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ACPM
Policy Committee Meeting
November 6, 1999
4:00-6:30 pm
Hyatt Regency - Chicago, Illinois
MINUTES
Participants
Christopher
Armstrong; Mike Barry (staff); Patricia
Byrns; Jacqueline Christman; Barbara Clark
(staff); Steven Fox; Arvind Goyal; Bob
Harmon (Chair); Neal Kohatsu; Dorothy
Lane; Edward Lichter; Perrianne Lurie;
Michael Parkinson; John Poundstone;
Marilyn Radke;
Jud Richland
(Executive Director); Hugh Tilson.
Welcome
and Introductions
Dr.
Harmon welcomed members of the Policy
Committee and made several
‘housekeeping’ announcements.
The minutes of the March 17, 1999,
meeting were approved.
Charge
and Priority Setting Criteria
Dr.
Harmon led the committee through a review
of the Policy Committee charge,
responsibilities, and operating
procedures.
Several editorial changes were
suggested and approved by the committee,
including:
making the title of committee staff
more generic, adding a phrase in the
charge statement about creating policy
positions that support preventive medicine
education; and weaving the proposed
priority setting criteria into the charge
document.
The committee questioned whether a
process was in place for re-appointing
members to the committee. Staff noted that
re-appointments are currently made to the
database automatically when they expire.
ACPM
will develop a more formal process of
notifying members when their terms are up
and ensuring the Chair officially
re-appoints them.
The
discussion shifted to the proposed policy
setting criteria.
The committee agreed that
ACPM
policy activities should be both proactive
and reactive.
Dr. Parkinson suggested the
criteria serve as a tool for
ACPM
staff in making decisions on which issues
to focus attention and scarce advocacy
resources and that fiscal, political, and
health impacts all need to be considered.
The committee affirmed that the
criteria should balance an assessment of
the risks and benefits—including
strategic, financial, political, and
health consequences—of the policy
position.
After
lengthy discussion, the committee agreed
on the following criteria:
mortality and morbidity burden of
the population; potential favorable impact
on the health of the population;
scientific validity of the policy; extent
to which the
ACPM
policy position will help advance the
mission and goals of
ACPM
; extent to which
ACPM
can make a unique contribution or has
special interest in the issue; potential
for increasing visibility of
ACPM
and the preventive medicine specialty;
potential costs and benefits to
ACPM
in human, financial, and political
resources; prior analysis of
ACPM
policy compendium; and potential to
promote
ACPM
membership recruitment, involvement, and
professional interests. The Chair and
ACPM
staff agreed to write-up the criteria
overnight and share with the full Board
the following day as an informational
item.
The criteria will then be
distributed back to the committee for
review and refinement, approved, then
submitted to the Board for final adoption.
Medicare
GME Funding
Mike
Barry provided an overview of the status
of Medicare GME funding (pages 1-2,
November ’99 Policy Report). He
described the disbanding of the Bipartisan
Commission on the Future of Medicare
without a final Medicare reform strategy
and the MedPAC report on GME payment
policies (Attachments A and B to the
November ’99 Policy Report).
The
Policy Committee felt that
ACPM
should push for a change in how Medicare
GME payments are made so that they support
residency training programs, rather than
the institutions in which residents train.
The committee urged
ACPM
to join forces with Residency Program
Directors to develop a strategic advocacy
plan, including identifying the
appropriate congressional committee staff
and other strategic allies, and continue
to push the issue on the Hill.
Appropriations
and Title
VII
Mike
Barry described the impasse on the FY 2000
spending bills and related appropriations
issues, including an across-the-board
budget cut and delayed obligations for
many PHS agencies (page 2, Policy Report
and Attachment C).
He also reported on the status of
Title VII funding for public health and
preventive medicine training, which were
eliminated from the administration’s
budget, but restored to FY ’99 levels in
the Conference Committee report.
Policy Committee members discussed
the administration’s tactic of zeroing
out the Title VII funds in order to free
up budget room for other priorities,
knowing that the health professions lobby
is strong enough to ensure Title VII
funding is restored.
However, the committee felt that
ACPM
needs to continue to fight for not only
level funding, but for significant
increases in this small, but important
source of preventive medicine training
funds.
Tobacco
Mike
Barry discussed
ACPM
’s continued involvement in tobacco
prevention policy through the ENACT
coalition.
He summarized four recent
developments, including the tobacco
settlement federal waiver, Department of
Justice lawsuit, recent enforcement of the
Synar Amendment, and a tobacco tax (pages
3-4, Policy Report and Attachments D and
F). He
also pointed out to the committee OSHA’s
unsatisfactory response to
ACPM
’s letter regarding indoor air quality
standards (Attachment E).
Committee
members discussed
ACPM
’s limited success in this area.
One member felt
ACPM
’s policy advocacy should focus on where
the action is—at the state level, rather
than at the federal level.
The committee suggested that
ACPM
concentrate more on working directly with
states to help them with their legislative
activities and allocation of funds from
the Master Settlement Agreement. The
committee approved a motion for
ACPM
to obtain the CDC model criteria for state
programming of tobacco settlement dollars
and distribute to the committee for review
and approval. These guidelines should then
be distributed to all 50 state
legislatures, and
ACPM
regional Regents and Fellows could work
with their respective states in promoting
the guidelines.
Federal
Privacy Rule
The
committee discussed
HHS
’ plans to soon release a rule on
privacy of medical records and health
information, as required by HIPAA (pages
4-5, Policy Report).
Dr. Tilson described a recent
conversation he had with the Secretary
where she assured him that the proposed
rule would provide a ‘safe haven’ for
data needed for public health and
epidemiologic research purposes.
Mike Barry referred the committee
to a letter signed by
ACPM
President, George Anderson, to the
Secretary commending her for the
Department’s stated intention to strike
a balance between patient protections and
socially responsible uses of the
information.
The letter attached a copy of
ACPM
’s recently adopted policy statement
(Attachment G).
The
committee urged for
ACPM
to weigh in on the proposed regulations
when they are officially released.
The committee expressed concern
about AMA’s position on privacy.
ACPM
should aim to educate AMA on the
importance of preserving epidemiologic and
public health research in federal privacy
rules and hold it accountable for
advocating its previous policy statements.
The committee also expressed
concern about HHS’ rule not containing a
state preemption clause, meaning we could
end up with a patchwork of privacy
regulations that inhibit access to data
for multi-state or national studies.
Folic
Acid Fortification
The
committee discussed the FDA’s response
to the
ACPM
letter calling for raising the federal
standard for daily folic acid consumption
to prevent neural tube defects in
pregnancies (page 5, Policy Report and
Attachment H). The FDA’s response
asserted that not enough data or
scientific evidence existed to show at
what level folate consumption was still
considered safe for the entire population.
The committee passed a motion for
ACPM
to send another letter to FDA pointing to
the recent article published in the
American Journal of Public Health as
additional evidence of the need to
strengthen folic acid requirements for
women of childbearing age.
In addition, the committee moved
that
ACPM
form strategic alliances with other
organizations to push the issue.
Local
Health Department Accreditation
Dr.
Parkinson pointed to a resolution passed
at the AMA I-98 meeting calling for AMA to
work with the appropriate organizations to
develop a process for establishing
criteria for the potential accreditation
of health departments and past Policy
Committee discussions on the issue (page
5, Policy Report).
He described the current activity
at CDC in partnership with major public
health organizations (ASTHO, NACCHO, APHA)
to develop public health performance
standards, but noted how there has been no
real discussion of the linkage between
clinical medicine and population-based
health.
He sees
ACPM
as an ideal organization to work with
organized medicine to make this linkage
happen.
The committee supported this view,
but cautioned that
ACPM
be viewed as partners in this effort,
rather than a group trying to wrestle
control of the accreditation issue.
Antibiotic
Resistance
Dr.
Lurie noted that a strong evidence base is
beginning to form around the relationship
between use of antibiotics in animal feed
and antibiotic resistance in humans (page
5, Policy Report and handouts provided).
She suggested the Policy Committee,
as well as the Practice Guidelines
Committee, review the policy statement
from the Council of State and Territorial
Epidemiologists and consider whether
ACPM
should endorse it.
State
Medical Licensing Requirements
Mike
Barry led a discussion on the emerging
issue of changing state medical licensing
requirements and the Federation of State
Medical Board’s (FSMB) policy statement
urging for three-year post-graduate
training requirements for state licensing
(pages 5-7, Policy Report and Attachment
I). He
reported on the results of a survey of
preventive medicine residency program
directors showing that the FSMB position
statement had not been adopted by any of
the states represented in the survey, and
changes are only being considered by a few
states.
Concern was raised about the
potential impact on preventive medicine
training, particularly if state medical
boards view the policy as a mandate for
three years of clinical training.
The committee discussed several
strategies, including initiating a
dialogue with ACGME, FSMB, and others.
Initially, a motion was passed to
send a letter to FSMB expressing the
unique nature of preventive medicine
training and that FSMB clarify the spirit
of its policy.
However, after further discussion,
the committee agreed that, since this is
not yet an issue in the states, any action
could backfire and “restraint and
vigilance” may be the best policy at
this time.
The committee retracted its motion
and called on
ACPM
to continue to monitor and report on the
situation.
Private
Employers’ Coverage of Preventive
Services
Jud Richland
provided a brief overview of the recently
released Partnership for Prevention report
on private employers’ coverage of
preventive services (page 8, Policy Report
and Attachment L). As a member of
Partnership, Mr. Richland asked the
committee to consider whether
ACPM
should endorse the recommendations
targeted to policy makers and if the
College should take any additional action.
The committee supported the
recommendations and asked the Chair to
forward them to the Board for
ACPM
endorsement.
Universal
Access Joint Policy Statement
The
committee discussed whether or not
ACPM
should sign-on to the joint statement on
universal health insurance, originally
co-signed by AMA and six other national
medical specialty societies (page 7,
Policy Report and Attachment J).
The committee expressed concern
about the statement’s focus on insurance
coverage, rather than access, particularly
in the title of the statement.
After some debate, the committee
passed a motion recommending that the
Board
support the statement.
The motion also called for
ACPM
to include a cover letter that calls for a
revised statement that shifts its focus
from insurance to access, pushes for
coverage of preventive services, and
outlines strategies for funding the
proposal.
Medicare
Coverage of Preventive Services
Mike
Barry referred the committee to the
Medicare Wellness Act of 1999, a bill
introduced by Senator Graham (D-FL) in
September, 1999 (page 7, Policy Report and
Attachment K).
While the committee was supportive
of the intent of the bill, several members
pointed out how an earlier version of the
bill included an associated drug benefit
and that
ACPM
went on record in support of the bill.
The committee passed a motion to
recommend that the Board approve the
Graham bill, but with the caveat that the
bill’s sponsors seek opportunities to
expand the bill to include related drug
benefits.
Internet
Quality Review Criteria
Mike
Barry referred the committee to the report
of the Health Summit Working Group
proposing criteria for evaluating the
quality of health information on the
Internet (pages 8-9, Policy Report and
Attachment M) and called on the committee
to take a position.
Dr. Christman noted that the YPS
had written a resolution calling for the
AMA House of Delegates’ to support the
criteria and that several Preventive
Medicine Section Council members had
voiced support for it.
The committee passed a motion
recommending that the
ACPM
Board endorse the criteria in principal
and that
ACPM
’s delegation at AMA voice their
support.
It was also suggested that
ACPM
’s Home Page be consistent with these
criteria.
Late
Breakers
The
committee agreed to make itself available
on short notice for a potential conference
call to address AMA resolutions, as
needed.
One committee member recommended
that the committee consider using
conference calls to address major issues
in between meetings.
Dr.
Kohatsu, Chair of the Practice Guidelines
Committee, alerted the committee to a
consensus policy statement on prostate
cancer screening being developed by the
American Cancer Society in partnership
with
ACPM
and other medical specialties.
When the statement is further
developed, he would like to vet it through
the Policy Committee and, ultimately, the
ACPM
Board, for approval.
The
meeting adjourned at 6:30 PM.
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