The AMA House of Delegates (HOD) took several actions at the 2017 AMA Annual Meeting in Chicago that were aimed at improving research on and payment for preventive care.
The newly adopted policies encourage expert committees making preventive-services recommendations to follow transparent, evidence-based processes, encourage comparative-effectiveness research on secondary prevention and advocate that all payers be required to provide first-dollar coverage of routine preventive pediatric care.
Delegates also voted to support requiring Medicare to waive coinsurance for colorectal screening and any interventions required during the procedure, such as polyp removal, and support removing insurance barriers to securing coverage for HIV pre-exposure prophylaxis (PrEP).
The policy on expert committees that make preventive services recommendations originated from a joint report co-written by the AMA Council on Medical Service and Council on Science and Public Health. The expert committees include the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, the Health Resources and Services Administration Bright Futures Project and the Women’s Preventive Services Initiative.
The AMA, American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP) and other specialty societies represented in the HOD have roles in the expert committees.
More than 100 tests and treatments are paid for without cost-sharing as directed by the Affordable Care Act (ACA) based on the recommendations of the expert committees, the councils’ report says. The HOD adopted new policy asking these committees to develop evidence reviews with enough specificity to inform cost-effectiveness analysis, work together to identify preventive services that are not cost effective and consider development of recommendations for secondary prevention.
Secondary prevention lacks coverage
The councils note in the report that, because of the high number of required “free” services, there is concern that many secondary prevention services that may reduce hospitalizations and morbidity are not covered. Delegates also reaffirmed policy on supporting the use of value-based insurance design and cost-effective analysis in comparative effectiveness research.
In a separate action, the HOD called on the AMA to advocate for first-dollar coverage of pediatric preventive services as recommended by the AAP and AAFP and for immunizations recommended by the AAP, AAFP and Centers for Disease Control and Prevention.
The third prevention-related policy addressed co-pays associated with colonoscopies during which interventions to treat polyps or lesions are performed. Currently, if such therapeutic interventions are performed during colorectal cancer screening tests, patients with Medicare coverage can be responsible for cost-sharing.
The AMA has already submitted letters to sponsors of Congressional legislation that calls for requiring Medicare to waive the coinsurance for colorectal screening tests, regardless of whether therapeutic intervention is required during the procedure.
The HOD also adopted policy that supports removing insurance barriers to securing coverage for HIV pre-exposure prophylaxis (PrEP), including prior authorization and mandatory consultation with an infectious disease specialist. In addition, the policy advocates that individuals not be denied any insurance on the basis of PrEP use.
In its report, the reference committee notes how speakers emphasized that “insurance denials levied against those who make efforts to protect themselves against contracting HIV are excessively discriminatory.”
Read more news coverage from the 2017 AMA Annual Meeting.
