Highlights from the 2018 AMA Interim Meeting

Catch up with the news and other key moments from the AMA House of Delegates’ meeting in National Harbor, Maryland. The 2018 AMA Interim Meeting was held Nov. 8–13.

Confronting harassment within medicine head on. In a joint AMA Leadership Viewpoints column published today, AMA President Barbara L. McAneny, MD, and AMA Board of Trustees Chair Jack Resneck Jr. MD, detail delegates' unanimous action on a resolution reaffirming the Association’s age-old commitment to equity, fairness and respect.

“Like every other sector, medicine must operate with zero-tolerance for sexual and other forms of harassment,” they write. Read more.

Delegates finished up their business yesterday, but several policy actions were not announced until today. Read about them below.

Creating—and sustaining—patient-centered medical homes requires support from payers. Primary care and the patient-centered medical home (PCMH) are “bedrocks of high-quality patient-centered care,” says an AMA Council on Medical Service report whose recommendations were adopted. But practices of all sizes and settings need support to overcome cultural and financial obstacles to adopting the PCMH model, it notes.

The costs of PCMH implementation and maintenance are significant, as are integrating innovations such as telemedicine to increase access. Efforts to improve care quality also may be expensive, the council report says.

To this end, delegates adopted policy to:

• Urge the Centers for Medicare & Medicaid Services to assist physician practices seeking to qualify for and sustain medical home status with financial and other resources.
• Advocate that all payers support and assist PCMH transformation and maintenance efforts recognizing that payer support is crucial to the long-term sustainability of delivery reform.
• Encourage health agencies, health systems, and other stakeholders to support and assist patient-centered medical home transformation and maintenance efforts.

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Physician credentialing info shouldn’t fall victim when hospitals close. Loss of medical staff credentialing files following the closure of a hospital can lead to delays in future credentialing efforts at other institutions, due to inaccessibility of historical credentialing information.

States such as Illinois and New York require hospitals to have policies to preserve medical staff credentialing files, but most states lack similar legislative or regulatory requirements, says an AMA Board of Trustees report whose recommendations were adopted. A majority of states don’t require that physicians be notified about the location of their files, though some payers, states and other stakeholders have begun creating physician-credentialing depositories.

Delegates directed the AMA to develop model state laws and regulations that would require hospitals to:

• Implement a procedure for preserving credentialing files in the event of a hospital closure.
• Provide written notice to state health agencies and medical staff before a hospital closing indicating whether arrangements have been for transfer of credentialing files and where the files will be located.

The AMA also will:

• Monitor the development and implementation of physician credentialing repository databases that track hospital affiliations—including tracking hospital closures, as well as where these closed hospitals are storing physician credentialing information.
• Explore the feasibility of developing a universal clearinghouse that centralizes the verification of credentialing information, and report back at the 2019 AMA Interim Meeting.

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AEDs can save lives, but are underused. More than 40,000 people suffer a sudden cardiac arrest in a public place each year in the U.S. and automatic external defibrillators (AEDs) can be a key to their survival, yet AEDs are used in only 5 percent of these events. Poor public awareness of AEDs and other factors have contributed to the poor take-up of these lifesaving tools, says a resolution presented by several heart-care medical specialty societies.

To promote wider use of AEDs, the delegates adopted new policy to “endorse efforts to promote the importance of AED use and public awareness of AED locations, by using solutions such as integrating AED sites into widely accessible mobile maps and applications.”

AMA sets out eight ways to promote affordable access to high-value care. The Affordable Care Act (ACA) requires health plans to cover certain preventive health care services with no cost to the patient, but this ACA benefit is limited. An AMA report highlights how patients face conflicting incentives when it comes to high-value health care.

That is, even when evidence indicates that a certain health care service could save patients’ health and finances in the future, that service may be unaffordable. In such cases, patients are weighing science and their doctors’ recommendations against their immediate financial well-being. In policy adopted at the Interim Meeting, physicians detail eight educational tools, insurance plan designs and advocacy initiatives that can help. Read more.

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Boost internet access to cut rural health disparities. A lack of broadband internet access is a social determinant of health that limits access to health care resources, government services, economic growth, job opportunities and educational programs, says a resolution presented by delegations from 10 states. More than 20 million Americans live in areas without broadband internet access, which is needed to provide telemedicine to underserved rural areas.

To address the issue, delegates adopted new policy to “advocate for the expansion of broadband and wireless connectivity to all rural and underserved areas of the United States while at all times taking care to protecting existing federally licensed radio services from harmful interference that can be caused by broadband and wireless services.”

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Sex ed should include age-appropriate content on bullying, consent. More than 11 percent of high-school girls are victims of forced sex, along with 3.5 percent of high-school boys, says a 2017 Centers for Disease Control and Prevention survey. A resolution presented by the AMA Women Physicians Section notes that a majority of U.S. teens “may graduate high school without any formal instruction on consent” in sexual relations, though at least two states—California and Missouri—mandate that sex ed cover sexual consent and healthy relationships.

To encourage this approach, delegates directed the AMA to “support state legislation mandating that public middle and high school health education programs include age-appropriate information on sexual assault education and prevention, including but not limited to topics of consent and sexual bullying.”

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Time to modernize 911 infrastructure for smartphone age. About 95 percent of Americans own at least one cellphone, yet the nation’s 911 infrastructure does not uniformly support the advanced technologies, causing it to be vulnerable to preventable outages and cyberattacks. More than 70 percent of 911 calls are made from cellphones, says a resolution presented by the AMA Medical Student Section.

Internet protocol (IP)-based communication technologies allow the transmission of data over the internet, creating an opportunity for increased information to be obtained by the receiver, the resolution says. Congress’ failure to nationally incorporate IP-based technology into existing 911 infrastructure can lead to inaccurate caller location accuracy, which causes increased response times and morbidity.

To improve accuracy and reduce morbidity, delegates adopted new policy to “support the funding for and modernization of 911 infrastructure, including incorporation of text-to-911 technology.”

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Physicians again forcefully spoke out on gun-violence policy as AMA delegates today adopted policy calling for better a background-check system for firearms purchases, a ban on 3D-printed firearms, and “gun violence restraining orders” for people arrested or convicted of domestic violence or stalking.

The AMA’s actions stem from comprehensive policy adopted in previous House of Delegates meetings to stem the deadly toll of firearm violence. Read more.

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Better data needed to guide suicide prevention efforts among physicians and medical students. Citing the high rate of suicide completion among medical professionals when compared with the general population and work-related stress as a risk factor for doctors, delegates want a better understanding of patterns linked to physician and medical student suicide.

Long work hours are commonly cited as a reason for the prevalence of mental illness and burnout among physicians and medical students, but additional institutional factors can contribute to suicide. Read more.

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AMA seeks better patient access to medical forensic examinations after sexual assault. Hospital emergency departments serve as the primary point of care for survivors of sexual assault by conducting a medical forensic examination (MFE), which takes an average of two hours to perform and must be completed within 72 hours of the assault.

Because emergency physicians typically see almost three patients per hour, it is difficult to effectively complete the MFE and maintain chain-of-custody of the evidence alongside their clinical responsibilities. Involvement of sexual assault nurse examiners—registered nurses who have completed specialized education and clinical preparation to perform MFEs—and other trained and qualified clinicians, is associated with higher rates of psychological recovery for survivors and offender prosecution due to better collection of forensic evidence.  

Although several programs for access to a medical forensic examination exist around the country, many communities, especially rural locations, may not have access to to these services. To improve access for patients, delegates adopted new policy to “advocate for increased post-pubertal patient access to sexual assault nurse examiners, and other trained and qualified clinicians, in the emergency department for medical forensic examinations.”

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What does the label say? AMA says transparency is the way to go. Many front-of-package (FOP) labels on food products feature nutrient claims that suggest or imply nutritional properties related to its content of energy, proteins, fats, carbohydrates, dietary fiber, vitamins or minerals, according to a resolution presented by the AMA Medical Student Section. 

Delegates adopted policy asking the Food and Drug Administration to give food companies a reason to think twice about such misleading labeling tactics. The AMA also wants food manufacturers to do a better job of making it obvious when their products contain potentially deadly allergens. Read more.

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Steps taken to foster diversity among physician leaders in public and population health. Investments in preventive medicine and public health are cost-effective and save lives, but more support is needed to help interested physicians seek qualifications and credentials in preventive medicine or public health to strengthen public health leadership, especially in rural communities.

Educational interventions and resources intended to help physicians and medical students develop these skills and qualifications should be highlighted and supported to ensure a diverse, robust body of leaders in those fields.

Delegates directed the AMA to encourage:

• The Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, and Accreditation Council for Graduate Medical Education to highlight public or population health leadership learning opportunities to all learners, but especially encourage dissemination to women physician groups and other groups typically underrepresented in medicine.
• Public health leadership programs to evaluate the effectiveness of various leadership interventions.

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All sexual assault survivors should be offered HIV post-exposure prophylaxis. Between 65,000 to 90,000 emergency department visits per year are associated with sexual assault cases, says a resolution presented by the AMA Medical Student Section. However, only 14.5 percent of assault survivors were offered post-exposure prophylaxis (PEP), an antiretroviral medication that should be taken within 72 hours of HIV exposure to prevent infection. PEP is very effective at preventing seroconversion after HIV exposure.

The Centers for Disease Control and Prevention estimates the risk of contracting HIV from a known HIV-positive person through consensual vaginal or anal intercourse is extremely low. The risk may increase, however, during sexual assault due to injuries. Physicians failed to offer PEP or provided incorrect counseling due to a lack of knowledge about state or national guidelines, the resolution says.

Delegates adopted new policy to:

• Support education of physicians about the effective use of HIV post-exposure prophylaxis and the U.S. PEP clinical practice guidelines.
• Support increased access to, and coverage for, PEP for HIV, as well as enhanced public education on its effective use.

Delegates also amended current policy to state that the AMA “believes that HIV testing and Post-Exposure Prophylaxis (PEP) should be offered to all survivors of sexual assault, who present within 72 hours of a substantial exposure risk, that these survivors should be encouraged to be retested in six months if the initial test is negative, and that strict confidentiality of test results be maintained.”

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Help homeless people get the government ID cards often needed to access medical care. More than 3.5 million Americans will experience homelessness at some point in a given year—and nearly 80,000 are chronically homeless, according to data cited in a resolution presented by the AMA Medical Student Section. For these people, lack of government-issued identification remains a major barrier to seeking medical care.

With more than 36 percent of the U.S. homeless population suffering from severe mental illness or chronic substance abuse, a lack of ID prevents them from accessing drug treatment and rehabilitation programs, says the resolution whose recommendations were adopted by the AMA House of Delegates. This can also prevent access to benefits from the Supplemental Nutrition Assistance Program and delayed care due to lack of insurance.

Delegates adopted new policy to:

• Recognize that among the homeless population, lack of identification serves as a barrier to accessing medical care and fundamental services that support health.
• Support legislative and policy changes that streamline, simplify and reduce or eliminate the cost of obtaining identification cards for the homeless population.

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More awareness, research needed on intimate partner violence in LGBTQ community. Intimate partner violence (IPV) can occur between heterosexual or same-sex couples and does not require sexual intimacy. Yet most efforts to address this public health problem have focused on heterosexual women, says an AMA Council on Science and Public Health report whose recommendations were adopted by the House of Delegates. Data suggests that individuals who LGBTQ people experience an equal or greater likelihood of IPV compared with heterosexuals.

To address intimate partner violence against LGBTQ people, the delegates amended existing policy to:

• Encourage physicians to familiarize themselves with resources available in their communities for LGBTQ survivors of IPV.
• Advocate federal funding to support programs and services for survivors of IPV that do not discriminate against underserved communities, including on the basis of sexual orientation and gender identity.
• Encourage research on IPV in the LGBTQ community to include studies on the prevalence, the accuracy of screening tools, effectiveness of early detection and interventions, as well as the benefits and harms of screening.
• Encourage the dissemination of such research  to educate both physicians and the community.

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Fix hospital eligibility criteria for drug-discount program. The 340B program requires drugmakers to sell outpatient prescription medications at a discount to “covered entities” that include disproportionate-share hospitals, children’s hospitals, certain cancer hospitals, critical access hospitals and other safety-net or remote institutions.

The number of these entities quadrupled in six years, according to research cited in an AMA Board of Trustees report. Delegates adopted policy to "support a revised 340B drug-discount program covered-entity eligibility formula, which appropriately captures the level of outpatient charity care provided by hospitals, as well as stand-alone community practices." Read more.

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AMA moves to protect income-based loan repayment programs. Several income-driven repayment plans allow borrowers another option to manage their student-loan burdens. These plans are particularly important to medical trainees, many of whom begin residency with large student-loan debt totals.

The AMA Resident and Fellow Section’s resolution on the matter cites news reports indicating that the cost of these plans has not been adequately budgeted for by the U.S. Department of Education, with cuts to IDR plans proposed.

To address the matter, delegates adopted new policy to “advocate continued funding of programs including income-driven repayment plans for the benefit of reducing medical student loan burden.”

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Vaping is an epidemic and the FDA must act. The nation’s physicians sent a strong message on “the urgent public health epidemic” of the skyrocketing use of e-cigarettes and called on the Food and Drug Administration (FDA) to take action to address it.

Research has shown that the use of e-cigarettes and vaping products is unsafe and can cause addiction, according to data cited in a resolution presented by the AMA Organized Medical Staff Section. The AMA will work with the FDA to counteract the marketing and use of e-cigarettes, “including but not limited to bans and strict restrictions on marketing to minors under the age of 21.” Read more.

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Amid news reports about potential federal action to narrow the definition of gender, the AMA will work to inform officials about the medical spectrum of gender identity .

About 1 million adults are transgender, according to data cited in a resolution presented at the Interim Meeting. The resolution also notes that “sex and gender are complex and fluid parts of individuals’ identities that may not align with the sex assigned to them at birth.” The AMA already has been working to educate the medical community and the public about the facts on gender identity.

To further those efforts, delegates adopted policy so that the AMA will:

• Educate state and federal policymakers and legislators on and advocate policies addressing the medical spectrum of gender identity to ensure access to quality health care.
• Oppose any efforts to deny an individual’s right to determine their stated sex marker or gender identity.
• Affirm that an individual’s genotypic sex, phenotypic sex, sexual orientation, gender and gender identity are not always aligned or indicative of the other, and that gender for many individuals may differ from the sex assigned at birth.

 

The research of 12 medical students, residents and international medical graduates was honored in the 16th annual AMA Research Symposium, held during the AMA Interim Meeting and judged by the physicians in attendance.

Find out more about the poster presentations that won honors in the categories of clinical vignette, improving health outcomes, clinical research, basic science, public health and clinical medicine. The contest draws hundreds of participants from across the country.

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AMA supports in-person importation of Canadian prescription drugs if safety can be assured. Letting American patients import prescription drugs in person from licensed Canadian brick-and-mortar pharmacies has the potential to improve cost-sharing levels and address a major barrier to medication adherence. Canadians spend about half the $1,026 that Americans spend, per capita, on prescription drugs each year.

The AMA’s action comes as the Department of Health and Human Services examines ways to lower prescription-drug costs, including the option of allowing Canadian drug importation. Read more.

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How physicians should approach hard calls involving child patients. Some of the most difficult medical decisions involve pediatric patients who may be unable to have a say in their own care. Delegates have adopted new ethical guidance for physicians to help parents and their children.

In the report that delegates adopted, the AMA Council on Ethical and Judicial Affairs lays out some questions for parents and physicians to consider, including: overall goals for care, what the child’s likely developmental course will be with and without immediate intervention, and whether interventions can reasonably be staged developmentally to allow the patient and family time to gain experience in living with a condition that is not immediately life-threatening. Read more.

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This morning’s education sessions:

• “Effects of health care payment models on physician practices: Is the U.S. making progress in value-based care models?” 1.5 CME credits.
• “CEJA open forum—Ethics of providing care abroad.” 1.5 CME credits.

This afternoon’s education sessions:

• “Busharat Ahmad, MD Leadership Development Program: How to earn an AMA leadership position.” No CME.

• “Litigation Center Open Meeting.” 1.5 CME credits

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AMA member groups and sections representing medical students, residents and fellows, and many others across career stages, special interests and more are having their own gatherings in National Harbor.

The Interim Meetings of the AMA member groups and sections offer physicians and medical students the opportunity to influence policy, attend educational programs and network.

Discover what each group or section has learned and accomplished at their meetings in Maryland, and learn how you can attend the June 2019 meeting in Chicago:

• AMA Academic Physicians Section.
• AMA Advisory Committee on LGBTQ Issues.
• AMA Integrated Physician Practice Section.
• AMA International Medical Graduates Section.
• AMA Medical Student Section.
• AMA Organized Medical Staff Section.
• AMA Resident and Fellow Section.
• AMA Senior Physicians Section.
• AMA Women Physicians Section.
• AMA Young Physicians Section.

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AMA delegates provided testimony this morning on more than 100 reports and resolutions up for consideration at the meeting. Delegates draw on their expertise, the best evidence in the medical and health policy literature, and the insights of their state and medical specialty societies to weigh in on proposals that run the gamut of issues affecting patients and physicians.

These reference committees met:

• Reference Committee on Amendments to Constitution & Bylaws, which covers the AMA constitution, bylaws and medical ethics matters.
• Reference Committee B, which covers legislation.
• Reference Committee C, which covers medical education.
• Reference Committee F, which covers AMA governance and finance.
• Reference Committee J, which covers medical service, medical practice and insurance matters.
• Reference Committee K, which covers science and public health.

This evening’s education sessions:

• “Acculturation: Continuous Immersion and Improvement for IMGs.” 0.5 CME credits.
• “The more things change: Issues facing senior women physicians.” No CME.
• “The business of improving workforce diversity.” No CME.

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Doctors as disruptors? AMA Executive Vice President and CEO James L. Madara, MD, says medicine’s future demands it. Tensions surrounding health care today are evident to patients and physicians. When it comes to alleviating those tensions and shaping practical changes to improve care, the onus is on physicians to lead the way, Dr. Madara told delegates.

“New solutions must facilitate, not complicate medical practice,” Dr. Madara said. “These solutions must save time, not take time.”

Dr. Madara highlighted the AMA’s role in “an Uberized approach” to lifestyle change programs to prevent diabetes, as well as the Association's efforts to help physicians accelerate digital health implementation in practice. Read more.

 

 

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AMA President Barbara L. McAneny, MD, says it is time create a system that values health over money, power. The AMA is fighting the forces that make the U.S. health system so dysfunctional, Dr. McAneny told delegates gathered at the opening session. 

She told the heartbreaking story of her patient with metastatic cancer who was denied an opioid prescription due in part to prior authorization.

“The health plan does not have the chart, doesn’t know the patient, and basically countermanded my orders without even telling me—using the prior-authorization process,” Dr. McAneny said.

The patient, wracked with pain and shamed by the episode, nearly died of suicide. Dr. McAneny explained how the AMA is working to #FixPriorAuth.

Dr. McAneny also addressed pressing topics such as physician burnout, health industry consolidation, the skyrocketing cost of prescription drugs, access to health insurance and excessive time on the EHR. Read more.

 

 

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AMA Medal of Valor goes for Texas doctor’s Hurricane Harvey service.When the hurricane hit Texas as a Category 4 storm in 2017, clinical anesthesiologist G. Ray Callas, MD, worked without rest to help those affected. His outstanding efforts earned him the AMA Medal of Valor. The award is given to an AMA member who demonstrates courage under extraordinary circumstances in nonwartime situations. 

Dr. Callas, from Beaumont, Texas, was one of seven physicians and others honored at the opening session of the Interim Meeting. Read more.

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Watch this video recording, on the AMA’s Facebook page, of the remarks delivered at the Interim Meeting’s opening session by AMA President Barbara L. McAneny, MD, and AMA Executive Vice President and CEO James L. Madara, MD.

The beginning of the video features the presentation of AMA awards. The AMA leaders’ remarks begin at the about the 55-minute mark in the video.

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This morning’s education sessions:

• “Design thinking in health care.” No CME.
• “Communications: Perfecting your elevator speech and your personal brand.” 1.0 CME credits.
• “Caring for vulnerable populations: What you can do to support LGBTQ+ youth.” No CME.
• “Train the trainer: Empowering your community to combat the opioid crisis.” No CME.
• “Is there a vaccine for burnout? Building resilience in the medical student community.” No CME.
• “Mind the gap: Improving undocumented patients’ access to care.” 1.0 CME credits.
• “Difficult conversations: End of life care.” No CME.
• “Older and wiser: Assessing competency of elder physicians.” 1.5 CME credits.

With the first full day of the meeting come a slew of educational opportunities for the physicians in attendance.

Today’s education sessions:

• “Identifying victims of sex trafficking: The role of the physician.” No CME.
• “Direct contracting with large employers: Is your organization an appealing partner? 2.0 CME credits.
• “Can system-level and individual medical staff needs coexist? Spoiler: Yes! 1.0 CME credits.
• “Don't just survive, thrive: Wellness for young physicians.” 1.5 CME credits.
• “Coalition building: Fundamental steps for success.” 1.0 CME credits.
• “Providing care for child and adolescent refugees.” No CME.
• “2019 Medicare payment policy: Everything you need to know.” No CME.
• “Alternative privileging criteria: Evaluating competency without MOC.” No CME.
• “Health care think tank: Members moving medicine.” No CME.
• “The forgotten Americans: An introduction to U.S.-Mexico Border colonias.” No CME.
• “The FDA: What do they do for physicians and patients?” No CME.
• “Opioid rehabilitation and care coordination: What physicians in training need to know.” No CME.
• “Mergers, acquisitions and partnerships in health care: Why is New York-Presbyterian in the Florida Keys?” No CME.
• “Advocacy in action: Enacting change at a grassroots level.” No CME.
• “How will the November elections affect LGBTQ patients and physicians?” No CME.

There are lots of great ways to follow the meeting online. Look for and use the #AMAmtg hashtag to help track the meeting’s special moments as they unfold and follow the AMA on Twitter.

You also can use the #OurAMA hashtag to share your favorite AMA memories and talk about what you’re seeing at the meeting and the impact it will have on the future of medicine.

And find out how AMA members move medicine—and share how you are doing it—by using the #MembersMoveMedicine hashtag.

The AMA’s Facebook page also features a steady flow of outstanding meeting-related content.

And to get a real insider’s view of the sights at the Interim Meeting, follow the AMA on Instagram.

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Here are some quick links to help you get the most out of the meeting, in person or online.

• Access reports and resolutions delegates will consider, as well as reference committee reports and final actions as they become available.
• Search the AMA Pictorial Directory to find your peers and stay connected before, during and after Annual and Interim Meetings (AMA members only).
• Find out more about the education sessions held at the meeting and how to claim AMA PRA Category 1 Credit™ when available.