New AMA Policies Adopted on Final Day of 2018 Interim Meeting

NATIONAL HARBOR, Md. - 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 at the Interim Meeting this week include:

Protecting and Improving Access to Zero-dollar Preventive Care

The AMA will take steps promoting patient access to preventive interventions as the health care industry strives to provide coverage for select preventive services without cost-sharing as required by the Affordable Care Act's (ACA).

"The ACA requirement for coverage of select preventive services without cost-sharing has been a popular and successful step in promoting access to preventive care, but more could and should be done to facilitate and incentivize high-value care," said AMA Secretary Russell W.H. Kridel, M.D. "The AMA can play a critical leadership role in building needed common understanding, coding tools and education resources to protect and improve access to zero-dollar preventive care."

Stakeholders throughout the health care community can benefit from common understanding of which preventive services are covered without patient cost-sharing, how such services should be coded for billing, and education tools about recommended preventive services and their availability without cost-sharing.

The AMA decided to pursue three steps to protect and improve access to zero-dollar preventive care:

• First, the AMA will continue to support requiring private health plans to provide coverage for evidence-based preventive services without imposing cost-sharing on patients.
• Second, the AMA will develop coding guidance tools to help providers appropriately bill for zero-dollar preventive interventions and promote common understanding regarding what will be covered at given cost-sharing levels.
• Finally, the AMA will develop physician educational tools that prepare physicians for conversations with their patients about the scope of preventive services provided without cost-sharing and instances where and when preventive services may result in financial obligations for the patient.

Continued 9-1-1 Modernization and Implementation of Text-to-9-1-1 Service

With the current 9-1-1 system primarily built upon infrastructure that does not uniformly support modern communications technologies including texting, geolocation and images, delegates approved a resolution aimed at bolstering the system, particularly with regard to SMS messaging. The resolution supports funding for the modernization of the 9-1-1 infrastructure and the incorporation of text to 9-1-1 technology, which would improve access to 9-1-1 services for those with hearing and speech disabilities, as well as in locations where 9-1-1 call centers are not currently mandated to accept SMS messages.

"Infrastructure and SMS improvements to our 9-1-1 system will save lives, period," said Albert J. Osbahr, III, M.D., a member of the AMA Board of Trustees. "At a time when Americans overwhelmingly own smart phones and the vast majority of 9-1-1 calls are made from cell phones or other handheld devices, it is inexplicable that this technology is not being used to its fullest extend to help in an emergency. Hopefully, by highlighting this gap, we can spark action that will ensure all Americans have access to 9-1-1 services when they need them the most."

Expanding Broadband and Wireless Connectivity

The AMA will advocate for the expansion of broadband and wireless connectivity in underserved areas to ensure equal access to digital health tools that require connectivity.

"Patients stand at the intersection of health and technology. Without broadband and wireless, patients in underserved areas will face even greater health challenges," said Gerald E. Harmon, M.D., immediate past chair of the AMA Board of Trustees.

Sexual Assault Education and Prevention in Public Schools

The AMA will support state legislation mandating that public middle and high school health education programs include age appropriate information on sexual assault education and prevention, including but not limited to topics of consent and sexual bullying.

"This topic often is discussed in college, 42 percent of forced sexual violence victims are assaulted before they are 18 years old. We need to tackle this problem earlier to protect our children," said Gerald E. Harmon, M.D., immediate past chair of the AMA Board of Trustees.

New AMA Policy Encourages More Future Physicians to Seek Public, Population Health Training to Enhance Access to Care in Rural Areas

NATIONAL HARBOR, Md - As the need for investments in public health and preventive medicine continues to grow in the U.S., the American Medical Association (AMA) adopted policy during its 2018 Interim Meeting today aimed at encouraging more medical students and residents to pursue training opportunities in public and population health leadership--and increasing access to care in rural areas.

Under the new policy, the AMA is calling on the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education to increase awareness of these opportunities across the medical education continuum, particularly among women physician groups and other underrepresented groups in medicine.

"With an estimated 27 million uninsured U.S. citizens and resource deficiencies documented in both rural and urban communities, there is an increasing need for more physicians who are skilled in public and population health to help close the gaps that exist in patient access to care," said AMA Board Member Willarda V. Edwards, M.D., M.B.A. "We know that investing in preventive medicine and public health is cost effective and saves lives. That's why we're encouraging more physicians-in-training, especially women, to pursue qualifications and credentials in public and population health."

Although the number of women in leadership roles is increasing, women remain underrepresented in the top echelons of health care leadership, and gender differences exist in the types of leadership roles that women attain. In fact, a recent study found that 73 percent of deans of schools of public health were male. Given the many ways that sex and gender influence disease presentation and patient management, the new policy aims to increase the number of women physicians who receive training in preventive, public, population and rural health leadership.

There are numerous training opportunities across the continuum of medical education that are available to help all physicians-in-training develop the professional skills and qualifications they need to pursue a career in public health leadership. This includes the curricular innovations developed and offered through the AMA's Accelerating Change in Medical Education Consortium launched in 2013 to create the medical schools of the future. More than half of the consortium's 32 medical schools have been working over the last five years to integrate population, public, and rural health education for medical students.

Additionally, the AMA's Health Systems Science textbook, which was developed as part of the Accelerating Change in Medical Education Consortium, is an important resource that focuses on providing a fundamental understanding of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. Health Systems Science has emerged as the third pillar of medical education, along with basic and clinical sciences, to help physicians-in-training learn how to advocate for their patients and communities and understand the socioecological determinants of health, health care policy, and health care economics.

AMA Adopts New Policy Aimed at Preventing Medical Student and Physician Suicide

NATIONAL HARBOR, Md - The American Medical Association (AMA) adopted policy during its Interim Meeting today aimed at identifying patterns that could predict and ultimately prevent suicide among physicians-in-training. The new policy calls on the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education--the accrediting bodies for medical schools and residency training programs respectively--to collect data on medical student, resident and fellow suicides.

"Studies have shown that physicians face a higher rate of suicide than any profession in the United States. While we have been working hard to reduce burnout and increase access to mental health services for physicians and medical students, it is imperative that we also work toward fully understanding the problem," said AMA Board Member Ryan J. Ribeira, M.D., M.P.H. "We believe that collecting data on the incidence of suicide among physicians-in-training will help us identify the systemic factors that contribute to this problem, and ultimately save lives."

The policy adopted today builds on the AMA's continued commitment to reducing physician and medical burnout by fighting it on every front, improving wellness, and supporting physicians throughout their career journey. Through the AMA's Professional Satisfaction and Practice Sustainability initiative launched in 2013, the AMA is partnering with physicians, leaders, and policymakers to reduce the complexity and costs of practicing medicine so physicians can continue to put patients first.

As part of this work, the AMA's Steps Forward program offers a series of practice transformation modules designed to improve the health and well-being of patients by improving the health and well-being of physicians and their practices. These online modules focus on improving physician wellness, preventing burnout, and increasing resilience.

The AMA is planning to issue a report on the most efficient and accurate mechanism to study the actual incidence of medical student, resident, and physician suicide that will be introduced at the 2019 AMA Annual Meeting of the House of Delegates with recommendations for action.

AMA Adopts Policy to Bolster Firearm Background Checks

NATIONAL HARBOR, Md. -- Building on its extensive policy on firearm safety, the American Medical Association (AMA) called on states today to strengthen their reporting of all relevant information to the National Instant Criminal Background Check System (NICS) to help prevent firearm injuries and deaths.

The new policy, adopted at the interim meeting of the House of Delegates, supports federal grants to states to improve NICS reporting and encourages states to automate the reporting of relevant records to NICS to improve the quality and timeliness of the data.

"For NICS to be a useful tool in the prevention of firearm injuries and deaths, it needs to contain the records of individuals disqualified under law from possessing firearms -- and the data needs to be reported in a timely manner," said AMA President Barbara L. McAneny, MD. "Inconsistencies in state reporting has contributed to the lack of success in identifying individuals who should not have a firearm."

The Brady Handgun Violence Prevention Act of 1993 required the establishment of a computerized system to facilitate background checks on individuals seeking to acquire firearms from federally licensed firearms dealers. Administered by the FBI, NICS was created in 1998 and has denied hundreds of thousands of gun purchases to prohibited persons. Records in NICS, however, are provided voluntarily by state, local, tribal, and federal agencies. And states are inconsistent in how they report records that would disqualify someone from purchasing a gun. Also, loopholes in the law (e.g., unlicensed dealers) have limited the reach of background checks. As a result, the individuals who are disqualified from possessing firearms are managing to buy guns.

"Making sure that relevant information is consistently reported could help save lives," McAneny said. "Physicians often see patients at risk of firearm injury and death, including patients at risk of suicide. A stronger federal background check system will help protect patients."

The AMA also amended existing policy regarding the ban on the manufacture, importation and sale of any firearm that cannot be detected by airport screening devices to include 3D-printed firearms. It also supported a ban on production and distribution of 3D-firearm digital blueprints.

"The proliferation of 3D printers will increase access to guns in an unregulated manner. We need to address this issue now before these weapons play a role in the terrifying rate of gun violence in this country," McAneny said.

As one of the main causes of intentional and unintentional injuries and deaths, the AMA recognizes that firearm-related violence is a public health crisis in the United States. The AMA has extensive policy on firearm safety and violence prevention. The AMA "recognizes that uncontrolled ownership and use of firearms, especially handguns, is a serious threat to the public's health inasmuch as the weapons are one of the main causes of intentional and unintentional injuries and deaths" (H-145.997). AMA policy supports legislation calling for a waiting period before purchasing any form of firearm (H-145.991, H-145.992, and H-145.996), and supports requiring background checks for all handgun purchasers (H-145.991, H-145.996).

Delegates adopted another resolution encouraging the Centers for Disease Control and Prevention, the National Institute of Mental Health, and news organizations to develop recommendations for media coverage of mass shootings in a manner that is unlikely to provoke additional incidents. The CDC and the World Health Organization have developed similar recommendations for coverage of suicides in the belief that a "contagion effect" exists in which one violent episode is more likely to lead to another.

AMA Expands Anti-tobacco Policies to Further Protect Youth

NATIONAL HARBOR, Md - Furthering its longtime commitment to preventing tobacco use amongst youth, the American Medical Association (AMA) adopted new policies at its Interim Meeting aimed at making e-cigarettes less appealing to youth. Recognizing the use of e-cigarettes and vaping as an urgent public health epidemic, the AMA will actively work with the U.S. Food and Drug Administration (FDA) and other relevant stakeholders to counteract the marketing and use of addictive e-cigarette and vaping devices--including but not limited to bans and strict restrictions on marketing to minors under the age of 21.

"The AMA is committed to keeping harmful tobacco products out of the hands of young people and we will continue to urge the FDA to ban flavors, as well as marketing practices, that enhance the appeal of these products to youth," said Albert J. Osbahr, III, M.D., a member of the AMA Board of Trustees. "We believe more stringent policies will help protect our nation's youth from the harmful effects of tobacco use."

Over the years, the AMA has proudly supported anti-tobacco efforts to improve public health, and has strongly advocated for the FDA to extend its tobacco regulations and oversight to include e-cigarettes, cigars and other tobacco products, and ban the sale of these products to minors. Most recently, the AMA called on the FDA to create a non-addictive nicotine level standard for all tobacco products, including cigarettes, smokeless tobacco and e-cigarettes.

Improving the health of the nation is a top priority for the AMA and we will continue to advocate for policies that help reduce the burden of preventable diseases like cardiovascular disease and type 2 diabetes, which can both be linked to smoking.

AMA Adopts New Policy Supporting Services for LGBTQ Survivors of Intimate Partner Violence

CHICAGO - While intimate partner violence (IPV) can occur between heterosexual or same-sex couples, efforts to address this public health problem have remained mostly focused on heterosexual women despite other populations experiencing IPV at similar or higher rates. The American Medical Association (AMA) adopted policy at its Interim Meeting today aimed at addressing IPV in the LGBTQ population. The new policy calls for physician and community awareness of IPV among LGBTQ patients, and federal funding to support programs and services for survivors that do not discriminate against underserved communities, including sexual and gender minorities.

Due to the limited data available, the policy encourages more research on IPV in the LGBTQ community to include studies on the prevalence, accuracy of screening tools, effectiveness of early detection and interventions, as well as the benefits and harms of screening. The policy also encourages dissemination of such research to educate physicians and the community on these issues.

"We encourage physicians to be alert to the possibility of intimate partner violence among their LGBTQ patients and for them to become familiar with the resources available in their communities for these patients," said E. Scott Ferguson, M.D., a member of the AMA Board of Trustees. "As Congress considers reauthorization of the Violence Against Women Act, it will be important to ensure federally funded programs and services for survivors do not discriminate against sexual and gender minorities."

IPV includes physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner--including current or former spouses, boyfriends or girlfriends, dating partners, or sexual partners.

In 2010, the Centers for Disease Control and Prevention's National Intimate Partner and Sexual Violence Survey provided the first national-level data on the prevalence of intimate partner violence, sexual violence, and stalking among the lesbian, gay, and bisexual population. The pattern of results suggests that these individuals experience an equal or greater likelihood of experiencing sexual violence, stalking, and IPV compared with heterosexuals. In particular, the lifetime prevalence of IPV in the LGBTQ community is estimated to be comparable to or higher than that among heterosexual couples.

AMA Adopts New Policies at 2018 Interim Meeting

NATIONAL HARBOR, Md. - 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:

Affirming the Medical Spectrum of Gender

The AMA will oppose efforts to deny an individual's right to determine their stated sex marker or gender identity. The new policy comes just weeks after a memo circulated within the Trump Administration proposed narrowly defining sex as "a person's status as male or female based on immutable biological traits identifiable by or before birth," according to a New York Times report.

"Sex and gender are more complex than previously assumed," said AMA Board Member William E. Kobler, M.D. "It is essential to acknowledge that an individual's gender identity may not align with the sex assigned to them at birth. A narrow limit on the definition of sex would have public health consequences for the transgender population and individuals born with differences in sexual differentiation, also known as intersex traits."

The AMA will work to preserve access to quality health care by educating state and federal policymakers to ensure they have a fundamental understanding of the scientific nature of a person's sex.

Protecting the Integrity of Public Health Data Collection

In recognition of a need to better understand the health of sexual and gender minorities, the AMA will advocate for collection of demographic data in federal and state surveys that is inclusive of sexual and gender identity.

The collection of sexual orientation and gender identity data is essential to allow physicians, public health experts, researchers and others to address health disparities and ensure care needs are met," said AMA Board Member William A. McDade, M.D., Ph.D. "The AMA will advocate against the removal of demographic data inclusive of sexual and gender identity from public health surveys and registries without plans for updating measures of these data."

The new AMA policy covers, but is not limited to, data collection by the Current Population Survey, United States Census, National Survey of Older Americans Act Participants, and the claims databases of public and private health insurers.

Opposing the Detention of Migrant Children

The AMA will continue to oppose and object to policies separating migrant children from their families, as well as any effort to end or weaken a 1997 legal settlement that limits the length of time and conditions under which the U.S. government can detain immigrant children.

"The AMA supports the humane treatment of all undocumented children, and advocates for regular, unannounced auditing of the medical conditions and services provided at all detention facilities," said Dr. Kobler. "These audits should be conducted by independent experts in the care of vulnerable children."

According to reports, some immigrant children detained by the U.S. government were given psychotropic drugs without parental permission or court order. New AMA policy does not support this violation of medical protocol.

"While immigrant children have experienced multiple emotional traumas on their travels to the U.S., the AMA only supports the practice of administering psychotropic drugs when there has been an evaluation by appropriate medical personnel, and with parental consent or court order in the case of imminent danger to the child or others," said Dr. Kobler.

Increased Access to Identification Cards for the Homeless Population

Recognizing that a lack of identification serves as a major barrier for homeless individuals seeking medical care, in particular preventing them from enrolling in Medicaid, delegates approved a resolution supporting legislative and policy changes that streamline, simplify, and reduce/eliminate the cost of obtaining identification cards for the homeless population. Unlocking Medicaid access would have tremendous benefit for the homeless population, 36 percent of which suffers from a severe mental illness or chronic substance abuse. Additionally, 43 states allow pharmacists to require photographic identification prior to dispensing drugs, and, according to the National Law Center on Homelessness and Poverty, 54 percent of homeless individuals were denied housing or shelter because of lack of ID.

"It is outrageous that the small fees associated with getting a birth certificate or state ID are preventing homeless Americans from receiving access to care and services they desperately need," said E. Scott Ferguson, M.D., a member of the AMA Board of Trustees. "The AMA has long prioritized access to care as key to improving the health of the nation, and, by today's action, we make very clear that more should be done to ensure that a lack of photo ID does not keep our fellow Americans from seeing a doctor."

Increasing Patient Access to Sexual Assault Medical Forensic Examinations and Post-Exposure Prophylaxis (PEP) for HIV in Emergency Departments

There were 323,450 reports of rape or sexual assault in the United States in 2016, according to the U.S. Department of Justice. Hospital emergency departments typically serve as the primary point of care for survivors of sexual assault, accounting for approximately 65,000 to 90,000 emergency department visits per year. Given the high volume of medical forensic examinations that need to be performed in emergency departments, the AMA adopted new policy today advocating for more emergency departments to have access to sexual assault nurse examiners and other trained, qualified clinicians in performing these examinations on post-pubertal patients.

"It is critical for sexual assault survivors to undergo a medical forensic examination within 72 hours of being assaulted to properly document their physical injuries and obtain evidence necessary for prosecution. It is also essential that these patients are offered HIV testing and Post-Exposure Prophylaxis within 72 hours. However, it can be difficult for emergency physicians to simultaneously oversee these very necessary and specific multiple-hour examinations while also caring for emergent patients," said E. Scott Ferguson, M.D., a member of the AMA Board of Trustees. "Having greater access to sexual assault nurse examiners, along with other trained and qualified clinicians, to perform medical forensic examinations will help increase timely access to care for patients."

Additionally, the AMA's new policy calls for HIV testing and Post-Exposure Prophylaxis (PEP) to be offered to all survivors of sexual assault who present within 72 hours of a substantial exposure risk. The new policy also aims to increase public education on PEP, which is an antiretroviral medication that has been shown effective in preventing infection after HIV exposure only if taken within 72 hours.

AMA Adopts New Ethical Guidance for Health Care Decisions Involving Minor Patients

NATIONAL HARBOR, Md. - Helping families make clinically well-informed decisions for individual children is challenging when choices involve socially and culturally sensitive issues that can have enormous significance. In response, physicians gathered at the Interim Meeting of the American Medical Association (AMA) approved a general framework to help physicians work with families to balance the child's interests with the scope of parental authority.

"Few people know what they would do if faced with a life-altering medical situation involving their child," said AMA Immediate Past President David O. Barbe, M.D. "When confronting their child's unexpected diagnosis or uncertain prognosis, parents can struggle to balance their own hopes, fears, and value commitments with the consequences of a medical choice. They need help. The AMA's new ethical framework emphasizes a shared decision making process where doctors help parents reach clarity and empower choices carefully tailored for each patient."

Parents are expected to make health care decisions in children's best interest. In doing so, they are expected both to protect children and, at the same time, to empower children and promote children's developing capacity to become independent decision makers.

Physicians who counsel parents facing life-altering medical decision for a child need to be aware of the ethical complexity of their role. These situations can involve a mix of factors, including the current state of medical technology and society's prevailing legal, political, economic, and cultural attitudes. Each of these factors can shape how treatment options are categorized as beneficial, futile, or somewhere in between. The greater the uncertainty or lack of robust evidence supporting alternative courses of action, the more difficult the task becomes.

In situations when no single approach can be designated as essential, preferred, or acceptable, the AMA guidance for ethically sound practice recommends a process of shared decision making for pediatric patients. Parents, physician and the patient - in keeping with the child's capacity to participate - should seek a shared understanding of goals and determine a plan of care that is carefully tailored for the patient's unique circumstances.

This approach to shared decision making will not always lead to decisions that doctors would prefer. Sometimes, parents' values are different from those of professionals. When decisions about treatment fall within the zone of parental discretion, however, the process should give great deference to parental preferences.

When there is ongoing disagreement about patient's best interest or treatment recommendations, the AMA guidelines recommend that clinicians work with ethics committees and other institutional resources to define the boundaries for parental discretion at each medical center.

At Opening of Interim Meeting, AMA President Outlines Efforts to Attack Dysfunction in Health Care

Dr. McAneny also issues urgent calls for physician leadership to help reduce gun violence in America, end harassment in medicine

NATIONAL HARBOR, Md. - In her address to physician leaders gathered from across the nation at the opening session of the American Medical Association (AMA) Interim Meeting, President Barbara L. McAneny, M.D., today outlined the AMA's an ongoing effort to attack dysfunction in health care.

In addition to highlighting physician efforts on behalf of patients from the past year - from fighting prior authorization processes that delay patient care to fighting for drug price and cost transparency so patients can afford the prescription drugs they need - Dr. McAneny called on her colleagues to take on harassment in medicine and reasserted the AMA's urgent pleas for action to reduce gun violence.

"The AMA steps in where others fear to tread, and it will take time but we will get there," said Dr. McAneny. "Gun violence is another area where many 'fear to tread.' Just in the last two weeks we have mourned still more senseless deaths from the mass shootings in Pittsburgh, and in Thousand Oaks. Meanwhile, the CDC reported yesterday that both firearm homicides and suicides are at their highest levels in more than a decade. Colleagues, these deaths - from mass shootings, from suicide, from children gaining access to a parent's firearm - are preventable. Thoughts and prayers just won't cut it anymore. Policymakers at the state and federal level must act on common-sense, data-driven measures to prevent yet more carnage. We must also continue to speak out."

Dr. McAneny's full remarks, as prepared for delivery, are here.