A sense of anticipation permeated the recent annual meeting of the American Medical Association (AMA) House of Delegates (HOD), as participants of all political stripes eagerly awaited the Supreme Court decision on the constitutionality of the Affordable Care Act (ACA). Rumors abounded that the Court’s decision would be released sometime during the June meeting, but that did not happen.
Events during the HOD meeting in Chicago, IL, followed an established democratic process, with the American College of Surgeons (ACS) delegation representing ACS views at reference committee hearings and on the floor of the HOD. ACS delegates in attendance at the meeting are listed below.
The annual HOD meeting is the designated venue for electing AMA officers, trustees, and council members. Highlights of the elections were as follows: Ardis Hoven, MD, an infectious disease specialist from Lexington, KY, and immediate past-chair of the AMA Board of Trustees, was installed as AMA President-elect; Mary Anne McCaffree, MD, a pediatrician and specialist in neonatal-perinatal medicine from Oklahoma City, OK, was re-elected to the Board of Trustees (BOT); and William Kobler, MD, a family physician from Rockford, IL, also was elected to the BOT. Lee R. Morisy, MD, FACS, a general surgeon from Memphis, TN, and Chair of the AMA Council on Science and Public Health, was not elected to the BOT; however, the ACS was pleased to have endorsed his candidacy.
An educational session sponsored by the Surgical Caucus, titled Can Efficiency and Quality Be Improved in Your Operating Room? Practical Applications of Lean Methodology, was well-received. This session described how the basic principles of Lean methodology may be applied in the operating room. Robert R. Cima, MD, FACS, FASCRS, associate professor of surgery at Mayo Clinic College of Medicine, Rochester, MN, and David B. Hoyt, MD, FACS, Executive Director of the ACS, spoke at the session. They described how the Lean approach may be used to improve the quality of surgical care and presented an overview of the ACS Inspiring Quality initiative and how this program will affect practicing surgeons.
Resolutions and reports
More than 170 resolutions and 63 reports were submitted for consideration at the meeting. The ACS delegation focused its review and comments on issues of greatest interest to surgery, taking positions on the following:
CEJA Report 6-Amendment to E-9.011, “Continuing Medical Education,” was referred back to the Council on Ethical and Judicial Affairs (CEJA). The ACS delegation determined that this “informational” report was an overreach by CEJA to further restrict the AMA’s position on financial relationships with industry in continuing medical education without HOD discussion.
Resolution 126, Transitioning Medicare to a Premium Support Program, which the Louisiana delegation introduced, sought AMA support for transitioning Medicare to a premium support system. Under this system, beneficiaries would receive a set amount from the federal government to be used for the purchase of traditional Medicare or private health insurance. Premium support amounts would vary based on income, health status, and local socioeconomic conditions. The HOD passed a substitute resolution that would include premium support among the financing options available to beneficiaries. The AMA Council on Medical Service will continue to study this issue.
Substitute Resolution 404, Helmet Safety, from the Medical Student Section, was adopted. As resolved, the AMA will urge the Consumer Product Safety Commission and other appropriate agencies and organizations to establish standards designed to accomplish the following: ensure that athletic and recreational equipment produced or sold in the U.S. include features that provide protection against head and facial injury; support requirements that children and adolescents use protective head and facial gear when engaged in potentially dangerous athletic and recreational activities; encourage the use of head and facial protection for adults who engage in potentially dangerous athletic and recreational activities; assist physicians in educating their patients about the importance of head and facial protection; and increase the availability of rental helmets at all commercial athletic and recreational sites.
Resolution 415, Taskforce on Medical Disaster Response and Indigent Care, from the California delegation, was referred to the BOT. This resolution asked that the AMA convene a task force to collect information on existing disaster response teams, including those in place in the state medical societies, hospitals, and the medical reserve. Information pertaining to federal and state-sponsored disaster medical assistance teams and addressing the issue of physicians volunteering to fill unmet medical needs of indigent persons, including liability coverage for physician volunteers, also would be gathered. However, because the AMA is closing its Center for Public Health Preparedness and Disaster Response, the organization no longer has the resources necessary to fulfill these objectives—hence, the referral to the BOT.
Council on Science and Public Health Report 6, Screening Mammography, was adopted. This resolution calls for making all women age 40 and older eligible for screening mammography. ACS testimony led the discussion to bring together all stakeholders in support of standardized, patient-centered guidelines.
Substitute Resolution 507, 2013: The Year of the Ultrasound, from the American Institute of Ultrasound in Medicine and 14 co-sponsors (including the ACS), was adopted with a title change. The renamed resolution on Diagnostic Ultrasound Utilization and Education calls upon the AMA to affirm that ultrasound imaging is a safe, effective, and efficient tool when used by or under the direction of appropriately trained physicians. It also directs the organization to support the educational efforts and widespread integration of ultrasound throughout the continuum of medical education.
Resolution 517, Cause the United States Preventive Services Task Force (USPSTF) to Seek Appropriate Physician Specialty Society Input and to be Subject to Transparency and Appeal, from the American Urological Association and the American Association of Clinical Urology, was adopted. This resolution calls upon the AMA to: (1) express concern regarding recent USPSTF recommendations on screening mammography and prostate specific antigen screening and the effects these recommendations have on limiting access to preventive care for Americans; and (2) encourage the USPSTF to implement procedures that allow physicians and other stakeholders to provide meaningful input on the development of task force proposals.
Over many years of thoughtful and focused involvement in the HOD, the ACS delegation has ensured that surgery has a voice within that deliberative body. Delegates remain committed to preserving surgery’s integrity in the HOD through serious review of policy implications of resolutions and reports; maintaining the focus on issues of greatest interest to surgeons; and careful selection of candidate endorsements in AMA elections. Fellows who are AMA members are encouraged to support the College’s delegation by selecting the ACS as their specialty representative within the HOD.