The Interim Meeting of the American Medical Association (AMA) House of Delegates (HOD) took place November 10–13, 2018, in National Harbor, MD. The agenda included 30 reports from the AMA Board of Trustees and various AMA councils, as well as 106 resolutions submitted by state medical societies, specialty societies, and AMA sections. Approximately 600 delegates representing state medical societies, national specialty societies, and national medical societies gathered to discuss a variety of policies and issues that affect patients and physicians.
The American College of Surgeons (ACS) sent a five-person delegation to the meeting. The ACS delegates also participate in AMA activities in other capacities, including in the AMA Council on Medical Education, the AMA Young Physicians Section, and the AMA Resident and Fellow Section. These three groups met in conjunction with the HOD meeting, which provided further opportunity to influence the adoption of health care policy. See the sidebar on page 66 for the list of ACS delegates and their other AMA roles.
Issue highlights
During the interim meeting, delegates discuss and adopt policies covering a variety of issues focused on legislation; medical education; governance and finance; medical services, practice, and insurance; and science and public health. Those issues of particular interest at this meeting are as follows.
Competence, self-assessment, and self-awareness
The Council on Ethical and Judicial Affairs (CEJA) regularly presents reports centered on professional ethics. Once a report is adopted, it is then presented at the next meeting of the HOD as an ethical opinion; if adopted at that time, the new item is added to the Code of Medical Ethics.
At the interim meeting, the CEJA brought forth a revised report examining the physician’s ethical responsibility to commit to competence, as well as a broader notion of competence that deals with a physician’s wisdom and judgment about his or her own ability to provide safe, high-quality care “in the moment.” The HOD commended the CEJA for its work on this complicated issue, but referred the report back to the CEJA for further discussion.
Aid in dying as end-of-life option
The CEJA has, for the last few years, been studying the differences between “physician-assisted suicide” and “aid in dying” to clearly distinguish between the two to correctly use the terms in AMA policy and position statements. As part of its report to the HOD, the CEJA determined that the terms aid in dying and physician-assisted suicide reflect different ethical perspectives. The CEJA also concluded that there are irreducible differences in moral perspectives regarding the issue of physician-assisted suicide, such that both sides share common commitment to “compassion and respect for human dignity and rights” but draw different moral conclusions from these shared commitments. The CEJA determined that the current Code of Medical Ethics offers sufficient guidance to support physicians and the patients they serve in making well-considered, mutually respectful decisions about legally available options for care at the end of life while respecting the intimacy of a patient-physician relationship.
The report generated extensive mixed testimony, and the HOD recommended that the report be referred back to the CEJA for further discussion.
Scope of practice
The ACS strongly supported a resolution that the American Academy of Ophthalmology brought forth calling on the AMA to support legislation prohibiting optometrists from performing surgical procedures as defined by existing AMA policies and to encourage state medical associations to support state legislation and rulemaking prohibiting optometrists from performing surgical procedures as defined by existing AMA policy. The HOD adopted this resolution, which received overwhelming support.
Firearm violence prevention
Expanding on existing AMA policy related to firearms, a Board of Trustees report and two resolutions resulted in the adoption of a revised policy to support requiring the licensing and permitting of firearms owners and purchasers. Also adopted was policy supporting “gun violence restraining orders” for individuals arrested or convicted of domestic violence or stalking, as well as extreme risk protection orders (red flag laws) for individuals who have demonstrated significant signs of potential violence. In relation to these restraining orders, the AMA also supports the importance of due process so that individuals can petition for their rights to be restored.
Furthermore, the HOD adopted language to enhance existing policy on banning the manufacture, importation, and sale of any firearm that ordinary airport screening devices cannot detect to include three-dimensional (3-D) printed firearms and production and distribution of 3-D firearm digital blueprints.
Maintenance of Certification (MOC)
The Florida delegation brought forth a resolution calling on the AMA to do the following:
- Conduct a study of the certifying bodies that compete with the American Board of Medical Specialties and issue a report on the qualifications of each such certifying body and whether each entity should be added to the list of approved certifying bodies in states where they are yet to be approved
- Develop model state legislation that would encourage competition among qualified certifying bodies and would modify board certification requirements so that MOC participation would not be required for board certification
The Council on Medical Education testified that it regularly reports to the HOD on MOC and studied other certifying bodies in 2016 and 2017. It was recommended and the HOD agreed that, in lieu of the resolution, the Council continue to study these certifying bodies and include their findings in its annual report at the June 2019 meeting.
Out of network/surprise billing
In light of congressional efforts to develop federal legislation to address out-of-network/surprise billing problems, a resolution was introduced with two directives to the AMA to advocate for the following:
- Any federal legislation on unexpected out-of-network medical bills should be consistent with AMA policy and apply to ERISA (Employee Retirement Income Security Act) plans not subject to state regulation
- Federal legislation that would protect state laws that do not limit surprise out-of-network medical bills to a percentage of Medicare or health insurance fee schedules
Although specialty society and state medical society delegates were supportive of appropriate AMA advocacy on this issue, the Reference Committee noted that existing AMA policy already addressed the concerns expressed in the resolution. The HOD agreed and reaffirmed AMA Policy H-285.904 in lieu of the resolution.
Administrative burden
The HOD unanimously adopted a resolution with the intention of helping to reduce physician administrative burden. The resolution creates the policy that the AMA agrees that documentation for outpatient physician services should be completed in a timely manner and that it will work with government health plans and private insurers to help them better understand the unintended consequences of imposing documentation rules with unrealistically short time frames. The resolution also calls for the AMA to oppose the use of such rules or regulations in determining whether submitted claims are valid and payable.
Insurance coverage for screening in dense breast
Over the last two years, state legislatures have been dealing with insurance coverage issues for additional screening when dense breast tissue is found on initial mammogram. Although the AMA has some policy on this issue, a resolution was introduced directing the AMA to support insurance coverage for supplemental screening recommended for patients with dense breast tissue following a conversation between the patient and the physician. The resolution also calls for the AMA to advocate for insurance coverage for, and adequate access to, supplemental screening recommended for patients with dense breast tissue following a conversation between the patient and the physician. After thoughtful debate, the HOD adopted an amended resolution reaffirming existing AMA policy and adding the following two policies:
- The AMA will encourage research on the benefit and harm of adjunctive screening for breast cancer for women identified to have dense breasts on an otherwise negative screening mammogram in order to guide appropriate and evidence-based insurance care and coverage of the service.
- The AMA supports insurance coverage for and adequate access to supplemental screening recommended for patients with dense breast tissue following a discussion between the patient and the physician, which integrates secondary risk characteristics.
Surgical Caucus
Managed by the College for many years, the Surgical Caucus gives surgeon delegates and alternates the opportunity to meet to discuss HOD business from a surgical perspective. At every meeting of the HOD, the caucus sponsors an educational session. Because the Interim Meeting fell just after the midterm elections, the well-attended session focused on the election results, what they mean for Congress, and their potential impact on the legislative agendas of the AMA and the ACS.
At the June 2019 meeting, the caucus will celebrate its 30th anniversary with a special event planned for all caucus participants. Over the years, the caucus has played a more prominent role in the HOD’s policymaking.
The 2019 Annual Meeting of the AMA HOD will take place June 8–12 in Chicago, IL. Elections for AMA councils, Board of Trustees, and officers will be held, and the College’s delegation will be well-prepared to represent ACS priorities.
Fellows with questions about the AMA HOD or suggestions for resolutions should contact jsutton@facs.org.
