The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 7–11 in Chicago, IL. Late spring weather welcomed more than 800 delegates and alternate delegates to the Windy City for lengthy days of policymaking, educational programming, and electioneering.
The five delegates from the American College of Surgeons (ACS) at the meeting were: John H. Armstrong, MD, FACS, Surgeon General and Secretary of Health for the State of Florida and co-author of this article; Jacob Moalem, MD, FACS, endocrine surgeon, University of Rochester, NY; Leigh Neumayer, MD, FACS, general surgeon and professor and the University of Utah School of Medicine, Salt Lake City; Patricia L. Turner, MD, FACS, general surgeon and Director, ACS Division of Member Services; and Richard Reiling, MD, FACS, Board of Directors, ACS Foundation.
With this meeting, Dr. Reiling completed his 22-year tenure as an ACS Delegate. He chaired the delegation from 2006 to 2010 and was the first Fellow in the modern era to be elected to an AMA Council as a nominee of the College. The ACS Delegation recognized his leadership, and he was on the list of retiring delegates presented to the HOD.
The College delegation was assisted at the meeting by Timothy Kresowik, MD, FACS, a vascular surgeon, University of Hospitals and Clinics, Iowa City, and an alternate delegate from the Society for Vascular Surgery; and Kenneth Louis, MD, FACS, a neurosurgeon affiliated with multiple hospitals in Tampa, FL, and an alternate delegate for the Florida Medical Association.
The June meeting of the HOD generally includes the elections of AMA officers, trustees, and council members. This year, three members of the ACS were among several health care professionals elected to serve on the AMA board and councils: Andrew Gurman, MD, FACS, a hand surgeon in Altoona, PA, was re-elected as speaker of the HOD, and announced his intention to run for AMA president in June 2015; Russell Kridel, MD, FACS, a plastic surgeon in Houston, TX, was elected to the AMA Board of Trustees; and Luke Selby, MD, a surgical resident from New York, NY, was elected as the resident/fellow member of the AMA Council on Medical Education.
An announcement card was distributed for Dr. Turner, an ACS nominee running for re-election in 2015 to the AMA Council on Medical Education.
Policymaking at work
The primary function of the HOD is to adopt AMA policy, and the June meeting provided many opportunities to influence the organization’s position on a number of issues. The HOD considered 176 resolutions and 72 reports for business at the June meeting, with multiple reference committee hearings pruning them to more manageable forms.
A great deal of behind-the-scenes collaboration helps the HOD achieve successful results for each delegation.
Issues relevant to surgeons that came before the HOD included the following:
- Bariatric surgery as part of the essential benefits plan (Resolution 111): This resolution was authored by the College and asked the AMA to advocate for coverage of bariatric surgery as part of the essential benefits package for health insurance plans sold through the state health insurance exchanges. More than 25 states do not require this coverage. After recognizing existing AMA policy that advocates for limited benefits packages to promote market solutions, the College worked with the American Society of Clinical Endocrinologists and the American Society for Metabolic and Bariatric Surgery to propose a substitute resolution: The AMA will advocate for patient access to the full continuum of evidence-based obesity treatment modalities, such as behavioral, pharmaceutical, psychosocial, nutrition, and surgical interventions. The HOD adopted this quality-focused language.
- Opposition to genetic testing restrictions based on specialty (Resolution 115): Working with the lead sponsor of this resolution, the American Society of Clinical Oncologists, the ACS Commission on Cancer, and the ACS delegation provided assistance in reshaping the original resolution so that a substitute was adopted. This policy states that the AMA opposes public and private payors’ imposition of a practice standard that requires utilization review by external medical specialists or nonphysicians before ordering of genetic tests and continues to support pre- and posttest counseling by qualified health professionals for at-risk patients with a potential hereditary susceptibility for cancer and other diseases.
- Medicare claims data release (Substitute Resolution 204): Many resolutions (204, 211, and 226) introduced at this meeting centered on the recent release of individual physician Medicare claims data. The original Resolution 204 called on the AMA to condemn the Centers for Medicare & Medicaid Services (CMS) for releasing the data and to take an aggressive stance. Resolution 226 detailed the information that the AMA should seek. The College cosponsored Resolution 211, and the HOD adopted a substitute that incorporated the various related resolutions so that the AMA will continue to work with CMS to identify appropriate modifications that improve the usefulness and accuracy of any existing or future provider-specific data released by that agency.
- Physician workforce shortage: Approaches to GME financing (CME Report 7): Policy recommendations are made not only through resolutions, but also through recommendations from AMA Council reports. The ACS delegation succeeded in shaping final recommendations regarding AMA workforce policy to ensure an inclusive approach with all specialties to workforce financing. The AMA will continue to strongly advocate that Congress fund additional graduate medical education (GME) positions for the most critical workforce needs, especially considering the current and worsening maldistribution of physicians. The AMA will also encourage Congress to work with interested state and national medical specialty societies and other appropriate stakeholders to share and support legislation to increase GME funding, enabling a state to accomplish one or more of the following:
- Train more physicians to meet state and regional workforce needs
- Train physicians who will practice in physician shortage/underserved areas or train physicians in undersupplied specialties and subspecialties in the state/region
- Work with stakeholders such as the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, American Osteopathic Association, American Academy of Family Physicians, American College of Physicians, and other specialty organizations to analyze the changing landscape of future physician workforce needs as well as the number and variety of GME positions necessary to provide that workforce
- Breast density notification (Resolution 502): Many state legislatures are considering legislation to require that breast density information be provided to patients following mammograms, and in some cases requiring insurers to pay for follow-up testing. As adopted, AMA policy now supports the inclusion of breast tissue density information in the mammography report when appropriate and the education of patients about the clinical relevance of such information, but opposes state requirements for mandatory notification of breast tissue density to patients.
- Encouraging physician participation in veterans’ care (Resolution 231): In response to recent revelations of poor outcomes in Veterans Affairs (VA) facilities related to hidden wait lists, the AMA will advocate that: (1) the U.S. President take immediate action to provide timely access to health care for eligible veterans outside the VA until it can make necessary changes; (2) Congress act rapidly to enact a bipartisan long-term solution for timely access to entitled care for eligible veterans; and (3) state and local medical societies create and make available a registry of physicians offering to provide care to veterans to communities and the VA.
The Surgical Caucus of the AMA is administered by the College and brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding AMA resolutions relevant to surgical patient care. The Caucus held a one-hour continuing medical education program titled PQRS [Physician Quality Reporting System]—Not Just Alphabet Soup: Practical Tips and Tricks to Get Paid for Your Quality in an Evolving Healthcare System. Speakers provided a description of perioperative and surgical quality reporting.
The Interim Meeting of the HOD will take place November 8–11 in Dallas, TX. The ACS delegation will be ready and honored to represent the College in this policymaking forum. Fellows with questions, comments, or issues to bring forward to the HOD should contact the delegation at email@example.com.
The ACS delegation to the AMA continues to inspire quality in AMA policymaking through robust participation in the HOD.