Wrap Up: Ohio Delegation to the American Medical Association
Ohio Delegation to the American Medical Association Wrap Up Report
AMA Annual Meeting, June 2019 • Chicago, IL
Your OSMA Delegation to the AMA worked diligently on behalf of Ohio physicians during the recent 2019 AMA Annual Meeting. Ohio resolutions were carried forward and either adopted as new policy or committed the AMA to continue existing policy for another ten years. Below is a summary of the work done during the meeting.
Ohio was well represented by candidates for important AMA House of Delegates and Section Council leadership positions. Congratulations are due to Lisa Egbert upon her election as the AMA Vice-Speaker. Lisa’s commitment to the AMA and OSMA is unparalleled. While not successful in her bid for a seat on the AMA Board of Trustees, Robyn Chatman ran a vigorous and highly collegial campaign of which she and the OSMA should be extremely proud. Thank you, Robyn. Congratulations also to Deepak Kumar upon his election to the IMG Governing Council. Ohio will also be well represented by Dr. Kumar in his new role.
The Ohio Delegation is well respected at the AMA House of Delegates and represents the physicians of Ohio well. Feel free to reach out to me or any other member of the Delegation if you have any questions or comments.
Richard Ellison, MD
Chair, Ohio Delegation to the American Medical Association
Resolutions & Committees Summary
Reference Committee CC&B
The following resolutions were controversial or pertinent to Ohio.
CEJA 01 was referred back to CEJA since it was not felt that the issue of demented or mentally disabled physicians cannot be expected to be self-aware and should not considered unethical. More specific language was requested (again).
There was a huge amount of testimony on CEJA 02, Physician assisted suicide. After much discussion on this report, and a related resolution (#20) regarding this topic, the CEJA report was ultimately approved by the house of delegates and felt to be nuanced enough to allow for differing state laws on this issue.
Resolution 19, “Opposition to requirements for gender-based medical treatments for athletes” was recognized as a complicated, and important topic in Ohio. It was referred and a request made for a response by interim 2019.
Resolution 21 “health in all its dimensions, is a basic human right” received powerful testimony for adoption from former AMA presidents and was adopted by the House of Delegates.
Reference Committee A
Reference committee A was a very busy as well as rewarding. It was highlighted by Ohio having four resolutions that were presented. Recommended for adoption was "Investigate Medicare Part D-Insurance Company Upcharge." This resolution asks that the AMA investigate Medicare Part D rules that allow providers to keep up to 5% more in their actual cost of providing pharmacy prescription services and at the same time are eligible to get paid by CMS reinsurance rules for certain losses.
Two more resolutions were debated on the floor of the House of Delegates and were adopted with the assistance of expert testimony from Dr. Carl Wehri. They were: "Part A Medicare Payments to Physicians", which asks the AMA to help establish legislation to direct cash payments from Part A Medicare to physicians in direct proportion to demonstrated savings that are made in Part A Medicare through the efforts of physicians.
Next was "Practice Overhead Expense And The Site of Service Differential" which is asking for the AMA to appeal to the US Congress for legislation that directs CMS to eliminate any site of service differential payments to hospitals for the same services that can safely be performed in a doctor's office as well as other multiple outpatient settings, and that any savings to Part B Medicare be distributed to all physicians that participate in Part B Medicare in the form of improved payments for office-based E & M codes.
The fourth resolution from Ohio was "Congressional Healthcare Proposals" which was placed on reaffirmation.
Of interest to OSMA members and Ohio physicians was a very good comprehensive report from the Counsel on Medical Services "Covering the Uninsured under the AMA Proposal for Reform" and "Medicare for All." Two other resolutions; "Reimbursement for Telemedicine Visits" and "Insurance Prescription Drug Price Transparency from Retail Pharmacies." These 2 issues are among the top priorities for the OSMA and will be addressed in the Governors new budget proposal.
Reference Committee B
Reference Committee B (Legislation) again dealt with a variety of topics at the Annual Meeting of the AMA House of Delegates. The summary that follows will briefly address the highlights of these topics. For further details, please see the AMA website, where the final actions of the HOD for this committee (and others) will be available.
Given the current opioid crisis, several resolutions and Board of Trustees reports dealt with opioid related issues. One such report (BOT 23), dealt with the issue of prior authorization for post-operative opioids. It focused on advocating for the removal of barriers to post-operative pain control, including non-opioid options. Similarly, a separate resolution and BOT report was adopted that discussed the inappropriate use of CDC Guidelines for prescribing opioids, stressing the importance of individualized treatment while minimizing opioid prescribing. Other resolutions that were adopted advocated for improved coverage of medications and other treatment modalities (non-opioid) for treatment of pain in a variety of settings. Improved integration of prescription drug monitoring programs in the EHR for rapid access was the topic of another adopted resolution.
While several items dealt with issues surrounding prescribing opioids and other treatments for pain, other items dealt with privacy and confidentiality surrounding treatment of substance use disorders. BOT 30 discussed some of the issues surrounding opioid treatment programs reporting to prescription monitoring programs. There were also resolutions that were adopted suggesting alignment of HIPPA with 42 CFR Part 2. The debate focused on the balance between privacy of the patient and the ability for the prescriber to make appropriate treatment decisions.
Yet another timely topic that was addressed involved Augmented Intelligence. BOT 21 outlined the topic and expressed the AMA’s support of use and payment of AI as appropriate. Amendments stressed the importance of high-quality clinical evidence and that AI should enhance the patient-physician relationship and physician decision making, not replace it.
Other resolutions of interest that were adopted included topics such as extending Medicaid coverage to 12 months postpartum, GME cap flexibility, and support for funding for a COPD National Action Plan. Resolutions regarding direct-to-consumer genetic testing, medical marijuana license registry as part of prescription drug monitoring programs, and Appropriate Use Criteria in Medicare were all referred to the Board of Trustees.
One other issue of importance was a BOT report regarding “no cause” network terminations within Medicare Advantage. The initial recommendations dealt primarily with accurate provider directories, ensuring adequate access to providers, and other associated issues. The language was amended to more strongly address/oppose the issue of “no cause” network terminations within MA plans.
The items briefly discussed above are only a few of the issues addressed in Reference Committee B. Additional information can be found on the AMA website.
Reference Committee C
Council on Medical Education (CME) Report 2 - Update on Maintenance of Certification and Osteopathic Continuous Certification. The Council authored a comprehensive, very well received report on improvements being made to the previous, Maintenance of Certification (MOC), now Continuing Board Certification (CBC) process by 23 medical boards, primarily moving away from costly, high stakes exams – largely due to AMA advocacy efforts.
CME Report 4 - Augmented Intelligence in Medical Education was passed, asking the AMA to review and promote parity in access to resources incorporating Augmented Intelligence into medical education.
CME Report 6 – Study of Medical Student, Resident and Physician Suicide was referred back to council (in lieu of resolutions 307 and 310) in order to establish ongoing data collection, surveillance and recommendations regarding suicide in this population as well as to discuss the best way to ensure confidential, universally accessible mental health counseling resources for physicians and physicians in training.
Resolution 301 – American Board of Medical Specialties (ABMS) Advertising was referred for study, asking the AMA to oppose any effort by ABMS to use funds obtained from physicians for the self-promotion or advertising of their board and/or certification processes. There was robust support for the resolution, but concerns by both ABMS and our Council on Medical Education that this directive may be unenforceable by AMA
Resolution 302 - The Climate Change Lecture for US Medical Schools passed, asking the AMA to support education on the health impact of climate change during all levels of medical training
Resolution 311- Grandfathering Qualified Applicants Practicing in U.S. Institutions with Restricted Medical Licensure asking our AMA to help identify a reasonable pathway for competent physicians trained outside of the US to obtain full licensure to practice here, was referred for study.
Resolution 316 - Medical Student Debt passed, asking the AMA to study and provide recommendations regarding medical student debt and how to reduce the impact of debt on specialty choice.
Resolutions 318 - A Study to Evaulate Barriers to Medical Education for Trainees with Disabilities and 323, Improving Access to Care in Medically Underserved Areas through project ECHO and the Child Psychiatry Access Project Model asking the AMA to evaluate, promote and incentivize efforts to increase primary care and mental health services (especially to children) in rural areas, was passed with robust support.
Reference Committee D
The American Medical Association House of Delegates (HOD) recently met in Chicago and passed a number of important measures.
The HOD was supportive of Board of Trustees (BOT) reports in regards to the Development of Sustainable Solutions for Discharge of Chronically Homeless Patients, and sustained its Opposition to Measures that Criminalize Homelessness.
The Council on Science and Public Health (CSAPH) chaired by Ohio’s Robyn Chatman, M.D., produced two outstanding reports in regards to a Low Nicotine Product Standard and Vector-Borne Diseases. The AMA recognizes that combustible and non-combustible nicotine products should remain under the regulatory authority of the FDA, and AMA policy encourages the production of low nicotine products and urges the modification of these products to reduce addiction to nicotine or the use of any delivery device. CSAPH’s report on Vector-Borne Disease was supported by the AMA via a recommendation of improved surveillance of vector-borne diseases, and by the development and funding of comprehensive and coordinated vector-borne disease prevention and control programs.
A host of resolutions were additionally considered. The HOD passed policies to Reduce Gun Violence by improved use of smart technology to prevent the accidental discharge of a firearm, and passed policy to Reduce the Consumption of Processed Meats because of their inherent risk to patients with cardiovascular disease and diabetes, and supported programs for health care professionals outlining the risks of processed meats and the benefits of healthy alternatives for our patients. Non-Medical Exemptions from Immunizations was an important topic, as the AMA adopted strong policy advocating for legislation, regulations, programs, and policies that incentivizes states to eliminate non-medical exemptions from mandated pediatric immunizations. The AMA adopted extensive policy on the Dangers of Vaping Nicotine through the use of increased warning labels on packaging, and voted to advocate for the repeal of legislation that criminalizes the Non-Disclosure of HIV Status for people living with HIV, so that ongoing treatment is encouraged.
Reference Committee E
Reference Committee E (science and technology) at A-19 had resolutions that focused on several main themes.
First, physicians in Ohio have been adversely affected by requirements surrounding the compounding and administration of medications. There were two resolutions, resolutions 501 and 517, that addressed guidelines 800 and 797 by the US Pharmacopeia (USP). The USP and multiple physicians impacted by this issue provided testimony. As passed by the HOD, resolution 501 asks “that our AMA continue its compounding working group… to advocate for appropriate application of standards and to monitor policy impacting physicians.”
Resolution 517 asks “that our AMA work with medical specialty societies to preserve a physician’s ability to prepare medications in physicians’ offices, and to be able to do so without being subject to unreasonable and burdensome equipment…”
Secondly, the U.S. Surgeon General, Dr. Jerome Adams, spoke about the importance combating the opiate epidemic. There were several resolutions that addressed this important issue:
Resolution 524, called for the AMA to “support the widespread implementation of easily accessible Naloxone rescue stations (public availability of Naloxone through wall mounted display/storage units that also include instructions) throughout the country following distribution and legislative edicts similar to those for Automated External Defibrillators.”
Resolution 523 called for increased availability and use of low starting opioid doses such as hydrocodone 2.5 mg.
Resolution 532 called for the AMA to disseminate educational materials to dispel the myth of first responders overdosing after contact with fentanyl or other opiates.
Resolution 515 called for inclusion of information regarding the impact of gender on the perception of pain and risk of opiate use disorder. All of the above resolutions were adopted.
Third, our neighbors from Illinois proposed resolution 507, which asked that ethylene oxide, the chemical used to sanitize the majority of healthcare equipment that cannot be sterilized by autoclave, be substituted for less toxic alternatives. In reference committee, it was noted that ethylene oxide is a group 1 carcinogen, but legislation in California that limited its use led to unintended consequences including surgical supply shortage. The FDA is currently investigating this issue and the resolution was referred to the Board of Trustees for decision.
Reference Committee F
2018 annual report of the American Medical Association was presented. Membership in all categories is up a little over 5%;
Resolution 617 asked our American Medical Association to study and report back to the HOD on eliminating stigmatization and enhancing inclusion of physicians with disabilities. It further asked that AMA identify medical, professional and social rehabilitation, education, vocational training and rehabilitation, aid, counseling and placement services which will enable physicians with disabilities to develop their capabilities and skills to the maximum will hasten the processes of their social and professional integration or reintegration. Lastly he had asked that are AMA support physicians and physicians in training education programs about legal rights related to accommodation and freedom from discrimination are physicians, patients, and employees with disabilities.
Resolution 606 asked that are American Medical Association study the risks and benefits of collective bargaining for physicians and physicians in training in today’s healthcare environment;
Board of Trustees Report 10 and resolution 602 discussed how to deal with inappropriate conduct and AMA meetings and events.
Reference Committee G
Reference committee G is most frequently assigned resolutions and resorts dedicated towards the systems in which our practices operate. This year Ref Com G adopted several key measures that advocate for greater health of the physician and the physician practice. While specifics can be found at https://www.ama-assn.org/system/files/2019-06/a19-refcomm-g-annotated.pdf, a summary of key issues for Ohio follows:
- The AMA is taking a stand against non-payments and “take backs” and penalties based on EMR/voice recognition errors and extrapolation from inferior data sets.
- The AMA is advocating for wellness by adopting policies seeking to reverse physician demoralization and removing roadblocks to pointless pre-authorization barriers. This includes clear credentialing processes for demonstrating competency during physician workforce re-entry.
- Further, the AMA adopted policy to better understand the impact of hospital consolidation and private equity impact on health systems, physician wellness, and patient care.
Lisa Egbert, MD (Dayton) –Elected the Vice Speaker of the AMA House of Delegates.
Alisha Reiss, MD (Greenfield) – Elected to the Young Physician Section Governing Board
Robyn Chatman, MD (Cincinnati) – Dr. Chatman ran a very positive, strong campaign but was not elected to the AMA Board of Trustees.
OSMA CEO & Staff Notes from the meeting
From attendance at several different sessions at the AMA including a round table with other state medical society CEOs, a forum with state CEOs, national CEOs and AMA staff, a litigation center briefing, an update from the AMA’s Advocacy Resource Center and the scope of practice meeting…
- Lengthy discussions on out-of-network billing (state and federal activity)
- Price transparency
- Several different scope of practice challenges
While we work closely with state specialty societies today, we will look at work done in Mississippi and other states to put together a formal scope of practice coalition in Ohio.