February 20, 1998
To: Local and State Medical Societies and Medical Specialty Societies
We are seeking to know whether other societies share our concerns about the American Medical Accreditation Program (AMAP). We do know that at least three societies, including the Arizona Medical Association, have proposed resolutions to stop the AMAP, but these apparently have had no significant effect.
A summary of our concerns follows. We would appreciate knowing whether your organization agrees, disagrees, or is of no opinion about each. A place to indicate your response on this letter is provided, along with a self-addressed envelope.
1. The process of undergoing site inspections and resubmitting credentials periodically will become increasingly onerous and expensive, like JCAHO inspections, to the disadvantage of solo practitioners and small groups.
2. There is no evidence that "practice guidelines" or site inspections have a net beneficial effect on patient care.
3. The establishment of a nationwide program under the auspices of the AMA or the Federation will work to the disadvantage of local or specialty societies that currently provide credentialing services.
4. Although "practice guidelines" are supposed to be voluntary, adherence to them is one of the factors weighed in the accreditation process. Physicians could be subjected to undue pressure to practice contrary to their own best judgment, base on "guidelines" heavily influenced by special interest groups, such as managed care organizations that may profit from rationing care.
5. Just as no businessman would like to be subjected to the possibility of nonaccreditation at the discretion of competitors, physicians should be wary of potential conflicts of interest. The AMA is not necessarily a disinterested outside agency, immune to influence by physicians' competitors.
6. Large sums of money will be involved (or will be at stake) in the decision to accredit or deny accreditation, creating a potential for corruption.
7. There are no constitutional or statutory protections against unwarranted actions by private agencies. Even if AMAP damaged a physician's ability to earn a livelihood through actions taken in bad faith, a physician would have no effective recourse.
8. Our organization is in favor of the AMAP.
9. Our organization will work against the AMAP program, as by bringing resolutions to the AMA House of Delegates or by other means (please elaborate).
Name, address, and telephone number of contact person for further discussion.
Thank you for your assistance.
Jane M. Orient, M.D., Executive Director