request that review and approval can be expedited via electronic vote and /or conference call
with the Membership Committee, Finance Committee and the Board of Trustees to allow
immediate response to members in time of need.

The Board voted to reaffirm the current protocol on approving financial hardship dues waivers
due to natural disaster as acceptable with the inclusion that the review and approval can be
expedited by electronic vote and/or conference call.




                                         The Board meeting adjourned at 11:00am (Central Time).



                                         ___________________________________
                                         Edward L. Langston, MD, Chair



                                         ___________________________________
                                         William A. Hazel, Jr., MD, Secretary

				
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