AMA Takes Steps to Protect Residents, Fellows Impacted by Teaching Hospital Closures

November 21, 2019 - The American Medical Association (AMA) has adopted a new policy to help ensure residents and fellows who lose their jobs due to unexpected teaching hospital closures are financially and professionally protected.

The organization's new policy comes on the heels of the recent closure of Philadelphia's Hahnemann University Hospital, which displaced more than 570 residents and fellows.

Hospitals have been closing at a rate of about 30 per year, according to the American Hospital Association, and 98 rural hospitals have closed since 2010, the National Rural Health Association reports.

The new policy calls for the AMA to urgently partner with interested parties to identify viable options to secure malpractice insurance "tail coverage" for residents and fellows impacted by the Hahnemann closure, covering their time at Hahnemann, and also for residents and fellows impacted by any future teaching hospital closures, at no cost to those who are displaced.

The policy was adopted by the AMA's House of Delegates at its interim meeting this week.

The organization will also work with the Centers for Medicare & Medicaid Services (CMS) to establish regulations that will help protect residents and fellows affected by training program closures.

Pennsylvania law requires that physicians, residents, and fellows have malpractice tail coverage from their previous employers, the AMA said.

"We have an ethical obligation to do everything we can to provide assistance to physicians-in-training who are left in professional and financial limbo after their teaching institution closes unexpectedly. By no fault of their own, these residents and fellows are forced to find new training programs and many face deep financial hardships as a result," AMA Board Chair Jesse Ehrenfeld, M.D., said in a statement "We are committed to working together with other organizations to help protect these students and help eliminate financial and regulatory barriers as they seek new residencies, relocate and transition to their new training programs."

In July, after Hahnemann University Hospital closed its doors, the AMA issued a letter to CMS urging it to offer an increased level of support, technical guidance and applicable waivers for any rules or regulations creating barriers for displaced residents and fellows.

The organization also simultaneously sent a letter to the U.S. Department of State's U.S. Citizenship and Immigration Services, calling on them to waive the grace-period requirement under the J-1 physician visa program for the impacted physicians-in-training.

New policy on EHRs for health surveillance
During its Interim Meeting, AMA delegates also took steps to push for the use of electronic health records (EHRs) to modernize public health surveillance to help alleviate the burden on physicians.

Public health surveillance is focused on the detection of acute, chronic and emerging threats to the health of the population to direct disease control and prevention efforts. These efforts rely on healthcare providers to report to public health agencies conditions or outbreaks that may impact the broader population.

Historically, case reporting has been based on paper reports or Internet-based entry of reports to state health department systems, but these reports are often slow or incomplete and place a substantial burden of work on healthcare providers.

The AMA is calling for increased state and local funding to modernize the country's public health data systems to improve the quality and timeliness of the data. To help alleviate the burden of reporting on physicians, the policy also supports efforts underway to implement electronic case reporting—a process by which reportable conditions are automatically generated from EHR systems directly to public health agencies for review and action.

"We know that disease surveillance is essential to monitoring, controlling, and preventing disease and clinicians play an important role in this process. However, submitting data to public health agencies can be burdensome and disruptive to workflows for physicians and other mandatory reporters," AMA Board Member Willie Underwood III, M.D., said in a statement.

Modernizing the nation's public health surveillance systems and implementing electronic case reporting will help to improve the quality and timeliness of public health data while also removing the burden on physicians, Underwood said.

By: Heather Landi
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