CHICAGO — Physician and medical student leaders at the Annual Meeting of the American Medical Association (AMA) House of Delegates approved policies aimed at protecting patient access to needed health care. These steps build on the AMA’s longtime advocacy efforts.

The new policies adopted include:

Making prescriptions affordable for patients in Medicare Advantage

The AMA’s House of Delegates endorsed a policy intended to limit the expensive surprise that awaits Medicare Advantage patients who need physician-administered drugs or biologics.

Under the policy, the AMA will advocate for federal policy that limits a patient’s out-of-pocket cost to be the same or less than the amount that a patient with traditional Medicare plus a Medigap plan would pay. Supporters of the new policy said the current approach is tilted against under-resourced patients who discover that their MA plans have exorbitant co-pays that accompany biologics and physician-administered drugs, which are commonly used to treat chronic diseases. The financial exposure is less for patients in traditional Medicare.

“When signing up for Medicare Advantage, patients don’t know which expensive drugs they might require and then find out that the drugs aren’t covered or require a 20 percent co-payment. That guarantees a disparity in outcomes that this policy aims to address,” said Ilse R. Levin, D.O., MPH & TM, a member of the AMA Board of Trustees. “This change takes aim at a practice that exacerbates inequity in health care. Our patients deserve better.”

Medical-legal partnerships

To expand health equity, the AMA will support the establishment and funding of medical-legal partnerships and civil legal aid services to meet patients’ legal needs. Medical-legal partnerships integrate the expertise of lawyers in health care settings to help physicians, case managers, and social workers address social problems at the root of many health inequities.

Studies show that when legal services are used to address social needs, people are admitted to the hospital less frequently, are more likely to take their prescribed medications, and report lower levels of stress.

These partnerships help address social determinants of health relating to civil law, such as family violence, child support and custody, workplace conditions, post-incarceration rehabilitation, housing, utility shutoffs, disability access, debt relief, perinatal needs, and veteran benefits, by integrating lawyers in clinical settings team to meet patient’s legal needs.

“Medical-legal partnerships can help educate physicians and medical students on screening for social determinants and legal needs, addressing issues impacting health through legal advocacy, and referring patients to reliable legal resources,” said Ilse R. Levin, D.O., MPH & DM, a member of the AMA Board of Trustees.

Support for in-vitro fertilization

In response to a state Supreme Court recent ruling that embryos are human beings, the American Medical Association will oppose legislation or ballot measures that could criminalize in-vitro fertilization.

“The AMA has long opposed government interference in medical decisions and the patient-physician relationship. The Alabama court decision threatened to upend a safe, family-affirming medical procedure that is one of the most significant medical advances of the last century,” said AMA President-elect Bobby Mukkamala, M.D.

After the court decision, clinics halted IVF services, concerned that providing fertility treatment could result in civil and potentially criminal liability in the state. The legislature passed a bill to provide civil and criminal immunity to providers and patients for the destruction of, or damage to, embryos. The governor signed it into law.

“Physicians and families dodged a bullet. We now must be vigilant against politicians and judges who want to supplant their judgment for medical judgment. IVF is a godsend to so many patients who want families. We need to make sure it is available,” Dr. Mukkamala said.

Ethical use of de-identified patient data

The dynamic nature of today’s digital health information ecosystems challenges established procedures—such as informed consent and de-identification—for protecting patient privacy. Respecting patient privacy and informed consent are responsibilities that physician organizations and health care institutions must take on because the risks within digital health ecosystems extend far beyond the patient-physician relationship to areas where individual physicians have little influence. In response, physicians gathered at the AMA Annual Meeting adopted ethical guidance to help physicians address the handling of de-identified patient data in today’s rapidly changing digital health ecosystem.

“Because of potential public health benefits, de-identified and aggregated clinical health data should be treated as a form of public good, and the ethical standards and values of health care should follow the data and be upheld and maintained even if the data are sold to entities outside of health care,” said AMA Board Member, David H. Aizuss, M.D. “The medical profession’s responsibility to protect patient privacy – as well as to society to improve future health care – should be recognized as inherently tied to these data sets, meaning all entities granted access to the data become data stewards with a duty to uphold the ethical values of health care in which the data were produced.”