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Delegate’s Report – AMA Interim Meeting 2022

Delegate’s Report- AMA Interim Meeting 2022
By David Bensema, MD

The American Medical Association (AMA) held its Interim Meeting 2022 from November 12 to 15, 2022.  I was again privileged to represent the Lexington Medical Society and the Kentucky Medical Association as your Delegate to the AMA.  I want to thank you again and assure you that I take this privilege of representing you very seriously.  This was the first time in six meetings that I have not been serving on and/or chairing a reference committee, providing me an opportunity to pay more attention to the meeting as a whole.

On Friday, November 11 I was able to attend the newly organized Private Practice Physicians Section’s (PPPS) and the Organized Medical Staff Section’s (OMSS) business sessions and educational offerings.  The joint session, “Protecting Our Healers,” was worth the trip.  Michael Tutty, AMA group vice president, Professional Satisfaction and Practice Sustainability, moderated an excellent presentation and discussion regarding the increasingly hostile and stressful environment of practice in this divisive time of rising disinformation and distrust in scientifically informed care.  It is obvious that our profession and colleagues have paid a significant price for the irresponsible actions of a number of parties outside of medicine.  I would encourage all of you to join the PPPS and/or the OMSS and consider joining us at the AMA Annual Meeting in Chicago in June 2023.  You do not have to be a Delegate or Alternate Delegate to attend the meeting.  There are multiple other focused Sections in the AMA and I would recommend checking the AMA website (ama-assn.org) to see if there is one that appeals to you.  The PPPS, though new this meeting, is already very active, offering four resolutions of their own and supporting four additional resolutions from other groups.  The OMSS continues to be a strong voice for physicians in our hospital practice settings and offered three resolutions, opposing one from another source, and supporting six from other groups.  This activity is essential to ensure that the voice of practicing physicians and the challenges faced to ensure access to care for our patients and adequate reimbursement and protection of decision making autonomy is not lost amid the myriad social and environmental issues that, while important, have a risk of dominating the focus of our AMA. 

We need your voice and your presence at the AMA.  So, if you are not a member, please join.  If you are a member, please consider attending and adding your voice, both in the business sessions of the Sections or by drafting resolutions addressing issues relevant to your practice.

Below I am going to summarize some of the policies created, updated, or reaffirmed at this Interim Meeting, noting that the focus of the Interim Meeting is advocacy and governance, with the Annual Meeting providing a forum for all other issues germane to our profession.

Patients deserve greater clarity on who is a physician—and who isn’t. Physicians should make new strides to clarify their roles and credentials vis-a-vis other members of the health care team and also promote collaboration among all health professionals.

AMA holds fast to principle: Reproductive care is health care. The AMA House of Delegates adopted policies opposing the criminalization of pregnancy loss resulting from medically necessary care (this aligns with our KMA policy adopted in August 2022), supporting expanded access to abortion care and reproductive care.

Address private equity’s growing impact on residency training. In an effort to address the potential pitfalls of private equity ownership of GME institutions, delegates adopted new policy to: Affirm that an institution or medical education training program academic mission should not be compromised by a clinical training site’s fiduciary responsibilities to an external corporate or for-profit entity, and support publicly funded independent research on the impact that private equity has on graduate medical education.

Expand pathway programs to help bright young students.

Diversifying the medical profession is critical to improving care for all Americans. Pathway programs have proven valuable in providing comprehensive educational support and enrichment that levels the opportunities for participants to earn admission to medical school. Delegates adopted new policy to: Urge medical schools to develop or expand the reach of existing pathway programs for underrepresented middle school, high school and college aged students to motivate them to pursue and prepare them for a career in medicine, and encourage collegiate programs to establish criteria by which completion of such programs will secure an interview for admission to the sponsoring medical school.  Further it recommends that medical school pathway programs for underrepresented students be free-of-charge or provide financial support with need-based scholarships and grants, encourages all physicians to actively participate in programs and mentorship opportunities that help expose underrepresented students to potential careers in medicine. Finally it call for considering quality of K–12 education a social determinant of health, and thus advocate for implementation of Policy H350.979 encouraging state and local governments to make quality elementary and secondary education available to all.

Doctors eye illegal sources, better data to address firearm deaths. Adopted new policy to support research examining the major sources of illegally possessed firearms, as well as possible methods of decreasing their proliferation in the United States,work with key stakeholders to develop evidence-informed public health recommendations to mitigate the effects of violence committed with firearms, and collaborate with key stakeholders and advocate for national public forums that bring together key stakeholders and members of the general public to focus on finding common ground, nonpartisan measures to mitigate the effects of firearms in our firearm injury public health crisis.

Change resident-selection process to boost equity. Delegates adopted new policy to:encourage medical schools, medical honor societies, and residency and fellowship programs to work toward ethical, equitable and transparent recruiting processes, which are made available to all applicants. Also to advocate and support innovation in the undergraduate medical education to graduate medical education transition, to include pilot efforts to optimize the residency-and-fellowship application and matching process and encourage the study of the impact of using filters in the Electronic Residency Application Service by program directors on the diversity of entrants into residency. Additionally to encourage caution among medical schools and residency/fellowship programs when using novel online assessments for sampling personal characteristics for the purpose of admissions or selection and monitor use and validity of these tools.        

AMA backs stronger leave policies for medical students, doctors. The House of Delegates modified existing policy to encourage implementation of parental, family and medical necessity leave for medical students and physicians. The updated policies call on the AMA to: study the impact on and feasibility of medical schools, residency programs, specialty boards and medical group practices incorporating into their parental leave policies a 12-week minimum leave allowance. Recommend that medical practices, departments and training programs strive to provide 12 weeks of paid parental, family and medical necessity leave in a 12-month period for their attending and trainee physicians as needed.

No matter the patient’s skin color, pulse oximetry should work. Delegates directed the AMA to make recommendations to the FDA that will ensure health care personnel and the public are educated on the limitations of pulse-oximeter technology so they can account for measurement error.

Don’t put kids behind bars, says the AMA. Delegates adopted policy to establish minimal age of 14 years for juvenile justice jurisdiction in the United States. That aligns with the United Nations’ recommendation to boost the minimum juvenile jurisdiction age from 12 to 14.

Study pros and cons of virtual residency interviews. Delegates adopted new policy calling on the AMA to: work with relevant stakeholders to study the advantages and disadvantages of an online medical school interview option for future medical school applicants, including but not limited to financial implications and potential solutions, long-term success, and well-being of students and residents.  Also to encourage appropriate stakeholders to study the feasibility and utility of videoconferencing for GME interviews, and examine interviewee and program perspectives on incorporating videoconferencing as an adjunct to GME interviews to guide the development of equitable protocols for expansion of hybrid GME interviews.

What is physicians’ duty to treat during pandemics? The notion that physicians have a professional duty to treat during infectious disease outbreaks has waxed and waned historically, and became very real and immediate during the COVID-19 pandemic.The AMA Code of Medical Ethics clarifies that this obligation isn’t absolute, however, noting that “physicians also have an obligation to evaluate the risks of providing care to individual patients versus the need to be available to provide care in the future.”

Don’t ask Native American future doctors about blood quantum. Delegates directed the AMA to work with the Accreditation Council for Graduate Medical Education, the National Residency Matching Program, the Association of American Medical Colleges and other interested parties to eliminate questioning about or discrimination based on American Indian and Alaska Native blood quantum during the medical school, residency and fellowship application process.

U.S. health sector should decarbonize. Delegates added to policy a goal to reduce greenhouse gas emissions aimed at a 50% reduction in emissions by 2030, adding to existing policy calling for carbon neutrality by 2050. Physicians oppose mandatory gender-based treatments for athletes. Adopted new policy to oppose: mandatory testing, medical treatment or surgery for transgender athletes and athletes with DSD and affirm that these athletes be permitted to compete in alignment with their identity. Also opposes the use of specific hormonal guidelines to determine gender classification for athletic competitions or satisfying third-party requirements to certify or confirm an athlete’s gender through physician participation.

Harm-reduction efforts needed to curb overdose epidemic. Modified existing AMA policy to: encourage state and county medical societies to advocate for harm-reduction policies that provide civil and criminal immunity for the possession, distribution and use of “drug paraphernalia” designed for harm reduction from drug use, including but not limited to drug-contamination testing and injection-drug preparation, use and disposal supplies. Further, to support efforts to increase access to fentanyl test strips and other drug-checking supplies for the purpose of harm reduction. (This aligns with a resolution submitted by our own Resident member, Alex Thebert, MD.)

The hour has come to sunset daylight saving time. Moved to support ending daylight saving time (DST) and shift permanently to standard time.

Subject third-party Rx benefit administrators to PBM rules. Adopted policy recommending that third-party pharmacy benefit administrators that contract to manage the specialty pharmacy portion of drug formularies be included in existing PBM regulatory frameworks and statutes and be subject to the same licensing, registration and transparency reporting requirements. The AMA also will advocate that third-party pharmacy benefit administrators be included in future PBM oversight efforts at the state and federal levels.  

Make it easy to compare Medicare Advantage plans on the web. The AMA will advocate: better enforcement of Medicare Advantage regulations to hold the Centers for Medicare & Medicaid Services (CMS) accountable for presenting transparency of minimum standards and to determine whether those standards are being met for physicians and their patients. Also that Medicare Advantage plans be required to post all components of Medicare covered and not covered in all plans across the U.S. on their website, along with the additional benefits provided. And that CMS maintain a publicly available database of physicians in network under Medicare Advantage and the status of each of these physicians in regard to accepting new patients in a manner least burdensome to physicians.

Require mental health parity in Medicare. Amended existing policy to support: parity of coverage for mental health and substance-use disorders, and federal legislation, standards, policies, and funding that enforce and expand the parity and non-discrimination protections of the Paul Wellstone and Peter Domenici Mental Health Parity and Addiction Equity Act of 2008 to Medicare parts A, B, C and D. Also, requiring Medicare parts A, B, C and D to cover all levels of mental health and substance-use disorder care, consistent with nationally recognized medical professional organization level-of-care criteria for mental health or SUDs. Additionally, to require all health insurance plans to implement a compliance program to demonstrate compliance with state and federal mental health parity laws.

Work to close insurance coverage gaps for preventive care. Delegates took steps to address three such gaps at the Interim Meeting to help protect and expand coverage for vaccines under Medicare, PrEP for HIV, and treatments for adult and pediatric obesity.

Preventing deadly gun violence will be focus of AMA task force. The House of Delegates took action to explore new avenues to address this public health crisis, including a task force focus on gun-violence prevention and violence-interruption programs.

In closing, let me again encourage you to become active in both the KMA and the AMA.  Together our voice is stronger.  I know that making policy is tedious at times and the effects of our efforts are incremental, often delayed, and rarely revolutionary, but it does lead to change and it is our opportunity to advocate for our profession and our patients.  Thank you again for the honor of representing you.

Respectfully,

David J. Bensema, MD, MBA

Delegate to the American Medical Association

For further information, please use the links below.

The AMA is your powerful ally in patient care as an influential voice at the state and federal level that informs, guides and generates support for policies that advance meaningful health care initiatives. Learn from a new section on the AMA’s website—Advocacy in Action—about what’s at stake and what the AMA is doing to address the concerns most relevant to patients and physicians.

The AMA is actively working for America’s physicians on a broad range of issues. Learn about the full breadth of the AMA’s advocacy efforts, and explore further the AMA Recovery Plan for America’s Physicians.