AMA House of Delegates takes action on spectrum of issues

The American Medical Association (AMA) House of Delegates (HOD) met November 7–11, 2014, in Dallas, TX, and considered 96 resolutions and 33 reports, many of which were of interest to surgeons. Hot-button issues included Medicaid physician payment, maintenance of certification, and Ebola readiness.

Opening session

The HOD opened with a variety of speeches and presentations from leaders in the health care arena. Following is a snapshot of speaker remarks at the opening session.

Robert A. McDonald, Secretary of the U.S. Department of Veterans Affairs (VA) sought help with recruiting physicians for the VA system and sharing positive messages about the VA. “VA cannot accomplish its mission as a standalone system,” Mr. McDonald said. “We’re part of a larger community facing the same challenges you [in non-federal medicine] face.”

James L. Madara, MD, AMA executive vice-president and chief executive officer, shared an overview of the AMA’s three focus areas: improving health outcomes, accelerating change in medical education, and professional satisfaction and practice sustainability. “Working together, we can lead the way to improving health outcomes for our patients—attacking the enormous burdens of chronic disease. Working together, we can ensure the next generation of physicians is trained by 21st century standards. And working together, we will shape a more satisfying and sustainable practice environment for physicians,” Dr. Madara said.

American Medical Political Action Committee (AMPAC) chair John W. Poole, MD, FACS, added, “If you are in medicine, you are in politics.” AMPAC raised $2.76 million in the 2014 election cycle, up 11 percent from the previous cycle.

Reports and resolutions

The following items of business cover a range of issues and reflect the advocacy focus of the Interim Meeting.

Reference Committee on Constitution and Bylaws

• Council on Ethical and Judicial Affairs (CEJA) Report 1, Physician Exercise of Conscience, was adopted. The report examines the implications for patients and physicians when conflict arises between a physician’s professional commitments and personal moral beliefs, and offers guidance to resolve these conflicts.
• CEJA Report 3, Modernized Code of Medical Ethics, proposed an updated Code of Medical Ethics that has been a work in progress since 2008. Given the scale of the project, however, the update was referred back to CEJA for further refinement.

Reference Committee B (Legislation)

• Substitute Resolution 208, Stark Law and Physician Compensation, was referred to the Board of Trustees, who will review use of Stark Law regulations by hospitals to unfairly and arbitrarily cap or control physician compensation.
• Resolution 213, Cannabis—Expanded AMA Advocacy, was adopted. As a result, the AMA will initiate an aggressive campaign to educate the media and legislators regarding the scientifically established health effects of chronic cannabis use and the potential public health, social, and economic consequences of expanded use; urge legislatures to delay initiating full legalization of any cannabis product until the U.S. Food and Drug Administration (FDA) and Drug Enforcement Administration has completed further research; and increase efforts to educate the press, legislators, and the public regarding “public health” versus “criminal justice” approaches to cannabis. In addition, the AMA will encourage model legislation that would require placing the following warning on all cannabis products not approved by the FDA: “Marijuana has a high potential for abuse. It has no scientifically proven, currently accepted medical use for preventing or treating any disease process in the United States.”

Reference Committee F (Governance)

• Resolution 601, Employee Association and Collective Bargaining for Physicians, was adopted. The AMA will study and report back on physician unionization in the U.S.

Reference Committee J (Advocacy for Medical Service)

• Council on Medical Service Report 4, Network Advocacy, was adopted after considerable discussion. The report provides an overview of network adequacy in both state health exchange and Medicare Advantage plans; highlights emerging issues associated with out-of-network access to services; and recommends actions to ensure that networks provide meaningful access to all medically necessary and emergency care at the preferred, in-network benefit level on a timely and geographically accessible basis.
• Council on Medical Service Report 7, Medicaid Primary Care Payment Increases,was adopted as amended with a proposal from the American College of Surgeons (ACS) and neurosurgery delegations. The initial report recommended extension of primary care payment increases beyond 2014 and with the inclusion of obstetricians/gynecologists as qualifying specialists for these payment increases. The ACS delegation worked in the Reference Committee and on the floor of the HOD to emphasize that any payment increases for one group must “not negatively impact payment for any other physicians,” with which the HOD agreed.

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

• Substitute Resolution 920, Principles on Maintenance of Certification (MOC), consolidated four separate resolutions and amended the AMA’s Principles on MOC to include the following:
  • MOC should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care.
  • The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake, and intent to maintain or change practice.
  • MOC should be used as a tool for continuous improvement.
  • The MOC program should not be a mandated requirement for licensure, credentialing, reimbursement, or network participation or employment.
  • Physicians in active practice should be well-represented on specialty boards developing MOC.
  • MOC activities and measurement should be relevant to clinical practice.
  • The MOC process should not be cost-prohibitive or present barriers to patient care.

The AMA will also encourage specialty boards to consider alternative approaches for MOC, work with the American Board of Medical Specialties to eliminate practice performance assessment modules (as currently written) from the requirements of MOC, and prepare a yearly report regarding the MOC process.

A concern about potential conflict of interest by specialty boards, which simultaneously develop MOC standards and design and deliver MOC curricula that generate financial profits, was referred to the Board of Trustees.

• Substitute Resolution 925, AMA Role in Addressing Ebola, consolidated four resolutions by broadening the context. The AMA strongly supports U.S. and global efforts to fight epidemics and pandemics, including Ebola; improved public health infrastructure and surveillance in affected countries; and all health care workers and volunteers, U.S. Public Health Service, and U.S. military members responding to the Ebola epidemic and other epidemics and pandemics in affected countries. The AMA also reaffirms that the medical profession should collaborate with public health colleagues to take an active role in ensuring that quarantine and isolation interventions are based on science and encourages relevant specialty societies to educate their members on specialty-specific issues relevant to new and emerging epidemics and pandemics.

Complete actions on all items of business of the HOD are available on the November 2014 HOD Web page.

Surgical Caucus

The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions about relevant AMA resolutions through the lens of surgical interventions. The caucus held a one-hour continuing medical education program, From the Front Lines to the States: Continuum of Care for Soldiers/Veterans, which was well-timed to coincide with Veterans Day. Raj Ambay, MD, FACS, a plastic surgeon from Tampa, FL, and Allen Morey, MD, FACS, a urologic trauma and reconstruction surgeon from Dallas, TX, offered insights from their care of wounded troops in Iraq and Afghanistan. In addition, Chandramouli Pattabiramen Iyer, MD, MS, MCh, an anesthesiologist from the VA Medical Center in Dallas, joined the panel to discuss his experiences in treating wounded soldiers at home and abroad.

Next HOD meeting

The Annual Meeting of the AMA HOD will take place June 6–10, 2015, in Chicago, IL. The delegation is open to comments and feedback on issues before the HOD, as well as suggestions for resolutions. These may be directed to jsutton@facs.org.

In addition to addressing the volume of business conducted by the HOD, the ACS Delegation is preparing for the re-election campaign of Patricia L. Turner, MD, FACS, Director, ACS Division of Member Services, for the AMA Council on Medical Education. First elected in 2011, Dr. Turner has diligently worked to represent surgery’s perspective in dealing with many complicated medical education issues, and has been a key participant in the development of the Initiative to Transform Medical Education, a project of the Council on Medical Education, of which Dr. Turner is a member. Richard B. Reiling, MD, FACS, who previously served as the ACS Representative in the AMA HOD, was also a member of the Council.