ACPM Policy Committee Meeting
Minutes

ACPM Policy Committee Meeting
October 21, 2001
8:00 – 10:00 a.m.
Atlanta Marriott Marquis – Atlanta, GA

MINUTES

Participants

In-person: Mark Johnson (Chair); Christopher Armstrong; Patricia Byrns; Ron Davis; Gary Goldbaum; Arvind Goyal; Bob Harmon; Dorry Lane; Bob LeBow; Perrianne Lurie; Marcella Meyer; Joel Nitzkin; John Poundstone; Hugh Tilson; Johnnie Tyler; Bob Wallace; Mike Barry (Staff); Jessica Cafarella (Staff)

By phone: Erica Frank; Neal Kohatsu; Mike Parkinson; Nancy Sheehan; Kelly Woodward

Mark Johnson called the meeting to order at 8:01AM. He welcomed Policy Committee members and led introductions. The minutes from the February 2001 meetings were adopted as submitted. Dr. Johnson provided an overview of the agenda, which would be primarily devoted to discussion and action on proposed policy resolutions. He urged that committee members limit discussion on each resolution and strive to arrive at a recommended action on each resolution (according to the action list shown at the bottom of the agenda).

Resolution 01-01(I) – Health Care for All

Bob LeBow, one of the co-authors of the resolution, presented the resolution and urged that ACPM adopt the principles contained within the resolution and consider supporting any health reform proposal that promotes such principles (rather than take the lead on developing such a proposal).

Action Taken: The Policy Committee deferred action on this resolution until the Open Policy Forum at Preventive Medicine 2002 (February 20-24, 2002, in San Antonio, TX).

Remarks: This resolution was the product of several months of collaboration and dialogue by the authors, who had submitted somewhat similar, but separate, resolutions for consideration at the 2001 Open Policy Forum. At that time, the Policy Committee referred both resolutions back to the authors and urged them to coordinate their efforts and resubmit a combined, refined resolution. As a result of concerns about the scope and role of ACPM expressed by the committee via the listserv prior to the October 21 meeting, Dr. LeBow addressed the committee and urged ACPM to consider at least adopting the principles and supporting other organizations’ and coalitions’ advocacy efforts consistent with these principles. The committee questioned how these principles matched up with other organizations’ reform proposals (e.g., AMA) and expressed some additional concerns about some of the all-payer principles. One committee member suggested ACPM consider a more targeted approach, such as the "MediKids Health Insurance Act of 2001" currently being considered by Congress. Dr. LeBow reiterated that the proposed resolution seeks revolutionary system changes, with a focus on primary and secondary prevention for the whole population, not a tinkering around the edges for one segment of the population. The committee decided to defer action until the spring meetings of the committee and Open Policy Forum and urged the authors to do additional research into how their principles compare to other organization/coalition reform proposals.

The author of the resolution, Marcella Meyer, along with her colleague, Johnnie Tyler, presented the resolution.

Action Taken: The Policy Committee recommended that ACPM not adopt this resolution.

Remarks: This same resolution was submitted to ACPM and considered by the Policy Committee in February 2001. ACPM decided not to adopt it at that time as well. However, because the author was not able to present the resolution in February, and an evaluation of her sexual abstinence program had been completed since that time, she opted to resubmit it for consideration. At the October 21 meeting, she and her colleague presented the resolution and the results of the evaluation survey that demonstrated program success. Policy Committee members raised concerns about the validity of the survey evaluation results and methodology. The committee also noted the resolution’s stance against sexual activity in all cases except for marriage and felt that marriage excluded certain segments (e.g., gay and lesbian) of the population. The committee felt that ACPM could only support abstinence as part of a more comprehensive sexual education program, and encouraged the author to consider raising the issue at ACPM’s Open Policy Forum in February 2002.

This resolution was developed to submit to the American Medical Association House of Delegates (AMA-HOD) for consideration at its upcoming 2001 Interim meeting in San Francisco. Erica Frank, the author of the resolution, presented it to the committee.

Action Taken: The Policy Committee recommended the Board adopt the resolution in principle and delegate authority to a small working group to revise the language.

Remarks: The committee was supportive of the thrust of the resolution, but members expressed concern about some of the language regarding reprogramming of dollars from existing public health programs to bioterrorism-related initiatives. The committee urged language focusing on the importance of strengthening the public health infrastructure. A suggestion was made that ACPM, rather than submit its own resolution, should consider waiting for the AMA Board of Trustee report on this topic to be issued in November then weigh in on that report accordingly. The committee agreed on the importance of ACPM having its own free-standing policy on the issue and adopted a motion to submit the resolution to the Board with the intention of amending it to address the above-stated concerns. Mike Parkinson, Erica Frank, and Joel Nitzkin volunteered to amend the resolution before it is presented it to the Board.

Mike Barry presented the resolution, which was developed by ACPM staff to urge AMA support for a National Health Tracking Network.

Action Taken: The Policy Committee referred the resolution back to staff for further research and refinement and to report back to the committee at the February 2002 meeting.

Remarks: The committee supported the general thrust of this resolution, but raised concerns about the lack of specificity regarding the attributes and implementation strategies of the proposed system. The committee suggested that the Whereas statements should better describe what diseases would be tracked, what databases would be mined, etc. There was also concern about the timing of this resolution (i.e., how it would be received in the AMA at time when the HOD is primarily focused on the role of physicians in bioterrorism response and preparedness.

Mike Barry noted the ACPM had agreed earlier to cosponsor the resolution, which was developed by the American Academy of Neurology and cosponsored by several other specialty societies. This decision was based on ACPM having endorsed the original legislation.

Action Taken: No action required. The Policy Committee supported the action taken.

Ron Davis introduced the resolution to the committee (he had shared it on the listserv two days prior to the committee meeting).

Action Taken: The committee recommended the resolution be adopted as amended.

Remarks: There was unanimous support for this resolution with minimal discussion. However, the committee recommended a second Resolve be added to ensure that state or local medical societies are involved in the investigation of false testimony and that state medical licensing boards be notified of action taken.

Gary Goldbaum gave the report of the Preventive Medicine Residency Funding Task Force. He described current ACPM activities and plans around the following issues:

1. formulating ACPM’s position on all-payer GME legislation;
2. advocating for increased Title VII funding for preventive medicine residency programs;
3. working with the Department of Veterans Affairs (VA) to develop additional training opportunities;
4. examining opportunities to leverage funding from the Bush administration’s initiative to expand community health centers (CHCs);
5. promoting preventive medicine opportunities from the American Cancer Society; and
6. expanding eligibility in the National Health Service Corps (NHSC) to preventive medicine physicians.

The committee discussed the NHSC issue and agreed that the focus has to be on modifying the legislation, not on HRSA. Nancy Sheehan questioned if there were ways to access NHSC dollars for preventive medicine residents, describing how several years ago she completed an NHSC post-residency assignment in a CHC in Rhode Island.

Mike Parkinson highlighted the preventive medicine residency program being developed at the University of Dartmouth as a potential model to present to the VA. The Dartmouth preventive medicine residency will be an integrative quality improvement model that facilitates combined training in preventive medicine and other primary care specialties.

ACPM Policy Setting and Implementation Process

Mike Barry presented the final draft of the document to the committee, highlighted the changes that had been made as a result of committee comments posted on the listserv, and asked for the committee to recommend final approval to the Board. Because the committee had not been given ample time to review the document with the changes, it deferred action on final adoption and asked ACPM staff to re-distribute it via the listserv for a final review before sharing it with the Board of Regents for adoption.

Joel Nitzkin presented to the committee a resolution calling on ACPM to declare an emergency situation regarding the specialty of preventive medicine and to relegate all business of the College as lower priority than actions needed to strengthen the specialty. It also presented a variety of action steps regarding implementation of the JMI.

Action Taken: The Policy Committee recommended the resolution be adopted as submitted.

Remarks: The Policy Committee expressed some concerns with the specific details within the proposed resolution, such as use of the term "Board eligibility" and misrepresentation of the roles of the ACGME Preventive Medicine RRC. After discussion about adopting a more general resolve to deem the status of the specialty of preventive medicine a top priority for the College and refer the details of an action plan to an ACPM committee(s), the Policy Committee recommended the resolution be adopted as submitted.

Mark Johnson solicited comments on the Policy Report. Perrianne Lurie recommended that the College not lose sight of the medical privacy/research issue and urged ACPM to form a coalition among the public health research community to address the issue.

Mike Barry briefly mentioned the desire to develop annual objectives for the Policy Committee and agreed to draft some objectives for the committee’s consideration at the annual meeting in February 2002.

The committee adjourned at 10:00 AM.