Monday, May 10, 2010


Optometrists are among the health care professionals targeted under the American Medical Association's (AMA) growing Scope of Practice Partnership (SOPP) project, according to an overview of the program presented May 2 during the annual meeting of the Federation of State Medical Boards (FSMB).
The AMA's two-year-old SOPP effort is intended to unite doctors of medicine and osteopathy in opposition to the increasing use of "non-physician providers" in primary care, according to the presentation.
The program was developed in part to curtail growth in advanced practice nursing and in new "alternative health care" disciplines, according to the AOA Advocacy Group.
However, it also targets well-established health care disciplines with doctorate-level education programs - such as optometry, podiatry and psychology - that might compete with medical or osteopathic physicians for primary care patients, the AOA Advocacy Group notes.
The SOPP program attempts to respond to the evidence offered by non-MD and non-DO providers as a part of their successful efforts over recent years to win scope of practice legislation and coverage under health insurance programs, according to the AMA presentation. Launched in January 2006, the program provides funding as well as in-kind support for scope of practice campaigns by MD and DO groups at both the state and federal levels, according to the presentation.
In response to divisive efforts by the AMA and other physician groups to limit the ability of licensed health care professionals to provide care to millions of patients, the AOA Advocacy Group and AOA Communications Group have implemented new efforts of their own over recent years. The AOA is a member of the recently reactivated PARCA (formerly the Patient Access to Responsible Care Alliance); a Washington, D.C.-based coalition of non-MD health care providers. The AOA Communications Group has launched its Optometry Awareness and Public Affairs campaign targeted to both the public and legislators.
However, the SOPP program is growing and becoming more ambitious, the AOA Advocacy Group warns. During 2008, SOPP is attempting to limit non-physician scope of practice through a combination of legislative and regulatory activities, "judicial advocacy," and "programs of information, research, and education," according to the presentation.
This year, the program is also making available to members special resources to support such efforts, specifically the "AMA Scope of Practice Data Series" of studies on non-physician professions, dedicated listserves to facilitate rapid communication among members on scope of practice issues, and a SOPP Geographic Mapping Initiative.
An AMA Scope of Practice Data Series publication on optometry is under development, according to the presentation.
The SOPP mapping project is intended to counter claims that non-physician providers often practice in many areas where medical doctors do not have practices and that non-MD providers therefore play an important role in enhancing patient access to care.
"Distribution of rural providers is at the crux of these (legislative) scope (of practice) battles," the presentation text notes.
The SOPP program has already compiled maps documenting the locations of all actively practicing medical doctors and doctors of osteopathy in the United States, according to the presentation. Maps documenting the locations of all non-physician providers in specified professions were to be completed by the end of May, according to the presentation. Maps of MD and DO practice locations were already available at the time of last month's meeting.
'Truth In Advertising Campaign'
Much of SOPP's efforts are focused on enacting "truth-in-advertising" legislation at the federal and state level. The "Truth in Advertising Campaign" is intended to "build a national case for the important message of truth-in-advertising by limited-licensed health care providers," according to the presentation.
Typical of such legislation is the Sullivan bill (H.R. 2260), introduced in Congress last year, which would have required health care providers who do not hold MD or DO degrees to issue disclaimers to patients.
Failure to issue the disclaimer would have been considered a violation of federal unfair trade statues.
Strongly opposed by the AOA and other organizations, the Sullivan bill failed to win support among legislators and has effectively stalled.
The AMA claims to have introduced similar legislation in at least three states.
Judicial advocacy
Already playing an important role in the SOPP program is the AMA Litigation Center, according to the presentation. Established in 1995 to act as "the voice of America's medical profession in legal proceedings around the country," the AMA Litigation Center has already been involved in more than 150 court cases.
As evidence of the AMA Litigation Center's success, the presentation cites a March 14, 2008, Texas appeals court ruling that found the Texas State Board of Podiatric Medical Examiners had overstepped its authority by defining podiatrists' practice scope beyond the foot to include the ankle and leg.
The decision came as the result of a 2001 suit filed by the Texas Orthopedic Association against the osteopathic board.
The AMA Litigation Center assisted in the action by filing an amicus (friend of the court) brief that outlined the position of organized medicine and by helping to cover legal costs.
Other SOPP initiatives include creation of "rapid response coalitions," and potential collaboration in advocacy efforts with some non-physician groups.
SOPP work groups are being established to focus on naturopaths and clinical doctorates for advanced practice nurses.
The SOPP membership now includes medical associations in 49 states and the District of Columbia, 14 national medical specialty societies, two national medical associations (the AMA and the American Osteopathic Association), and 16 state osteopathic associations.
In addition, several non-physician groups have expressed interest in affiliating with SOPP, according to the AMA presentation.

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