The American Medical Association (AMA) House of Delegates (HOD) Annual Meeting took place June 6–10 in Chicago, IL. During the meeting, a delegation from the American College of Surgeons (ACS) advocated for policies of interest to surgeons and worked with other specialty and state medical societies to achieve consensus on recommendations from 185 resolutions and 68 reports.
The ACS Delegation is one of the largest specialty society delegations in the HOD, providing comments and leadership on surgical and health care system matters. Working collegially with other delegations is key to ensuring effective representation of surgical interests. A list of the ACS delegates appears in the sidebar on this page.
How the HOD functions
Twice a year, 530 delegates from national specialty and medical societies, state medical societies, and AMA sections participate in HOD meetings. The HOD operates like the U.S. Congress; each delegate is like a representative and has the opportunity to vote on policy matters and for AMA officers and council members in a way that represents the interests of his or her constituents.
Items of business—reports and resolutions—are introduced by medical societies and sections or by individual delegates. Each item receives a hearing by a reference committee, typically composed of seven delegates. The delegates listen to testimony on each item in an open hearing and distill comments into recommendations. These recommendations, with rationale, are then collated in a report for consideration by the entire HOD. Recommendations may be adopted, rejected, amended, or referred to the AMA Board of Trustees for study or action. If a contentious item cannot be resolved, it is generally referred to the Board of Trustees for study or action.
Elections for AMA offices are conducted at the June meeting. A number of surgeons were successful in their campaigns this year. Through the hard work and dedication of the College’s delegation and 22 endorsing organizations, Patricia Turner, MD, FACS, was re-elected to the AMA Council on Medical Education for a four-year term. In addition to serving as Director of ACS Member Services, Dr. Turner also is clinical associate professor, department of surgery, University of Chicago, IL, and member, Board of the AMA Foundation. She previously served on the AMA Council on Scientific Affairs.
Andrew W. Gurman, MD, FACS, an orthopaedic surgeon from Altoona, PA, was elected AMA president-elect and will become AMA president in June 2016. Dr. Gurman previously served as speaker and vice-speaker of the AMA HOD. James G. Hinsdale, MD, FACS, a general surgeon from San Jose, CA, was re-elected to the AMA Council on Medical Service. Bruce A. Scott, MD, an Associate Fellow of the ACS and otolaryngologist from Louisville, KY, was elected vice-speaker of the HOD. Also re-elected as an AMA delegate was Maya A. Babu, MD, MBA, Resident Member of the ACS and neurosurgery resident at the Mayo Clinic, Rochester, MN, as the resident member of the AMA Board of Trustees.
Business of the HOD
The HOD considered 185 resolutions and 68 reports at the June meeting. The following review of business items pertinent to surgeons is representative of the broad range of issues addressed.
Reference Committee A: Health Systems
- Resolution 103, Three-Day Stay Rule: One of the most significant issues discussed in this reference committee dealt with the Medicare three-day stay rule, by which a Medicare beneficiary must be an inpatient for a medically necessary stay of at least three consecutive days to qualify for post-discharge extended care services. Three resolutions were consolidated into one, consistent with ACS policy, which can be summarized as follows: the AMA will continue to advocate before Congress and the Centers for Medicare & Medicaid Services (CMS) for the elimination of the three-day inpatient hospital stay requirement for Medicare coverage of post-hospital skilled nursing facility services. Furthermore, as long as this requirement remains, the AMA will work to include patient time in hospital observation and emergency room settings as part of the three-day hospital inpatient window before transfer to a skilled nursing facility.
Reference Committee B: Legislation
- BOT Report 6, Medical Information and Its Uses: The HOD adopted Data Transparency Principles to Promote Improvements in Quality and Care Delivery as new AMA policy. The policy comprises 14 principles that are intended to leverage health care data in a way that helps physicians improve the quality reporting of patient care data and adapt to new payment and delivery models to transform the U.S. health care system.
- Resolution 211, ICD-10 Implementation: This resolution reflected a shift in tone on this issue from stopping ICD-10 to easing the transition to ICD-10. The AMA will now advocate to Congress and CMS through a grassroots campaign seeking a two-year grace period for the ICD-10 transition, during which physicians would not be penalized for errors or system malfunctions. CMS has since agreed to a one-year grace period.
- Resolution 222, Medicare and Sequestration: Sequestration, resulting from the federal budget impasse of 2012, creates a hidden 2 percent tax on Medicare physician payments. Strong support was expressed for the AMA to take all necessary legislative and administrative steps to prevent extended or deeper sequester cuts in Medicare programs. Many delegates felt that the success of stopping Medicare cuts due to the repeal of the broken sustainable growth rate formula used to determine Medicare physician payments should not be tarnished by cuts resulting from sequestration.
- Resolution 237, 96-Hour Rule for Critical Access Hospitals: This resolution asked the AMA and other stakeholders to support and lobby for passage of legislation to provide relief from the 96-hour rule for critical access hospitals. Under this rule, patients at these institutions who are otherwise progressing well must be transferred to a noncritical access hospital after 96 hours. The HOD agreed and adopted the resolution.
Reference Committee C: Medical Education
- Council on Medical Education Report 2, Update on Maintenance of Certification (MOC) and Osteopathic Continuous Certification: Reflecting continuing concern about the unintended financial consequences of MOC, the HOD passed this report, which directs the AMA to lobby the American Board of Medical Specialties (ABMS) to develop fiduciary standards that ensure all ABMS specialty boards provide full transparency related to the costs of preparing, administering, scoring, and reporting MOC and certifying/recertifying examinations. In addition, it directs the AMA to ensure that MOC and certifying/recertifying examinations do not result in significant financial gain to the ABMS specialty boards.
- Furthermore, the AMA will work with interested parties to ensure that MOC uses more than one pathway to accurately assess the competence of practicing physicians, to monitor for exam relevance, and to ensure that MOC does not lead to unintended economic hardship, such as hospital de-credentialing of practicing physicians.
- Council on Medical Education Report 3, The Value of Graduate Medical Education (GME): This report, adopted without amendment, has the AMA engaging in policymaking and public outreach to increase awareness of the societal value of GME, advocating for expanded all-payor GME funding, pushing for congressional appropriation of the National Healthcare Workforce Commission, and promoting transparency of GME funding.
- Resolution 315, Obesity Education: The ACS cosponsored this resolution with the American Association of Bariatric Physicians, American Association of Clinical Endocrinologists, and Colorado Medical Society. The adopted resolution directs the AMA to encourage medical school accrediting bodies to study and report back on the current state of obesity education in medical schools. Furthermore, the AMA will use this report to identify organizations that currently provide educational resources about obesity education for physicians in training and, in consultation with relevant specialty organizations and stakeholders, look for gaps and make recommendations regarding obesity education in medical schools.
Reference Committee D: Public Health
- Council on Science and Public Health Report 3, Concussion and Youth Sports: The AMA now promotes the adoption of requirements that a coach, trainer, administrator, or other individual responsible for the health and well-being of school athletes and participants in other organized youth sports immediately remove from the activity any player who is suspected of having sustained a concussion. The athlete would not be allowed to return to competitive play, practice, or other sports-related activity without the written approval of a licensed physician (MD or DO) or licensed health care professional whose scope of practice includes proper training in the evaluation and management of concussion. When evaluating individuals for return to play, physicians and health care professionals should be mindful of the potential for other occult injuries.
- Resolution 423, Support of Mandating Protective Headgear (Helmets) in the Sport of Girls/Women’s Lacrosse: Delegates expressed considerable support for this issue and adopted a resolution requiring helmet use in girls/women’s lacrosse.
Reference Committees E: Science and Technology, and F: AMA Governance
These committees did not cover pressing surgical issues.
Reference Committee G: Medical Service
- Council on Medical Service Report 4, Price Transparency: This adopted report recommends ways to expand the availability of health care pricing information that is meaningful for patients and their physicians who want to make value-based decisions. The ACS delegation emphasized that multiple health care providers and payors beyond physicians are responsible for pricing, and a report recommendation regarding physician fee schedules was adjusted so that the AMA encourages physicians to communicate information about the cost of their professional services to individual patients, taking into consideration insurance parameters and other relevant information (hospital costs, for example).
Reference Committee on Constitution and Bylaws
- Board of Trustees Report 13, Methods to Increase U.S. Organ Donor Pool: The HOD adopted a report with strong support that offers recommendations for the AMA to support studies that evaluate the effectiveness of mandated choice and presumed consent models for increasing organ donation; urge development of effective methods for meaningful exchange of information to educate the public and support well-informed consent about donating organs; and encourage the continued study of ways to enhance the allocation of donated organs and tissues.
More than 85 delegates attended an educational session sponsored by the Surgical Caucus. Surgical Quality at the Grass Roots: How Quality Collaboratives Improve Surgical Care featured ACS chapter leaders from the Connecticut and Tennessee quality collaboratives. Speakers described the factors that go into the development of statewide collaboratives and demonstrated how a quality collaborative can improve the delivery of surgical care.
The AMA House of Delegates will meet again November 14–17 in Atlanta, GA. The ACS delegation welcomes your questions and suggestions for ACS-sponsored resolutions. E-mail questions and suggestions to firstname.lastname@example.org.