June 23, 2015
Area(s) of Interest: Physician Leadership Professional Development & Education
The American Medical Association’s (AMA) House of Delegates tackled a diverse set of resolutions this year that are of interest to California physicians, including medical-only exemptions from school vaccination requirements, electronic health record (EHR) meaningful use, ICD-10 implementation, Medicaid rates and opioid abuse.
Given the high level of interest in California’s Senate Bill 277 (Pan), which would eliminate the personal belief exemption for school vaccination requirements in California, AMA adopted a policy calling for immunization for all, and only allowing exemptions where medical reasons contraindicate vaccination.
Several other vaccine-related resolutions were also passed, including supporting parents who want to help educate and encourage their peers to vaccinate [based on a California Medical Association (CMA) resolution adopted during the House of Delegates]; disseminating materials about the effectiveness of vaccines to states; encouraging states to eliminate philosophical and religious exemptions from state immunization requirements; and recommending that states have an “established decision mechanism that involves public health physicians to determine which vaccines will be mandatory for admission to schools.”
AMA also adopted several Medicare-related resolutions on controversial issues. The AMA House overwhelmingly supported a two-year grace period from penalties and recovery audit contractor audits during the ICD-10 implementation, and to make advance payments available if claims are delayed. Resolution 211 calls upon AMA to work with the Centers for Medicare and Medicaid Services (CMS) to give physicians partial credit for accomplishing objectives in the EHR Meaningful Use program, to engage with EHR vendors to reduce the negative effects on physicians, and for AMA to develop a model EHR vendor contract that protects physicians in the event of downtime due to vendor error and other technical problems.
The AMA HOD also adopted substitute Resolution 103 on the Medicare three-day stay rule. It asks AMA to continue to urge Congress to eliminate the three-day hospital inpatient requirement for Medicare coverage of post-hospital skilled nursing facility services, and to continue to advocate as long as the three-day stay remains in effect, that patient time spent in hospital observation care or in the emergency room count toward the three-day stay requirement.
AMA also renewed its commitment to expand funding sources for graduate medical education, to increase the number of residency slots and to study the reasons medical students fail to match to residency slots (and to assist those medical students).
There were several resolutions calling for sweeping reforms of the American Board of Medical Specialties (ABMS) Maintenance of Certification (MOC) process. The resolutions direct AMA to request that ABMS to develop fiduciary standards for its members boards and to provide full transparency related to the costs of preparing, administering, scoring and reporting MOC exams. It also seeks to ensure MOC “doesn’t lead to unintentional economic hardships.”
There were numerous resolutions on the rising costs of generic medications. Substitute Resolution 106 asks AMA to work with federal agencies to address the high and escalating costs of generic prescription drugs and to support legislation to ensure fair pricing of generic medications and price transparency. AMA also supported additional steps to address opioid abuse through a series of resolutions calling for increased reliance on prescribing data through modernized prescription drug monitoring programs and sharing data across state lines; more education; better coverage of addiction treatment; and an increased focus on physician-led, comprehensive, multidisciplinary pain management services.
The California delegation presented a number of important resolutions as well. The following are summaries of some of the California resolutions that the AMA House of Delegates adopted as policy.
Interest on Medicare Overpayments and Underpayments (Res. 404): That AMA support amending federal Medicare law to require that interest on both overpayments and underpayments to providers attaches upon notice of the error to the appropriate party in either instance.
Reimbursement for End-of-Life Counseling (Res. 402): That AMA advocate for public and private health care insurers to be required to cover counseling for end-of-life care planning as an accepted and integral part of good medical care.
Survivorship Care Plans (Res. 503): That AMA supports the voluntary use of survivorship care plans for cancer survivors when appropriate and also support reimbursement for physicians who prepare them.
Study the Impact of the Affordable Care Act (ACA) Medicaid Expansion (Res. 116): Asks that AMA use all available data to study the issues surrounding the ACA expansion of Medicaid to tens of millions of low-income adults to evaluate access, quality of care, adequacy of provider reimbursement and the impact of the ACA on the health care system as a whole.
Electronic Cigarettes (Res. 101): Asks that AMA support a ban on the advertising of electronic cigarettes; hold a position that e-cigarettes should be regulated at the federal, state and local level, consistent with other tobacco products; support education of the public on the known and potential health impacts of electronic cigarettes; and support the taxation of electronic cigarettes to fund research into these products.
The following additional California resolutions were reaffirmed by the AMA as existing policy.
- Res. 109: Medicare Coverage of Physician Administration of Medications Procured by Patients
- Res. 205: Doctor Hospital Ownership
- Res. 410: Mental Health Crisis Interventions
- Res. 411: Homeless Veterans
- Res. 509: Long Acting Reversible Contraception and Teen Pregnancy
In other California news from AMA, Jim Hinsdale, M.D., former CMA President, was re-elected to the AMA Council on Medical Services and Carol Berkowitz, M.D., was re-elected to the Council on Medical Education. Unfortunately, Jim Hay, M.D., former CMA President, was unsuccessful in his bid to be elected Vice-Speaker of the AMA HOD.
For an expanded summary of resolutions that were passed by the AMA House of Delegates, click here.
Contact: Elizabeth McNeil at firstname.lastname@example.org.