Updates from the AMA Interim Meeting

Nov 13, 2017 at 01:33 pm by Staff

AMA Adopts New Public Health Policies to Improve the Health of the Nation

HONOLULU - The American Medical Association (AMA), the premier national physician organization in the country, voted this week to adopt new policies aimed at improving the health of the nation. The new policies were approved during the voting session of the AMA's Interim Meeting.

The policies adopted by the House of Delegates include:


Backing Paid Leave for Organ Donors

To ease the financial burden on organ donors, the AMA approved new policy to encourage paid leave for those making organ donations. Studies have shown that direct costs to living organ donors are greater than one month's wage for 76 percent of donors, and many donors do not have sufficient medical leave and/or vacation time to accommodate their recovery.

"Living organ donors make a tremendous, brave sacrifice and often require more recovery time than employers provide. Our hope is that employers will take this selflessness into account and formulate policies that allow men and women to be living organ donors without taking a financial hit for doing so," said S. Bobby Mukkamala, M.D., a member of the AMA Board of Trustees.


Emergency Medicaid Funding and Assistance for Puerto Rico

With the Caribbean battered by Hurricane Irma and still dealing with its repercussions, the AMA will urge the federal government to help Puerto Rico and the U.S. Virgin Islands' recovery by adequately funding their Medicaid program.

"Increased federal funding for Puerto Rico and the U.S. Virgin Islands' Medicaid programs would provide support for the medical and public health needs of their residents and would help provide needed care and restore access to health care services," said Russell W.H. Kridel, MD, a member of the AMA Board of Trustees.


Need for Cervical Cancer Screening in Female-to-Male Transgender Patients

Although routine cervical screening has been shown to greatly reduce the incidence of new cervical cancers, as well as death from the disease, sexual and gender minority individuals may be less likely to undergo regular cancer and sexually transmitted infection screenings based on anatomy, despite their comparable or elevated risk for these conditions. To improve screening and health outcomes among sex and gender minority patients, the AMA House of Delegates approved policy to better educate physicians about the need for regular cancer screening and sexually transmitted infection screening among this population.

"Sexual and gender minority patients may be unaware of the risks they face and the screening that could lower their risk of cervical cancer," said Ryan Ribeira, M.D., MPH. "Equipping our physicians with the knowledge and tools necessary to fight this disease and treat this vulnerable population will reduce the incidence of cervical cancer and sexually transmitted infections and save lives."


Reducing Health Issues Associated with Births

With at least one in seven women experiencing anxiety or depression during pregnancy or in the first year after childbirth and 65,000 U.S. women having serious health complications from pregnancy-related causes, the American Medical Association adopted new policies to encourage a routine protocol that would include depression screening in pregnant and postpartum women. The AMA also will advocate for state and federal legislation that would establish Maternal Mortality Review Committees to analyze the circumstances surrounding deaths that occur during pregnancy or within the first year after childbirth.

"As attention is turned toward the newborn, the health and wellbeing of the mother can, unfortunately, take a back seat, even as preventable physical and mental issues pose dangers. We need to recognize that dangers of post-partum depression and recognize that pregnancy-related deaths have been increasing," said Albert J. Osbahr III, MD, a member of the AMA Board of Trustees.

AMA Adopts New Policy to Increase Organ Donation Nationwide

HONOLULU - With the need for donated organs far exceeding the number available for transplantation in the U.S., the American Medical Association (AMA) adopted policy during its Interim Meeting this week aimed at increasing organ donation rates--particularly among minority populations with historically low donation rates.

While reports show that the vast majority of U.S. adults support organ donation, only about half are actually registered as organ donors and only three in 1,000 of those registered actually become donors after death. Given the significant need to increase the number of organs available for donation, the AMA's new policy calls for the development of public education programs that are tailored to address the factors that most influence people's attitudes toward organ donation in order to improve their willingness to donate.

"Although the numbers of organ donors and transplants has been growing slowly over the last two decades, there aren't nearly enough donated organs to satisfy the number of people in need of transplants. We know this is due in large part to the factors that influence a person's decision on whether to designate themselves as a donor--ranging from religious and cultural beliefs to family influence, beliefs about body integrity after death, and limited knowledge about organ donation," said AMA Board Member Albert J. Osbahr III, M.D. "We will continue to support the implementation of programs aimed at improving the public's willingness to donate and help identify other approaches to encourage more people to become organ donors."

To help ensure sufficient organ donation nationwide, the AMA's new policy also calls for educational programs targeted to populations with historically low organ donation rates. Of the nearly 120,000 people who are on the national transplant waiting list, the proportion of racial and ethnic minority patients is higher than the corresponding proportion of racial and ethnic minorities who are donors. In fact, African Americans make up nearly 30 percent of the waiting list and Hispanics make up approximately 20 percent, yet only about 16 percent of donors are African American and only 14 percent of donors are Hispanic.

AMA Adopts New Policies at 2017 Interim Meeting

HONOLULU - The American Medical Association (AMA), the premier national physician organization in the country, voted to adopt new policies on emerging health care topics during the voting session of its Interim Meeting.

The AMA's House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.

The policies adopted by the House of Delegates today include:



• ICE Agents In Medical Facilities

Weeks after Immigration and Customs Enforcement (ICE) agents in Texas took into custody a 10-year-old girl with cerebral palsy shortly after she was discharged from a hospital where she just had surgery, the American Medical Association voted to oppose the presence of ICE enforcement at health care facilities. ICE policy states that enforcement actions, including interviews, searches, apprehensions, or arrests, should ot occur at sensitive locations, including healthcare facilities and medical treatment centers.

"Our patients should not fear that entering a hospital will result in arrests or deportation. In medical facilities, patients and families should be focused on recovery and their health, not the ramifications of their immigration status," said Andrew W. Gurman, MD, Immediate Past President of the AMA.


• Support for Communication and Resolution Program

The AMA expressed its support for communication and resolution programs as an option to settle disputes before litigation. Many studies show these types of programs are effective way to learn from medical errors and near misses, enhance patient safety and improve the liability system.

"A structured communication and resolution program can help identify necessary patient safety improvements while also improving communication with patients without a resulting increase in litigation. The programs help foster a culture of safety and transparency in a blame-free environment rather than the confrontational litigation route," said Carl A. Sirio, MD, a member of the AMA Board of Trustees.


• Treating Opioid Use Disorder in Correctional Facilities

As part of its ongoing effort to end the nation's opioid epidemic, the AMA adopted new policy today affirming that, while in correctional facilities, patients with opioid use disorder should have access to evidence-based treatment, including initiation and continuation of medication assisted treatment, as well as counseling. In addition, when people are released from prison, they should have access to providers so they can access treatment plans for opioid use disorder, including education, medication for addiction treatment and medication for preventing overdose deaths.

"Patients with opioid use disorder should not have their treatment interrupted once they enter prison. Access to evidence-based care is crucial to treatment, no matter what the setting," said Patrice A. Harris, M.D., chair of the AMA Opioid Task Force and immediate past chair of the Board of Trustees.


• Confronting Health Insurer Business Practices That Can Delay Patient Treatment

Health insurers bear responsibility when they systematically impose bottom-line business practices over accepted medical guidelines that result is an unfair devaluation or denial of legitimate physician services.

In the latest example, Anthem Blue Cross recently notified physicians in several states that effective on January 1, 2018 it would change company policy and reduce reimbursement for valid evaluation and management (E/M) services provided to patients. The change would routinely and automatically deny E/M services and procedures that are reported the health insurer under specific circumstances that require a designated code known as modifier-25.

In simpler terms, modifier -25 is reported on a medical claim when a physician evaluates, manages, and treats a patient for separate and distinct health care problems during the same visit. That work takes additional physician time and resources and should be reimbursed. However, health insurers frequently ignore modifier -25 and reimburse for just one service - typically the service with the lowest cost.

"The AMA will work aggressively to prevent implementation of unfair health insurer rules that are detrimental to physicians who are trying to practice medicine according to the needs of their patients." said AMA President David O. Barbe, M.D., M.H.A. "Health insurers that deny E/M services associated with procedures performed on the same day are needlessly forcing patients into multiple visits and delaying the provision of necessary care."

In response, physicians at the AMA Interim Meeting adopted policy to "aggressively and immediately advocate through any legal means possible, including direct payer negotiations, regulations, legislation, or litigation, to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate."

New Policy Furthers AMA's Efforts to Create Medical School of the Future

Policy aimed at helping train future physicians on lifestyle medicine, social determinants of health, and influences of sex and gender on clinical care

HONOLULU - The American Medical Association (AMA) adopted policy during its Interim Meeting this week that builds on its efforts over the past four years to help prepare future physicians to care for patients in modern health systems. The new policy calls for medical students, residents and physicians to receive training in both lifestyle medicine and social determinants of health in undergraduate, graduate and continuing medical education.

To help reduce disparities in patient care, the policy will also help medical students and residents receive training regarding implicit bias, diversity and inclusion. Under the new policy, the AMA will work to identify and publicize effective strategies for educating residents in all specialties about disparities in their fields related to race, ethnicity, and all populations at increased risk, particularly regarding access to care and health outcomes. Additionally, the AMA will support research to identify the most effective strategies for educating physicians on how to eliminate disparities in health outcomes in all at-risk populations.

"The AMA is committed to eliminating health disparities in our nation in order to achieve health equity. One critical component of our efforts is transforming medical education so that it keeps pace with our nation's changing health care system," said AMA Board Member and medical student Karthik V. Sarma, M.S. "By ensuring students and residents have proper training to address disparities in care from the outset of their careers, we can empower them to be the change agents that we need to achieve our mission to improve the health of the nation."

Several medical schools that are part of the AMA's Accelerating Change in Medical Education Consortium have been working on curricular innovations to address health care disparities, including University of California, Davis School of Medicine, A.T. Still University-School of Osteopathic Medicine in Arizona, Florida International University Herbert Wertheim College of Medicine, and Morehouse School of Medicine in Georgia.

New policy will also help medical students and residents understand the impact that sex and gender have on patient care. Specifically, the policy calls for the AMA to collaborate with other organizations to disseminate the work produced by medical schools participating in the Accelerating Change in Medical Education consortium and distribute pertinent information and a comprehensive bibliography about the influence that sex and gender have upon clinical medicine. This would include literature showing that some clinical trials may have skewed representation of specific gender and sexual traits making it difficult to generalize their results.

The AMA launched its Accelerating Change in Medical Education initiative in 2013, providing $11 million in grants to fund major innovations at 11 of the nation's medical schools. Together, these schools formed a Consortium that shares best practices with a goal of widely disseminating the new and innovative curricula being developed among all allopathic and osteopathic medical schools. The AMA expanded its Consortium in 2015 with grants to an additional 21 schools to develop new curricula that better align undergraduate medical education with the modern health care system.

Most recently, through its work with the 32-school Consortium, the AMA launched a health systems science textbook that can be used by all medical schools to help future physicians navigate the changing landscape of modern health care, especially as the nation's health care system moves toward value-based care. Another recent innovation to emerge through its initiative to create the medical school of the future is the Regenstrief EHR Clinical Learning Platform developed by Indiana University School of Medicine and the Regenstrief Institute. The AMA and Regenstrief are currently working together to disseminate the platform to medical schools throughout the country to ensure more medical students and medical trainees gain real-world experience using electronic health records during their training.

The AMA will continue its efforts to accelerate change in medical education to ensure future physicians learn about the newest technologies, health care reforms and scientific discoveries that continue to alter what physicians need to know to practice in modern health care systems.

AMA Expands Scope of Advocacy Efforts Supporting Drug Price Transparency

HONOLULU - Given that pharmaceutical companies, pharmacy benefit managers and health insurance companies have overlapping roles that affect prescription drug prices, physicians at the Interim Meeting of the American Medical Association (AMA) adopted new policy to expand the scope of its federal and state advocacy efforts to increase transparency of drug pricing.

"As spikes in prescription drug prices occur without justification, the American Medical Association believes we need more transparency to protect patients from drug price gouging and manipulation," said AMA President-elect Barbara L. McAneny, M.D. "Greater transparency among pharmaceutical manufacturers, pharmacy benefit managers and health plans will shed light on the rationale for drug price increases and why patients pay what they do for their medications."

According to the newly adopted policy, the AMA will:

The AMA has been fighting for price transparency for prescription drugs and created TruthInRx.org to hear from patients and their struggles to afford their medications. TruthInRx.org is an interactive site that gives consumers an opportunity to tell their stories of how rising prices are affecting their health and their pocketbooks. The site is home to a growing gallery of curated videos and testimonials. It gives supporters ways to take action, such as sending a message to Congress and sharing content within their social networks.

AMA Adopts New Policies on Health Insurance Affordability

Physicians advocate to protect meaningful health insurance coverage for patients and promote stable health insurance premiums

HONOLULU - Patients must have meaningful coverage for hospital, surgical and medical care and protections against catastrophic expenses, according to physicians gathered at the Interim Meeting of the American Medical Association (AMA). Taking a step to ensure quality health insurance coverage for their patients, physicians voted to oppose weakening or removing any of the 10 categories of essential health benefits (EHB) required by the Affordable Care Act (ACA).

The new policy was recommended by a report from the AMA's Council on Medical Service, which noted, "if insurers are allowed to offer plans with skimpier coverage, plan designs could potentially discriminate against people with pre-existing conditions. In addition, individuals who use services and benefits no longer included in the EHBs could face substantial increases in out-of-pocket costs."

According to newly adopted policy, the AMA will oppose the removal of categories from the EHB package. In addition, the AMA will also oppose waivers of EHB requirements that lead to EHB categories and their associated protections against annual and lifetime limits, and out-of-pocket expenses, being eliminated.

"Most costs associated with EHB requirements are attributable to such services as hospital inpatient and outpatient care, physician services, and prescription drugs. These services are fundamental components of health insurance coverage," said AMA President David O. Barbe, M.D. "Removing any categories from the EHB requirements, or allowing waivers of such requirements, could make individuals vulnerable to significant out-of-pocket expenses, or hinder patient access to necessary services."

Analyses have found that categories most likely to be removed from the EHB, if states are allowed flexibility to do so, include maternity care; mental health and substance abuse benefits; rehabilitative and habilitative services; certain pediatric services, including oral and vision care; and prescription drugs.

Physicians at the AMA Interim Meeting also evaluated various options to improve the stability of health insurance premiums by subsidizing the costs of high-cost and high-risk patients, who may have pre-existing conditions. Physicians favored directing resources to reinsurance programs given evidence that other programs involving high risk pools before the Affordable Care Act provided second-class insurance to individuals with pre-existing conditions. Newly adopted AMA policy prefers reinsurance programs as an economical and equitable mechanism to subsidize the expenses of high-cost and high-risk patients.

AMA Adopts Strategy for More Consistent Coverage of New Genetic Tests and Therapeutics
Physicians want greater transparency and standardization among payer coverage determinations

To improve patient access to useful new genetic tests and therapeutics that have clinical impact, physicians gathered at the Interim Meeting of the American Medical Association (AMA) voted today to encourage the development of a comprehensive strategy that facilitates more consistent coverage of genetic/genomic tests and precision medicine.

"Precision medicine tests, technologies and therapeutics are increasingly being adopted into clinical practice as evidence of their effectiveness grows," said AMA Board Member William E. Kobler, M.D. "However, many patients do not have access to precision medicine because most public and private health insurers do not offer coverage for genetic or genomic services unless certain clinical criteria and evidentiary standards are met. As a result, access to this next generation of clinical testing services is often limited."

According to a report considered by physicians at the AMA policy-making meeting, there is considerable variability among public and private payers with regard to the evidentiary requirements for coverage of genetic/genomic tests and services. Newly adopted AMA policy addresses the lack of transparency and standardization across payer coverage determination processes, which may hinder patient access to valid and meaningful tests and therapeutics, as well as future innovations in genetic/genomic precision medicine.

AMA policy encourages public and private payers to adopt processes and methodologies for determining coverage and payment for genetic/genomic precision medicine that:

Currently, there is a well-established clinical evidence base to support coverage of a broad range of genetic/genomic tests. Newer tests are rapidly and continuously becoming available, but the clinical usefulness of many new genetic tests and therapeutics cannot feasibly be demonstrated using traditional approaches, which includes randomized controlled trials (RCTs) for evidence generation.

Novel research approaches are required. As such, the AMA encourages coverage and payment policies for genetic/genomic precision medicine that are evidence-based and take into account the unique challenges of traditional evidence development through RCTs, and work with test developers and appropriate clinical experts to establish clear thresholds for acceptable evidence for coverage.

The AMA will support continued research and evidence generation demonstrating the validity, meaningfulness, short-term and long-term cost-effectiveness

HONOLULU - In his address at the American Medical Association (AMA) Interim Meeting, AMA President David O. Barbe, M.D., on Saturday recapped an aggressive year of advocacy and accomplishment, highlighting significant victories that protected patients and physicians, with the primary goal of improving the health of the nation.

Dr. Barbe highlighted the dedicated drumbeat by the AMA throughout the health reform debate - a push to protect insurance coverage gains on behalf of millions of Americans: "From the beginning, we have fought for nine key principles - including affordability, accessibility, protecting safety net programs and patient protections, and one overarching goal: maintaining and expanding health care coverage for Americans. Throughout this debate, the AMA has been a voice of reason, asking Congress to put Patients Before Politics, and urging Congress to work on bipartisan, sustainable solutions."

He also highlighted the AMA's successful work to prevent the Anthem-Cigna and Aetna-Humana insurance mega-mergers, and he provided an update on the AMA's robust efforts to rein in chronic disease, type 2 diabetes and cardiovascular disease, to fight the opioid epidemic, and to lead the way in building the medical school of the future.

Dr. Barbe touted significant victories in the regulatory realm, including helping physicians avoid penalties under the new Medicare payment program if they report one quality measure on one patient for one year; and significant efforts to improve physician satisfaction.

"We are fighting to prevent IT vendors from blocking information or making it expensive for physicians to share data, and we are making progress," said Dr. Barbe. "We are fighting physician burnout and the time crunch by working to improve EHRs, mobile devices, and interoperability, and again, those efforts are showing signs of success. Our work to improve physician satisfaction by reducing these headaches and making the practice environment more satisfying is at the heart of the AMA's shared strategic vision, as we: provide practice and payment resources; foster lifelong professional development, and improve the health of the nation."

Additional information about AMA's efforts can be found online:

To learn more about these and other efforts, visit www.ama-assn.org

The complete transcript of Dr. Barbe's speech, as prepared for delivery, is below. To see video, click here.

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