2017-06-28 AMA Policy

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AMA House of Delegates Policy Update

Posted: June 28, 2017

At the American Medical Association’s Annual House of Delegate Meeting in Chicago last week, hundreds of physicians, medical students, residents, and fellows gathered to discuss and address a wide range of healthcare issues, including the opioid crisis, physician burnout, regulating physician assistants and advanced practice registered nurses, and of course, healthcare reform and drug pricing. Here are some of the highlights:

• The delegates spent a relatively significant amount of time debating whether certain specialty societies should be able to retain their representation in the House of Delegates given that they did not meet appropriate requirements as established under AMA HOD rules. The American College of Rheumatology spoke out regarding the importance of encouraging adherence to the rules and only allowing those specialty societies that have fulfilled the requirements to retain representation, as its organization has worked hard to do. This debate exemplified the critical need for rheumatologists to become members of the AMA so that the ACR can continue to retain its representation and ensure rheumatology continues to have a voice in the AMA.
• In pledging their continued commitment to improving access to care for US veterans, the delegates voted to will working with the Department of Veterans Affairs to provide quality of care to veterans and advocate new funding for the Veterans Choice Program.
• The AMA emphasized its continued commitment to the extensive prior authorization advocacy campaign based on the Prior Authorization and Utilization Management Reform Principles released earlier this year and will seek to complete ongoing research on prior authorization burdens to further support this work. There was some debate among delegates regarding whether physicians should be compensated for their time spent pursuing prior authorization. One speaker in favor of compensation particularly emphasized that prior authorization is not a patient care issue but rather a payer approval and reimbursement issue and as such, since physician time spent on prior authorization is for the benefit of health plans, physicians should be compensated for this time. Testimony against compensation largely pointed out that if the AMA supported physician compensation, it would be signaling to health plans that prior authorization is an acceptable practice, which could ultimately limit physicians’ ability to push back on future prior authorization expansion, and thus the AMA should continue to push back against prior authorization expansion through its current legislative and advocacy efforts. In the end, the AMA decided that supporting prior authorization compensation would run counter to its current prior authorization advocacy efforts. However, although the AMA decided not to promote prior authorization compensation or make it a prior authorization advocacy priority at this time, it did note that it is worth monitoring potential physician prior authorization reimbursement opportunities in the future.
• Perhaps one of the most important issues discussed at the AMA was maintenance of certification for physicians. To that end, delegates voted to recognize that lifelong learning for a physician is best achieved by ongoing participation in a high-quality CME program appropriate to that physician’s medical practice and to reaffirm its commitment to helping states implement legislation that would bar hospitals, health care insurers, and state medical boards from requiring participation in MOC processes as a condition of credentialing, privileging, insurance panel participation, licensure, or licensure renewal. The AMA will also continue to educate state medical associations about related activity around the country, as well as on the risks and benefits of legislating the use of MOC. Due to concern over the complexity of MOC and uncertainty regarding the potential impact on professional self-regulation, the AMA agreed to study the use of satisfactory demonstration of lifelong learning with high quality CME as specified by a physician’s specialty society for credentialing as opposed to the ABMS sponsored MOC process using lifelong interval high stakes testing for credentialing and report its findings at next year’s HOD meeting.

Many resolutions introduced this year had to do with the US drug market, and as such there was significant discussion regarding drug pricing and rising drug costs in the US. However, pharmacy benefit managers (PBMs) were almost completely absent in the debate, with the focus being on manufacturers and other players in the drug industry. While it is certainly disappointing that PBMs managed to once again escape much needed criticism, the CSRO is hopeful that through its participation in ATAP, PBMs will become a priority for the AMA over the next year.