The debate continues: ACS at the AMA House of Delegates

The American Medical Association (AMA) House of Delegates (HOD) met November 16–19, 2013, at National Harbor, MD.

Medicare physician payment reform was the signature issue at the meeting in light of a bipartisan and bicameral proposal in Congress to repeal the sustainable growth rate (SGR) and replace it with a payment freeze linked to divisive specialty provisions. Ardis Hoven, MD, AMA president, an infectious disease specialist, noted, “Walking away from the single greatest opportunity we’ve had to remove this scourge once and for all… walking away before we even have legislative language before us…would be a colossal mistake. And that’s why we need to keep pushing—until we push through.” The ACS delegation focused much of the discussion regarding payment reform on the development of a patient-centered and equitable replacement for the SGR and ensured a direction consistent with the American College of Surgeons (ACS) Health Policy Advisory Group’s position on the topic.

James L. Madara, MD, AMA chief executive officer and executive vice-president, explained at the opening session the basis for the AMA’s three concerns in the physician payment reform debate—health outcomes, physician satisfaction, and medical education—which he referred to in his speech as “progress, partnerships, and promise.” “For more than 165 years the AMA has focused on protecting and enhancing the physician-patient relationship,” Dr. Madara said. “Let’s consider the components of that. Patients want us to protect that relationship because they value their health—they want good health outcomes. Physicians obviously want us to protect that relationship—but it can only be protected if it occurs in a practice environment that is sustainable and satisfies their desire to provide quality care. And society needs us to protect that relationship by ensuring future physicians are optimally trained for the health care systems of tomorrow.”

Dr. Madara referenced an AMA-funded report from the RAND Corporation that delineated elements of physician professional satisfaction. Major sources of dissatisfaction were obstacles to providing high-quality care and the electronic health record. The report can be accessed at

Also during the opening session, the AMA awarded the 2013 Benjamin Rush Award for Citizenship and Community Service to Kenneth L. Mattox, MD, FACS, Second Vice-President-Elect of the ACS. For details on the award presentation, see the January 2014 Bulletin.

Reports and resolutions

The HOD considered 69 resolutions and 35 reports at the meeting. Following is a summary of some key proposals of interest to surgeons.

Reference committee on constitution and bylaws

Three matters were referred to the Council on Ethical and Judicial Affairs (CEJA): CEJA Report 1, Physician Exercise of Conscience; CEJA Report 4, Ethically Sound Innovation in Medical Practice; and Resolution 6, Restriction on Marketing in Hospitals and Medical Centers. After thoughtful review of these items, the ACS Ethics Committee expressed their concerns to the ACS delegation, providing some guidance and direction in supporting a position of referral on these reports.

Reference Committee B (Legislation)

  • Resolution 218, FDA Regulation of Off-Label Drug Promotion, was referred to the AMA Board of Trustees. A proposed substitute that would direct the AMA to support the Food and Drug Administration’s authority to prohibit off-label marketing and promotion of medication was included in the referral.
  • Resolution 220, Delay or Cancelling of ICD-10, was adopted and remains consistent with AMA concerns regarding the International Classification of Diseases, 10th Edition, or ICD-10. The AMA will work to delay or cancel the implementation of ICD-10. Details on the transition to ICD-10 are available at
  • Resolution 226, Sustainable Growth Rate Repeal, was adopted as amended and represented a substantial coalition of large state medical societies and specialty groups. It reaffirmed AMA policy D-450.981, Protecting Patients Rights, which calls upon the AMA to advocate strongly for the repeal of the flawed SGR formula and for the AMA’s principles for pay-for-performance; to support SGR repeal proposals that are coupled with physician payment reforms that are consistent with the AMA’s Pay-for-Performance Principles and Guidelines; and to advocate with the Centers for Medicare & Medicaid Services (CMS) for alternative payment models developed in concert with specialty and state medical organizations and that include private contracting as an option.

Reference Committee K (Advocacy for Medical Education and Public Health)

  • Resolution 914, Change Rural and Off Site Rural Training Track Requirements in Order to Preserve and Encourage Interest in Rural Residency Programs, was referred to the Council on Medical Education for further study.
  • Substitute Resolution 915, Joint Commission Accreditation Standard for Pain Assessment, urges The Joint Commission to reevaluate its accreditation standard for pain assessment, including evidence on whether the standard improves pain management practices, to ensure that the standard supports physicians’ abilities to select the most appropriate treatment options for their patients.
  • Through Resolution 922, Examining the Changing Nature of U.S. Medical Residencies, the AMA will continue to study the effect of ever-increasing match participants and the stagnant growth of U.S. residency positions and will report at the 2014 Annual Meeting. The ACS delegation remains a consistent voice for an inclusive review of physician workforce issues that affect all medical and surgical specialties, as well as primary care.

For more information regarding the resolutions and reports that were discussed at the meeting, go to

Surgical Caucus

The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding AMA resolutions viewed through the lens of surgical and acute interventions. The caucus held a one-hour continuing medical education program, Perioperative Care in an Era of Quality Assessment. Robert Jasak, JD, then-Deputy Director of Regulatory and Quality Affairs, ACS Division of Advocacy and Health Policy, gave an overview of CMS programs for measuring and reporting surgical quality, and Jesse Ehrenfeld, MD, discussed the use of informatics to improve surgical quality and cost-effectiveness.

ACS delegation

The College was well represented by four delegates: John H. Armstrong, MD, FACS, Delegation Chair; Jacob Moalem, MD, FACS, assistant professor of surgery, University of Rochester Medical Center, NY; Richard Reiling, MD, FACS, Charlotte, NC; Board of Directors, ACS Foundation; and Patricia Turner, MD, FACS, Director, 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 Naveen Sangji, MD, ACS Health Policy Fellow, Boston, MA.

The annual meeting of the House of Delegates will take place June 7–11 in Chicago, IL. The ACS Delegation welcomes input from Fellows, and surgeons with ideas for potential resolutions or with questions or comments are urged to share these by e-mail to

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