AMA Defines Interventional Pain Management as Practice of Medicine; Debates Health Reform, Medicare At Interim Meeting

At a Meeting in Honolulu on November 10-13, the American Medical Association (AMA) House of Delegates adopted a resolution that the "interventional pain management of patients suffering from chronic pain constitutes the practice of medicine" -- and by inference, should not be conducted by certified nurse anesthetists or any health care providers other than physicians. The AMA delegates voted not to consider a late resolution to set guidelines for collaborative agreements with APRNs, and to review APRN education, training, quality of care, and physician oversight. In general, the major areas of interest to AMA delegates were health care reform - including caring for the uninsured, SCHIP and opposition to a single payer system; insufficient Medicare reimbursements to physicians; and limitations on physician practice by health insurers and hospitals.

Interventional Pain Management

AMA Resolution 903, entitled "Interventional Pain Management: Advancing Advocacy to Protect Patients from Treatment by Unqualified Providers," encourages state medical boards & societies to promote this view through advisory opinions and legislation. The ANA as well as the AANA (American Association of Nurse Anesthetists) submitted written comments objecting to the resolution. During discussion at the AMA meeting, some physicians echoed our concerns about it being overly broad, as well as lacking any definition of what constitutes "interventional pain management."

Resolution 903 was approved, however, with several amendments. A reference to the Scope of Practice Partnership was deleted. Other amendments limit the issue to "interventional pain management" rather than general chronic pain management, and also require treatment by physicians to be "directed by best evidence." The AMA is also directed to collect information regarding the educational programs in pain management and palliative care offered by nursing programs and medical schools, in order to demonstrate "adherence to current standards in pain management."

Model Agreements With APRNs

AMA delegates voted against considering a late "emergency" resolution entitled "AMA Model Agreements with Advance Practice Nurses." Introduced by state delegations in Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, the resolution called for developing "criteria or elements" for collaborative agreements or arrangements with advance practice nurses. It also would have addressed "quality of care, continuity of care, appropriate oversight, and the verification and ongoing maintenance" of APRNs' "skills, education and training." Since there was no debate on its merits, the resolution may have been rejected because the normal procedures were not followed, and therefore could resurface at future meetings.