Issues discussed at the AMA House of Delegates meeting include definition of surgery, obesity

ACS Delegates in attendance at the AMA House of Delegates meeting

John H. Armstrong, MD, FACS

Jacob Moalem, MD, FACS

Leigh Neumayer, MD, FACS

Richard Reiling, MD, FACS

Patricia L. Turner, MD, FACS

Timothy Kresowik, MD, FACS (alternate delegate, Society for Vascular Surgery)

Kenneth Louis, MD, FACS (alternate delegate, Florida Medical Association)

The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 15–19 in Chicago, IL. More than 550 delegates as well as alternate delegates converged on the Windy City to consider and adopt policy for the AMA. Issues such as health care policy were discussed, educational sessions were presented, and caucuses and elections took place.

Reports and resolutions

The HOD reviewed more than 160 resolutions and 65 reports, including the following, centered on issues of relevance to surgeons:

Invasive procedures: As originally submitted to the HOD, this report from the AMA Board of Trustees called for revising the current AMA definition of surgery and guidelines on invasive procedures for the treatment of chronic pain, including procedures using fluoroscopy. Efforts to bridge the definitions for surgery and procedures fell short. A revised report was adopted that retained the current AMA definition of surgery but focused only on invasive pain management procedures.

Recognition of obesity as a disease: The ACS and 10 other medical/specialty societies cosponsored this resolution, which called on the AMA to recognize obesity as a disease with multiple pathophysiological aspects requiring a range of interventions to advance treatment and prevention. Evidence presented demonstrated that obesity is a metabolic disease that occurs as a result of unhealthy behaviors related to food and beverage consumption, lack of sufficient physical activity, as well as work, school, and messaging environments. The resolution further noted that obesity leads to chronic diseases, such as hypertension, heart disease, diabetes, and arthritis. The ACS delegation emphasized that metabolic (bariatric) surgeons are on the front lines of treating severe obesity with life-improving and lifesaving results. The resolution passed with a 60 percent majority of the delegates.

Payment variations across outpatient sites of service: Cost transparency across sites of service was a major point of discussion, which received positive comments in reference committee testimony. In addition to adopting recommendations from the AMA Council on Medical Service to reaffirm some existing AMA policies related to Medicare payments across outpatient settings, the HOD adopted a recommendation that the AMA work with states to advocate for third-party payors to:

  • Assess equal or lower facility coinsurance for lower-cost sites of service (hospital outpatient department, ambulatory surgical center, or office-based facility)
  • Publish and routinely update pertinent information related to patient cost-sharing
  • Allow their plan’s participating physicians to perform outpatient procedures at an appropriate site of service as chosen by the physician and the patient

AMA support for states in their development of legislation to support physician-led, team-based care: With a focus on physician-led, team-based care, this resolution was adopted and directed the AMA to assist state medical societies and specialty organizations with seeking passage of legislation that would define the valued role of mid-level and other health care professionals within a physician-led team that promotes optimal quality patient care and patient safety. The resolution also called on the AMA to actively oppose health care teams that are led by nonphysician health care practitioners.

An update on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL): A major topic of discussion was MOC, OCC, and MOL requirements. Many resolutions introduced expressed concerns regarding the implementation, cost, and additional exam burdens on physicians that these requirements pose. For the most part, these resolutions largely recommended that the Council on Medical Education continue to monitor the requirements and engage in ongoing dialogues with medical and licensing boards.

Government interference in the practice of medicine and the patient-physician relationship: The AMA HOD passed several resolutions that led to the adoption of a Statement of Principles concerning the roles of federal and state governments in health care and the patient-physician relationship. These principles include:

  • Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors or disclosing information to patients, including proprietary information on exposure to potentially dangerous chemicals or biological agents that may affect their health or the health of their families, sexual partners, and other individuals with whom they have been in contact.
  • All parties involved in the provision of health care, including government, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.
  • The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.
  • Laws and regulations should not mandate the provision of care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, is either unnecessary or ill-suited for a particular patient at the time services are rendered.

In addition, the AMA will oppose any government regulation or legislative action on the content of the individual clinical encounter between a patient and physician without a compelling and evidence-based benefit to the patient, a substantial public health justification, or both.

For a complete list of HOD actions, visit the AMA website.

Elections

AMA officers, trustees, and council members are elected during the annual meeting. This year, three members of the College were elected to serve on AMA councils and in other leadership positions, as follows:

  • Maya Babu, MD, a neurosurgery resident at the Mayo Clinic, Rochester, MN, was elected to serve in the resident/fellow trustee position on the AMA Board of Trustees.
  • Andrew Gurman, MD, FACS, a hand surgeon who practices in Altoona, PA, was re-elected as speaker of the HOD.
  • Liana Puscas, MD, FACS, an otolaryngologist and assistant professor of surgery, Duke University Medical School, Durham, NC, was elected to the AMA Council on Medical Education.
  • Ardis Dee Hoven, MD, assumed the presidency of the AMA. An internal medicine and infectious disease specialist from Lexington, KY, she is the 168th president of the organization and only the third woman to hold this office.

Other officers elected are as follows:

  • President-elect: Robert M. Wah, MD, reproductive endocrinologist from Bethesda, MD
  • Board of Trustees: Gerald E. Harmon, MD, a family physician from Pawleys Island, SC; and David O. Barbe, MD, re-elected, a family physician in Mountain Grove, MO
  • Vice-Speaker of the HOD: Susan R. Bailey, MD, re-elected, an allergist in Fort Worth, TX

Surgical Caucus

The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding relevant AMA resolutions that affect surgical interventions. The Caucus held a one-hour program titled Visiting the Surgical Home. Speakers provided a description of the concept of the surgical home, discussed how the surgical home improves coordination of patient care and relates to other models of coordinated care, and reviewed some of the benefits of implementing the surgical home.

ACS Delegation

The College was well represented by five delegates. New to the delegation was Leigh Neumayer, MD, FACS, a general surgeon from Salt Lake City, UT, and a member of the ACS Board of Regents. She joined four seasoned veterans of the HOD, including: John H. Armstrong, MD, FACS, trauma surgeon, chair of the delegation, and Surgeon General/Secretary of Health for the State of Florida; Jacob Moalem, MD, FACS, an endocrine surgeon from Rochester, NY; Richard Reiling, MD, FACS, a general surgeon from Charlotte, NC; and Patricia L. Turner, MD, FACS, a general surgeon and Director of the ACS Division of Member Services.

In addition, the College Delegation was assisted by Timothy Kresowik, MD, FACS, a vascular surgeon from Iowa City, IA, and an alternate delegate from the Society for Vascular Surgery, and Kenneth Louis, MD, FACS, a neurosurgeon from Tampa, FL, and an alternate delegate for the Florida Medical Association.

The delegation is open to comments and feedback on issues before the HOD as well as suggestions for resolutions. The November Interim HOD meeting will take place November 16–19 in National Harbor, MD. For surgeons who would like to become familiar with pending issues and policies, items of business will be posted in early November on the AMA website. Fellows who follow this activity and have thoughts, comments, or questions may contact the ACS Delegation at jsutton@facs.org.

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