By Troy L. Thompson II, M.D.

The Association of American Medical Colleges (AAMC) is chaired this year by Herbert Pardes, M.D., a former APA president and current dean of Columbia University College of Physicians and Surgeons, and the AAMC is involved in many projects of importance to psychiatrists.

The AAMC is a nonprofit association comprising the 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teaching hospitals, including 74 Department of Veterans Affairs medical centers; 86 academic and professional societies, which represent 87,000 faculty members; and the nation's 67,000 medical students and 102,000 residents.

The AAMC has a Council of Deans of Medical Schools, Council of Teaching Hospitals, and a Council of Academic Societies. Harold Pincus, M.D., director of APA's Office of Research, and I are the APA representatives to the Council of Academic Societies.

Recent Joint Accomplishments

The AAMC is particularly active in lobbying for legislative action to protect patients and their families and the health of research and medical education activities. These are among our recent joint accomplishments:

1. The AAMC joined with APA and other groups in successfully achieving a 6.8 percent increase in the budget of the National Institutes of Health. In addition, the budget of the Substance Abuse and Mental Health Services Administration was increased 13.4 percent from Fiscal 1996 to Fiscal 1997 (to $2.135 billion).

2. Jeffrey Sanders and other members of the AAMC's Office of Governmental Relations are monitoring the effects of the limited parity provision under the V.A.-HUD appropriations legislation that President Clinton signed on September 26. The law requires certain health insurers that offer mental health policies to provide the same total dollar coverage as they do for medical and surgical claims beginning January 1, 1998 (Psychiatric News, October 18, 1996). The AAMC was a strong supporter of Jay Cutler and APA as well as other groups in getting parity legislation through Congress. The law does not require employer or health plans to cover or maintain coverage for treatment of mental illness. Benefits for treatment of substance abuse or chemical dependency are excluded from the mental illness parity requirement.

3. A new law also includes an amendment championed by Senator Bill Bradley (D-N.J.) that requires health plans to cover 48-hour hospital stays (96 hours for mothers who have had caesarean sections) for mothers and newborns if needed. This provision, however, will not preempt state maternity length-of-stay laws that are equivalent to or broader than the new federal law.

4. The Health Care Financing Administration (HCFA) published rules regarding Medicare payment for services of teaching physicians that became effective on July 1, 1996. The rule's major provision requires that if a resident participates in a service furnished in a teaching setting, a physician fee schedule payment is made only if the teaching physician is present to perform or observe the resident perform the key portion of any service or procedure for which payment is sought.

As an exception, physical presence of the teaching psychiatrist may be fulfilled through concurrent observation of the resident via a one-way mirror or video camera.

The rule requires that for all evaluation and management services, the teaching physician must provide a personal notation that he or she was physically present to perform or to observe the resident perform the key portion of the service, confirm or revise the history of present illness, clinical assessment, diagnosis, and the plan of care. The AAMC and APA continue to work closely with HCFA staff on refining the instructions for documentation and other implementation issues.

5. Ivy Baer of the AAMC and APA have closely followed the U.S. Department of Health and Human Services (HHS) Office of Inspector General announcement of the Physicians at Teaching Hospitals (PATH) initiative under which teaching physicians are being audited to determine whether (1) bills submitted to Medicare comply with the requirements and (2) the levels of service were properly coded or were "upcoded" to increase Medicare reimbursement. As of late September, Baer reports that the Office of Inspector General had selected approximately 23 faculty practice plans for audit.

If the Office of Inspector General agrees to allow a physician group to enter PATH, the group has the opportunity to hire an auditor to conduct the audit rather than having the audit conducted by a government auditor. In return for participation in PATH, the Office of Inspector General agrees to provide "favorable treatment" to the participant. This includes making the participant's level of participation and cooperation known to other federal officials, including the Department of Justice, the federal agency that decides the level of damages that the participant incurs. The AAMC and APA have a number of concerns with PATH, all of which have been brought to the attention of the Office of Inspector General in both correspondence and meetings.

AAMC Web Site

The AAMC Web site at is the most important gateway to information related to academic medicine. The Web site also offers the table of contents and abstracts from the AAMC's journal, Academic Medicine, and a wide range of current information in the areas of medical education, biomedical research, the nation's health care, relevant policy issues, and current AAMC activities. The AAMC Web site attracts some 30,000 accesses each week, and that number continues to grow.

AAMC STAT----an acronym for "short, topical, and timely"----is the association's new electronic newsletter containing news briefs from academic medicine. Web site browsers may register to receive the newsletter via e-mail each week free of charge; the newsletter is also available on the AAMC's Web site at . As of November, AAMC STAT had registered more than 6,000 readers, including a number of psychiatrists.

The Web site also provides a list of AAMC publications relating to medical education and health care, and browsers can print out a copy of the publication order form. Publications also may be ordered by calling (202) 828-0416 during business hours or faxing (202) 828-1123. Two recent AAMC books that may be of particular interest to many psychiatrists are Enhancing the Environment for Women in Academic Medicine: Resources and Pathways ($15) and The Public Perceptions of America's Medical Schools and Teaching Hospitals. The latter is provided free as an AAMC service and reports national opinion research on the public's attitudes on our medical schools and teaching hospitals, the cornerstone and foundation of our future health care expertise.

I am pleased to have APA members send me their comments and suggestions regarding AAMC/APA interfaces. Please call me at (215) 955-6912 or 955-5431; fax: (215) 923-8219.

(Psychiatric News, January 17, 1997)