More than 600 delegates attended the annual American Medical Association (AMA) House of Delegates (HOD) met at the Hyatt Regency Chicago, IL, June 8–12 to debate numerous policy issues brought forth by state medical societies and national specialty societies. With 233 resolutions and 52 reports from either the AMA Board of Trustees or AMA councils, plenty of opportunities existed for the American College of Surgeons’ (ACS) delegates to engage in the HOD policymaking process.
Beginning last year, the ACS received an expanded allocation of delegates, bringing the total number to 13. Because the HOD meeting coincided with the June ACS Board of Regents meeting, five of the College’s top leaders were available to extend their stay and serve as AMA delegates. Consequently, the College’s delegation was composed of the following individuals: Brooke Buckley, MD, FACS (Annapolis, MD); Daniel Dent, MD, FACS (San Antonio, TX); David B. Hoyt, MD, FACS (Chicago, IL); Jacob Moalem, MD, FACS (Rochester, NY); Lena Napolitano, MD, FACS (Ann Arbor, MI); Leigh Neumayer, MD, FACS (Tucson, AZ); Naveen Sangji, MD (Boston, MA); Kenneth Sharp, MD, FACS (Nashville, TN); Gary Timmerman, MD, FACS (Sioux Falls, SD); Patricia L. Turner, MD, FACS (Chicago, IL, and delegation chair); and Mark Weissler, MD, FACS (Chapel Hill, NC). Timothy Kresowik, MD, FACS, delegate for the Society for Vascular Surgery, actively caucused with the College’s delegation.
The annual meeting of the HOD includes elections for AMA officers, the Board of Trustees (BOT), and council positions. President-elect Patrice Harris, MD, a psychiatrist from Atlanta, GA, assumed her role as AMA president, and Susan Bailey, MD, an allergist and immunologist from Fort Worth, TX, was unanimously elected to be the next AMA president-elect.
The following ACS members were elected to the Board of Trustees: Willie Underwood III, MD, FACS, a urologist from Buffalo, NY (an ACS-endorsed candidate); Michael Suk, MD, FACS, an orthopaedic surgeon from Danville, PA; and Grayson W. Armstrong, MD, an ophthalmology resident, Harvard School of Medicine, Boston, MA.
Business of the HOD
Because of the high volume of issues that come before the annual House of Delegates, it is critical to focus on matters that relate to surgery, surgical practice, or other items of ACS interest—trauma, cancer, quality, and so on. One of the ACS delegation’s primary responsibilities is to cull the resolutions and reports fitting these criteria; following are some highlights from the meeting.
In 2017, the Pennsylvania Supreme Court ruled that physicians may not delegate their obligation to provide sufficient information to obtain a patient’s informed consent and that the duty of informed consent is a nondelegable duty owed by the physician conducting the surgery or treatment. Resolution 7 was introduced and subsequently adopted to address this ruling. In addition to calling on the AMA to review the ruling and determine its potential effects on informed consent, it requested that the AMA, in cooperation with other relevant stakeholders, advocate that qualified physicians, while retaining the ultimate responsibility for all aspects of the informed consent process, be able to delegate tasks associated with the process to other qualified members of the health care team who have knowledge of the patient, the patient’s condition, and the procedures to be performed on the patient.
For decades, attention has been directed toward the development of physician unions or collective bargaining activities that do not violate federal anti-trust law. In adopting Resolution 606, Investigation into Residents, Fellows, and Physician Unions, the HOD directed the AMA to study the risks and benefits of collective bargaining for physicians and physicians in training in today’s health care environment.
Frustration in dealing with prior authorization is a common issue across all specialties and physician practice types. As this relates to opioids, the HOD adopted BOT Report 23 containing the following recommendations:
- The AMA will advocate for state legislatures and other policymakers, health insurance companies, and pharmaceutical benefit management companies to remove barriers, including prior authorization, to nonopioid pain care.
- The AMA will support amendments to opioid restriction policies to allow for exceptions that enable physicians, when medically necessary in the physician’s judgment, to exceed statutory, regulatory, or other thresholds for postoperative care and other medical procedures or conditions.
- The AMA will oppose health insurance company and pharmacy benefit management company utilization management policies, including prior authorization, that restrict access to postoperative pain care, including opioid analgesics, if those policies are not based upon sound clinical evidence, data, and emerging research.
The HOD adopted Resolution 201, Assuring Patient Access to Kidney Transplantation, adding to AMA policy related to End Stage Renal Disease (ESRD). This resolution called on the AMA to work with professional and patient-centered organizations to advance patient and physician-directed coordinated care for ESRD patients and to oppose any legislative or regulatory efforts to remove patient choice and physician involvement in ESRD care decisions. It further directed the AMA to oppose any legislative or regulatory effort that would create financial incentives that would curtail access to kidney transplantation.
Surprise out-of-network billing
In light of state and federal legislative activity surrounding the issue of surprise billing, the HOD adopted policy that the AMA will advocate that any legislation addressing surprise out-of-network medical bills use an independent, nonconflicted database of commercial charges. Most often, this policy relates to the use of a payment benchmark if a billing dispute between a physician and a payor goes to arbitration.
Previously the HOD adopted a policy that supports training for both the lay public and professional responders in essential techniques of bleeding control. To enhance this policy, the HOD adopted Resolution 527, Increasing the Availability of Bleeding Control Supplies, indicating the AMA supports the increased availability of bleeding control supplies with adequate and relevant training in schools, places of employment, and public buildings.
This HOD meeting took on special significance as it marked the 30th anniversary of the Surgical Caucus. During the business meeting of the Caucus, Chair C. Bob Basu, MD, MPH, MBA, FACS, presented a brief history of the Caucus, reminding members that in June 1989, more than 200 surgeons attended the first Caucus event where “enthusiasm and good fellowship carried the day.” He also reminded attendees that for 30 years, the Caucus has diligently and reliably represented the views of surgery and other proceduralist specialties and has become a well-respected and influential organization within the HOD. Remarking on the solid management of the Caucus by Jon Sutton, MBA, Caucus Administrator, Dr. Basu finished his comments with the admonition to go forward for another 30 years with “enthusiasm and good fellowship carrying the day.”
At every meeting of the HOD, the Caucus sponsors a Continuing Medical Education session. Held Monday, June 10, the session, Intimate Partner Violence: Enhancing Patient Care, included presentations by ACS Immediate Past-President Barbara Lee Bass, MD, FACS, FRCSEng(Hon) FRCSI(Hon), FCOSESCA(Hon); John F., Jr. and Carolyn Bookout Presidential Distinguished Chair, department of surgery, Houston Methodist Hospital, TX; and Erin M. Shriver, MD, FACS, clinical associate professor of ophthalmology and visual sciences, University of Iowa Healthcare Carver College of Medicine, Iowa City. Attendees learned about identifying clinical signs and symptoms that are suggestive of intimate partner violence as well as strategies/steps to take when intimate partner violence is suspected.
Next HOD meeting
The interim meeting of the HOD will take place November 16–19 in San Diego, CA. With a focus on advocacy and legislation, delegates will have the opportunity to address emergent or year-end legislative policy issues. Fellows with suggestions for resolutions or with any questions regarding the AMA HOD should contact email@example.com.