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10/26/2023

Report from OSMA Delegation to the AMA

 

OSMA is the leading voice of Ohio physicians, residents, and medical students, yet advocacy for Ohio physicians and patients cannot occur on a state level alone. A strong representation on the national stage is crucial to promote and protect the mission and values of the OSMA.

Your OSMA Delegation to the American Medical Association (AMA) had the privilege of representing our association at the 2023 Annual Meeting of the AMA House of Delegates (HOD), from June 9 to 14 at the Hyatt Regency, Chicago, Illinois. The AMA Annual Meeting is a crucial avenue for national representation, traditionally held in Chicago each June. The AMA Interim Meeting, on the other hand, rotates locations every November. The AMA Interim 2023 is slated for National Harbor, Maryland, and Orlando, Florida in 2024.

The business of the Annual Meeting is robust and diverse in both range and topic, and the below reference committees were assigned resolutions relevant to the indicated topic. There were several hundred items of business (reports and resolutions) considered at this meeting, and each reference committee operates simultaneously. Your OSMA Delegation, in conjunction with the Great Lakes States Coalition, coordinated effectively to ensure Ohio's representation across all committees.

AMA Annual Meeting Reference Committees

CCB

Amendments of Constitution and Bylaws

A

Medical Service

B

Legislative Advocacy

C

Advocacy on Medical Education

D

Public Health

E

Science and Technology

F

AMA Governance and Finance

G

Medical Practice

 

Enclosed is the OSMA Delegation AMA Annual 2023 Report, summarizing the notable actions and resolutions from each reference committee. The focus is on OSMA policy and advocacy agenda items alongside other significant highlights.

We, the members of the Ohio Delegation to the AMA, devote our time voluntarily to uphold OSMA's representation at a national level. It's a privilege to advocate for Ohio physicians, our profession, and our patients. Your support is invaluable, and we welcome any inquiries you may have.

Warm regards,

Your elected OSMA Delegation to the AMA

OSMA AMA Delegates

OSMA AMA Alternate Delegates

Anthony Armstrong, MD

Gary Katz, MD

John Bastullli, MD

Chris Wee, MD

Tyler Campbell, MD

Deepak Kumar, MD

Christopher Brown, MD

 

Robyn Chatman, MD

Andrew Rudawsky, MD

Eric Drobny, MD

 

Brett Coldiron, MD

William Sternfeld, MD

Tani Malhotra, MD

 

John Corker, MD

Colette Willins, MD

Elizabeth Muennich, MD

 

Louito Edje, MD

Jennifer Wayland

Chris Paprzycki, MD

 

Richard Ellison, MD

 

Shannon Trotter, DO

 

 

Highlights by Reference Committee

The following sections contain highlights drafted from preliminary reports provided by the lead delegates of each Reference Committee. The text has been paraphrased for style consistency, though some portions remain verbatim. Please note that only the most important issues to Ohio were summarized below for brevity, but this by no means a comprehensive summary of the proceedings and activities of your delegation.

Amendments to Constitution and Bylaws - Brett Coldiron, MD

Reference Committee A - Tyler Campbell, MD

Reference Committee B - Deepak Kumar, MD

Reference Committee C - Lou Edje, MD

Reference Committee D - Tani Malhotra, MD

Reference Committee E - Andrew Rudawsky, MD

Reference Committee F - Anthony Armstrong, MD

Reference Committee G - Gary Katz, MD

 

 

Reference Committee on
Amendments to Constitution and Bylaws

Utilization Review, Medical Necessity Determination, Prior Authorization Decisions

CEJA Report 1 was generated from AMA Policy Policy D-320.977, “Utilization Review, Medical Necessity Determination” in June 2022, which requested that the Council on Ethical and Judicial Affairs review current ethical opinions regarding medical necessity determination and utilization review. This report referenced several opinions in the AMA Code of Medical Ethics that discuss a physician’s obligations when determining whether an intervention is medically necessary on behalf of health care organizations or third-party payers:

The report also recommended that:

“Our AMA will advocate: (a) for implementation of a federal version of a prior authorization “gold card” law, which aims to curb onerous prior authorization practices by many state regulated health insurers and health maintenance organizations; and (b) that health plans should offer physicians at least one physician-driven, clinically-based alternative to prior authorization, including a “gold-card” or “preferred provider program.”

The AMA Committee on Legislation has a task force working on this issue as a high priority item. This is consistent with OSMA policies 21-2021, 23-2023, 25-2023 and is a win for the patients and physicians of Ohio.

Supporting Efforts to Strengthen Medical Staffs Through Collective Actions and/or Unionization

This resolution asked our AMA to reevaluate the various efforts to achieve collective bargaining and/or unionization for physicians nationally, and to revise the AMA Code of Medical Ethics section 1.2.10 to allow for more flexibility on the part of physicians who have exhausted other non-disruptive methods for reform. The OSMA has a long history of supporting a strong, self-governed medical staff in policies dating back to 1978.

Reference Committee A - Medical Service

Bundled Payments and Medically Necessary Care

Council on Medical Service Report 4 was unanimously supported during testimony because it addressed safeguarding medically necessary care under bundled payment models.  For background, a prior Ohio resolution (at an earlier meeting) led eventually to this report.

Reporting Multiple Services Performed During a Single Encounter

Council on Medical Service Report 7 addressed coding for multiple services in a single encounter.  By adopting this report, new AMA policy will support mechanisms to report modifiers appropriately with the least administrative burden, including the development of EHR tools, to facilitate the reporting of multiple medically necessary services by modifier 25.  The AMA will also support comprehensive education for physicians and insurers on how to appropriately use modifier 25.

Understanding Physician Job Description for Disability Insurance

Based on a Young Physician Section resolution, the AMA adopted amended language that calls for the AMA to support efforts to develop specialty-specific job descriptions that reflect the true physical and cognitive demands of each given specialty.  The goal is to ensure physician disability policies are robust and protective if a coverage trigger occurs.  The AMA will also support removing barriers to obtaining and claiming disability insurance for physicians on visas.

Movement Away from Employer-Sponsored Health Insurance

The Medical Student Section introduced a resolution to have the AMA recognize that employer-sponsored health insurance is inefficient and alternative models are needed.  As expected, testimony is mixed, so it was referred to the Council on Medical Service given the inherent complexity of this issue and potential far-reaching consequences; this appears consistent with Ohio policy

Removal of Barriers to Care for Lung Cancer Screening in Medicaid Programs

Essentially, the AMA will work with national medical specialty societies and state medical associations to work with CMS and state Medicaid programs to increase access to low-dose CT screening.

Medicare Coverage of OTC Nicotine Replacement Therapy

The AMA will now advocate for OTC nicotine replacement therapies that have been FDA approved/cleared, excluding e-cigarette product device types and vaping products, to be carved out from the non-coverage by Medicare of OTC products and be specifically covered when prescribed by physicians who care for patients with Medicare, Medicare PArt D, or Medicare Part C.


Reference Committee B - Legislation

Reformation of the Medicare Physician Payment System

Resolutions 214, 234, 238, 250, and 257 combined to express strong support for urgent Medicare payment reform, as well as a mandate for the AMA to conduct a national media and lobbying campaign to reform Medicare payment. These new policies likely makes this issue an urgent AMA advocacy and legislative priority over the next year, with an annual report back to the AMA HOD by the board at each meeting.. The outgoing President Jack Resnick, MD introduced the new AMA website https://fixmedicarenow.org.

Drug Policy Reform

Resolution 203 calls for advocacy to reclassify drug offenses as civil infractions, as well as to reduce sentences for those currently incarcerated, monitored, or otherwise penalized for drug-related felonies. The OSMA has policy against the legalization of illicit drugs, and your OSMA delegation actively opposed this resolution. This was ultimately referred by the HOD.

Opposition to Pharmacists Testing, Diagnosing, and Treating Medical Conditions

Resolution 201 initially asked our AMA to oppose any legislation or regulation that would allow pharmacists to treat UTI’s. This was ultimately broadened by the HOD to include any and all medical conditions. OSMA has current policy addressing the increasing scope of pharmacists in the practice of medicine, and your delegation actively supported this resolution. The HOD adopted this resolution as amended.

Insurance Coverage of Ground Ambulance Services

Resolution 207 asks our AMA to support full insurance coverage for all costs associated with ground ambulance services in opposition to surprise billing practices. This is in line with active OSMA policy, and your delegation provided testimony and amendments to the HOD, which were ultimately adopted.

Physician-Owned Hospitals

Resolution 219, 222, and 261 called for advocacy for policies to support physician ownership of hospitals and remove restrictions on physicians owning hospitals, as well as research the impact of this repeal on access, cost, and quality of patient care within physician owned hospitals. These combined policies were adopted as amended.

Prohibiting Covenants Not-To-Compete in Physician Contracts

Resolution 237 and 263 call on AMA to support policies, regulations, and legislation to prohibit restrictive covenants and oppose the ongoing use of restrictive covenants in physician contracts. This resolution also calls for a study with report back on current contract trends with further recommendations for physician protections and patient access to care. The OSMA has policy opposing the use of restrictive covenants, and your delegation was in active support. This resolution was ultimately adopted.

Reference Committee C - Medical Education

Legacy Status in Medical School Admissions

The authors of the original resolution raised concerns regarding the use of legacy status in medical school admissions and how inquiring about an applicant’s legacy status may help them benefit from what was historically a discriminatory process.  The Council on Medical Education asked for a nuanced view, since an applicant could volunteer this information even if a school does not specifically inquire about legacy status on an application. Ultimately, language adopted called for the AMA to recognize that legacy status may be a stated reason for an applicant’s interest in a particular school, but oppose the use of questions explicitly inquiring about legacy status in the application.

Discriminatory Practices in Residency Application Process

Two separate resolutions were introduced with similar intent - to address the use of filters in the Electronic Residence Application Service (ERAS) system.  Specifically, concerns were raised regarding the use of filters to exclude consideration of international medical graduates.

Testimony was heard noting that some programs may need to use filters to consider factors such as visa status.  Ultimately, the AMA adopted amended language opposing discriminatory use of filter designed to inequitably screen applicants, including IMGs.

Unmatched Medical Students

A wide-ranging resolution asked the AMA to convene a task force of appropriate councils, medical education organizations, licensing and credentialing boards, government bodies, and impacted communities to study root causes of unmatched medical graduate statuses and develop best practices for schools and organizations to support these graduates.  There were a number of specific asks, but the Council on Medical Education felt that this was already addressed by the Coalition for Physician Accountability (of which the AMA is a member) report from its UME to GME review committee.  Some testimony argued this report did not reflect the intent of the resolution.  Given the complexity of the issue, the HOD referred this resolution to the Board for decision.

Reference Committee D - Public Health

AMA Public Health Strategy

This Board of Trustees Report 17 was adopted in lieu of a resolution that specifically asked the AMA to distribute evidence-based information on climate change and codify AMA policies toward environmental justice and a net-zero carbon society.  The BOT report was more broad, addressing public health in general, and calls on the Board to provide updates on AMA initiatives at I-23 regarding mental health, pre-COVID insurance coverage, climate change, and firearm violence.  The report also asked for the AMA to continue to support funding for public health infrastructure, including preventative medicine-related GME programs.

Encouraging Discussion of Family Planning Counseling as part of Recommended Routine Health Maintenance

Originating from a YPS resolution, the AMA will work with interested parties to encourage discussion of family planning counseling with patients of reproductive potential.  There were some concerns regarding if this is an unfunded mandate, but testimony was generally supportive of the idea to reduce stigma associated with infertility and assessment of patient priorities.

Additional Interventions to Prevent Human Papillomavirus (HPV) Infection and HPV-Associated Cancers

Some minor amendments were made to existing AMA policy regarding HPV infections and cervical cancer screenings to include awareness, vaccination, payor coverage more broadly for all HPV-associated cancers.

Accurate Abortion Reporting with Demographic by the Center for Disease Control

This resolution asked for the AMA to call on the CDC to develop mandatory reporting regarding abortion statistics, including but not limited to, age and race of woman, facility, gestational age, abortion procedure/medication, reason for abortion, and miles traveled to get the abortion.  Testimony was overwhelmingly in opposition given the unnecessary burdens in places on physicians, privacy, and potential harm to the patient-physician relationship.  Therefore, this resolution was not adopted.


Reference Committee E - Science and Technology

Oppose Scheduling of Gabapentin

In February 2022, the U.S. Food and Drug Administration (FDA) received a petition from a consumer advocacy group requesting that gabapentin be designated as schedule V. An AMA policy was passed in June, 2022 opposing scheduling of gabapentin. The Council on Science and Public Health authored a report, which examined the regulatory landscape of gabapentin, investigated off-label use, and concluded that there would be significant negative consequences of scheduling gabapentin.

Opioid Crisis

The opioid crisis remains a pressing issue for the OSMA, and the AMA continues to address the opioid crisis in a multifaceted approach. There were several resolutions in this reference committee that addressed this topic:

  • Development and Implementation of Recommendations for Responsible Media Coverage of Opioid Overdoses - The media often uses outdated and medically inaccurate language in reporting on opiate overdoses, and our AMA has an opportunity to drive public conversation towards evidenced based solutions. OSMA AMA delegate Chris Paprzycki proffered the amendment language adopted by the AMA.
  • Decriminalizing and Destigmatizing Perinatal Substance Use Treatment
  • Improving Access to Opioid Antagonists for Vulnerable and Underserved Populations

The policies adopted are in line with current OSMA policy, and are a step forward in addressing this national crisis.


Reference Committee F - Governance and Finance

Surveillance Management System for Organized Medicine Policies and Reports

AMA will maintain the current existing resolution management structure within the House of Delegates. Will also invest in critical IT and other appropriate infrastructure that allows for the tracking of past resolutions, existing policy, and supporting materials.

AMA Reimbursement of Necessary HOD Business Meeting Expenses for Delegates and Alternate Delegates

Proponents favoring adoptions of this resolution, which would have the AMA develop a reimbursement policy consistent with established AMA travel policies for reasonable travel expenses for state or specialty societies, noted that delegations have difficulty funding representatives due to continued membership declines.  Given the complexity of the issue, including the fiscal note of $8.1 million and fiscal obligations elsewhere, this was referred to the Board of Trustees for report back at Annual 2024.

Encouraging Collaboration Between Physicians and Industry in AI Development

The initial resolution called for augmenting the AMA’s Physician Innovation Network (PIN) to link physicians and specialty societies to companies/individuals working on AI.  Given that this is extremely complex, this was referred for study.


Solicitation Using the AMA Brand

This resolution was driven by the plethora of third-party advertisements/solicitations (e.g. AMA Insurance, Laurel Road, etc.) potentially negatively impacting the AMA’s reputation. The Board spoke in opposition to this resolution, given concerns that this will negatively impact revenue, a study would cost $200k, and technically all members can opt-out (though proponents of the resolution say this is challenging). This was referred to the Board for decision.

Reference Committee G - Medical Practice

Advocacy of Private Practice Options for Healthcare Operations in Large Corporations

Board of Trustees Report 14 arose from a resolution at A-22, which addressed Fortune 500 companies like Amazon and Walmart entering the healthcare industry, both internally for their own employees, and externally. The report provides an interesting market landscape assessment of the horizontal and vertical integrations that have taken place over the last several years. The AMA reaffirms several policies related to the preservation of the private practice of medicine and is actively working with corporations to create pilot programs for private practices to successfully participate in new “value-based” models without being acquired or owned by corporate entities.

Doctors’ Risk for Termination of Liability Coverage or Medical Privileges Consequent to Dobbs

This resolution recognized that in wake of the Dobbs decision, providers could be charged with a crime for complying with EMTALA or providing life-saving care. As a consequence, doctors charged were being dropped from their liability policies or having their medical privileges revoked. Ultimately, the HOD strengthened AMA policy to protect physician rights. This is consistent with OSMA policies 18-2012 and 15-2023.

These summarized discussions from each reference committee underscore the broad range of advocacy and policy deliberations the OSMA Delegation engaged in during the AMA Annual Meeting 2023, reinforcing the critical importance and impact of our delegation's participation on a national stage.

 

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