D. Robert McCaffree, MD, MSHA, FCCP

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both CHEST members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST Physician. One of the authors (DRM) was the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new AMA delegate. 

The American Medical Association (AMA) had its Annual Meeting of the House of Delegates (HOD) from May 9-13.  This meeting was attended by over 1,000 physicians who  are delegates from all geographic societies, ie, state societies and specialties and subspecialties, as well as the uniformed services. 

Policy and resolutions 

Process: 
Policies originate via resolutions submitted by individuals or societies.  These resolutions then go to one of several Reference Committees for open discussion.  These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House.  The diagram below explains the flow of resolutions to policies.

Chest/Allergy Section Council  (which is composed of CHEST, ATS, SCCM, AASM, and several allergy specialty organizations) meets prior to the voting in the House to discuss the pending business. The Specialty and Service Society (SSS) is the largest caucus in the AMA’s House of Delegates and is composed of all the delegates from the specialty societies, as well as the uniformed services.  
There are two categories of groups in the SSS: those societies that have seats in the HOD and those seeking admission to the house.

SSS groups in the HOD include:
•    119 national medical specialties
•    2 professional interest medical associations
•    5 military or uniformed service groups (the Public Health Service is “uniformed” but not “military” or “armed”)

The compendium of policies covers the entire range of topics impacting the practice of medicine – ethics, legislation, regulation, public health, individual health, and medical education, among them.  The full range of policies can be found in the AMA’s Policy Manual available on the web site, AMA-assn.org

Some of the issues discussed at the HOD are as follows:
•    Health care as a “right.”  In response to a resolution asking the AMA to support health care as a “right,” the Board of Trustees reaffirmed current policy supporting expanded access to health care for all but stopped short of calling health care a “right.”
•    POLST forms. The Board of Trustees will work with state organizations and others to recognize Physician Orders for Life Sustaining Treatment (POLST) forms and allow for reciprocity between states.
•    Influenza vaccination. The HOD enacted as AMA policy that no health-care worker should be terminated from employment due solely to their refusal to be vaccinated for influenza. 
•    e-Cigarettes and tobacco.

A.    The AMA was instructed to urge federal officials, including but not limited to the US Food and Drug Administration (FDA), to prohibit the sale of any e-cigarette cartridge that does not include a complete list of ingredients on its packaging, in the order of prevalence (similar to food labeling). We will also urge federal officials, including but not limited to the FDA, to require that accurate nicotine content of e-cigarettes be prominently displayed on the product alongside a warning of the addictive quality of nicotine (new HOD policy). 

B.    Develop a report on the individual health and public health implications of a low nicotine standard for cigarettes. Such a report should consider and make recommendations on scientific criteria for selection of a nicotine standard that is nonaddictive, regulatory strategies to ensure compliance with an established standard, and how a low-nicotine standard should work with other nicotine products in a well-regulated nicotine market. American Medical Association consider joining other medical organizations in an amicus brief supporting the American Academy of Pediatrics legal action to compel the US Food and Drug Administration to take timely action to establish effective regulation of e-cigarettes, cigars, and other nicotine tobacco products (Directive to Take Action).

•    Prior authorization for durable medical equipment.  The AMA will advocate that denials of prior authorization for durable medical equipment must be based on true medical necessity not arbitrary time limits or other paperwork issues and will continue to work to improve the prior authorization process for Medicare Managed Care Plans (Directive to Take Action).
•    Medical training (including IMG, Medical students, Residents, and Fellows). 

A.    EHR and Business training during Med Ed and residency 

B.    Fellowship Start Date.  The AMA will survey physicians who have experienced a fellowship start date of August 1 to further evaluate the benefits and drawbacks from this transition (Directive to Take Action).

•    Opioid abuse. Surgeon General Jerome Adams addressed the HOD about several topics but focused on opioid crisis.
•    Physician Burnout and Organizational efficiency. Physician burnout is a health-care crisis in all specialties, and critical care has a very high rate of physician burnout. The AMA has several tools available that can help with physician burnout both in the ICU and outpatient medicine. (https://www.stepsforward.org)

This is just a small sampling of the activities at the HOD.  More information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org. 

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both CHEST members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST Physician. One of the authors (DRM) was the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new AMA delegate. 

The American Medical Association (AMA) had its Annual Meeting of the House of Delegates (HOD) from May 9-13.  This meeting was attended by over 1,000 physicians who  are delegates from all geographic societies, ie, state societies and specialties and subspecialties, as well as the uniformed services. 

Policy and resolutions 

Process: 
Policies originate via resolutions submitted by individuals or societies.  These resolutions then go to one of several Reference Committees for open discussion.  These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House.  The diagram below explains the flow of resolutions to policies.

Chest/Allergy Section Council  (which is composed of CHEST, ATS, SCCM, AASM, and several allergy specialty organizations) meets prior to the voting in the House to discuss the pending business. The Specialty and Service Society (SSS) is the largest caucus in the AMA’s House of Delegates and is composed of all the delegates from the specialty societies, as well as the uniformed services.  
There are two categories of groups in the SSS: those societies that have seats in the HOD and those seeking admission to the house.

SSS groups in the HOD include:
•    119 national medical specialties
•    2 professional interest medical associations
•    5 military or uniformed service groups (the Public Health Service is “uniformed” but not “military” or “armed”)

The compendium of policies covers the entire range of topics impacting the practice of medicine – ethics, legislation, regulation, public health, individual health, and medical education, among them.  The full range of policies can be found in the AMA’s Policy Manual available on the web site, AMA-assn.org

Some of the issues discussed at the HOD are as follows:
•    Health care as a “right.”  In response to a resolution asking the AMA to support health care as a “right,” the Board of Trustees reaffirmed current policy supporting expanded access to health care for all but stopped short of calling health care a “right.”
•    POLST forms. The Board of Trustees will work with state organizations and others to recognize Physician Orders for Life Sustaining Treatment (POLST) forms and allow for reciprocity between states.
•    Influenza vaccination. The HOD enacted as AMA policy that no health-care worker should be terminated from employment due solely to their refusal to be vaccinated for influenza. 
•    e-Cigarettes and tobacco.

A.    The AMA was instructed to urge federal officials, including but not limited to the US Food and Drug Administration (FDA), to prohibit the sale of any e-cigarette cartridge that does not include a complete list of ingredients on its packaging, in the order of prevalence (similar to food labeling). We will also urge federal officials, including but not limited to the FDA, to require that accurate nicotine content of e-cigarettes be prominently displayed on the product alongside a warning of the addictive quality of nicotine (new HOD policy). 

B.    Develop a report on the individual health and public health implications of a low nicotine standard for cigarettes. Such a report should consider and make recommendations on scientific criteria for selection of a nicotine standard that is nonaddictive, regulatory strategies to ensure compliance with an established standard, and how a low-nicotine standard should work with other nicotine products in a well-regulated nicotine market. American Medical Association consider joining other medical organizations in an amicus brief supporting the American Academy of Pediatrics legal action to compel the US Food and Drug Administration to take timely action to establish effective regulation of e-cigarettes, cigars, and other nicotine tobacco products (Directive to Take Action).

•    Prior authorization for durable medical equipment.  The AMA will advocate that denials of prior authorization for durable medical equipment must be based on true medical necessity not arbitrary time limits or other paperwork issues and will continue to work to improve the prior authorization process for Medicare Managed Care Plans (Directive to Take Action).
•    Medical training (including IMG, Medical students, Residents, and Fellows). 

A.    EHR and Business training during Med Ed and residency 

B.    Fellowship Start Date.  The AMA will survey physicians who have experienced a fellowship start date of August 1 to further evaluate the benefits and drawbacks from this transition (Directive to Take Action).

•    Opioid abuse. Surgeon General Jerome Adams addressed the HOD about several topics but focused on opioid crisis.
•    Physician Burnout and Organizational efficiency. Physician burnout is a health-care crisis in all specialties, and critical care has a very high rate of physician burnout. The AMA has several tools available that can help with physician burnout both in the ICU and outpatient medicine. (https://www.stepsforward.org)

This is just a small sampling of the activities at the HOD.  More information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org. 

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both CHEST members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST Physician. One of the authors (DRM) was the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new AMA delegate. 

The American Medical Association (AMA) had its Annual Meeting of the House of Delegates (HOD) from May 9-13.  This meeting was attended by over 1,000 physicians who  are delegates from all geographic societies, ie, state societies and specialties and subspecialties, as well as the uniformed services. 

Policy and resolutions 

Process: 
Policies originate via resolutions submitted by individuals or societies.  These resolutions then go to one of several Reference Committees for open discussion.  These committees then report their recommendations back to the HOD, which then discusses and votes on the recommendations. In some instances, the question is referred for further studies by one of several Councils, which reports go to the Board of Trustees or back to the House.  The diagram below explains the flow of resolutions to policies.

Chest/Allergy Section Council  (which is composed of CHEST, ATS, SCCM, AASM, and several allergy specialty organizations) meets prior to the voting in the House to discuss the pending business. The Specialty and Service Society (SSS) is the largest caucus in the AMA’s House of Delegates and is composed of all the delegates from the specialty societies, as well as the uniformed services.  
There are two categories of groups in the SSS: those societies that have seats in the HOD and those seeking admission to the house.

SSS groups in the HOD include:
•    119 national medical specialties
•    2 professional interest medical associations
•    5 military or uniformed service groups (the Public Health Service is “uniformed” but not “military” or “armed”)

The compendium of policies covers the entire range of topics impacting the practice of medicine – ethics, legislation, regulation, public health, individual health, and medical education, among them.  The full range of policies can be found in the AMA’s Policy Manual available on the web site, AMA-assn.org

Some of the issues discussed at the HOD are as follows:
•    Health care as a “right.”  In response to a resolution asking the AMA to support health care as a “right,” the Board of Trustees reaffirmed current policy supporting expanded access to health care for all but stopped short of calling health care a “right.”
•    POLST forms. The Board of Trustees will work with state organizations and others to recognize Physician Orders for Life Sustaining Treatment (POLST) forms and allow for reciprocity between states.
•    Influenza vaccination. The HOD enacted as AMA policy that no health-care worker should be terminated from employment due solely to their refusal to be vaccinated for influenza. 
•    e-Cigarettes and tobacco.

A.    The AMA was instructed to urge federal officials, including but not limited to the US Food and Drug Administration (FDA), to prohibit the sale of any e-cigarette cartridge that does not include a complete list of ingredients on its packaging, in the order of prevalence (similar to food labeling). We will also urge federal officials, including but not limited to the FDA, to require that accurate nicotine content of e-cigarettes be prominently displayed on the product alongside a warning of the addictive quality of nicotine (new HOD policy). 

B.    Develop a report on the individual health and public health implications of a low nicotine standard for cigarettes. Such a report should consider and make recommendations on scientific criteria for selection of a nicotine standard that is nonaddictive, regulatory strategies to ensure compliance with an established standard, and how a low-nicotine standard should work with other nicotine products in a well-regulated nicotine market. American Medical Association consider joining other medical organizations in an amicus brief supporting the American Academy of Pediatrics legal action to compel the US Food and Drug Administration to take timely action to establish effective regulation of e-cigarettes, cigars, and other nicotine tobacco products (Directive to Take Action).

•    Prior authorization for durable medical equipment.  The AMA will advocate that denials of prior authorization for durable medical equipment must be based on true medical necessity not arbitrary time limits or other paperwork issues and will continue to work to improve the prior authorization process for Medicare Managed Care Plans (Directive to Take Action).
•    Medical training (including IMG, Medical students, Residents, and Fellows). 

A.    EHR and Business training during Med Ed and residency 

B.    Fellowship Start Date.  The AMA will survey physicians who have experienced a fellowship start date of August 1 to further evaluate the benefits and drawbacks from this transition (Directive to Take Action).

•    Opioid abuse. Surgeon General Jerome Adams addressed the HOD about several topics but focused on opioid crisis.
•    Physician Burnout and Organizational efficiency. Physician burnout is a health-care crisis in all specialties, and critical care has a very high rate of physician burnout. The AMA has several tools available that can help with physician burnout both in the ICU and outpatient medicine. (https://www.stepsforward.org)

This is just a small sampling of the activities at the HOD.  More information, including reports from the various Councils, are available on the AMA website, http://ama-assn.org. 

As many who read CHEST® Physician may know, we have a nucleus of dedicated volunteers who give unselfishly of their time and talent to represent our members in the area of “regulatory advocacy” and “policy advocacy” in the areas of pulmonary, critical care, and sleep medicine. It is our goal to recognize and support this valuable group of individuals who represent us in the space of coding and reimbursement, RUC activities, relationships with organizations like the ACP and the AMA, as well as our sister societies, such as ATS, SCCM, NAMDRC, CCNA, APSR, ALAT, and ERS, among others.

One of our goals, in addition to recognizing this group, is to identify and mentor the next generation of representatives. A great example of this mentorship is reflected in our involvement with the AMA. Dr. Bob McCaffree has represented CHEST for 22 years and is now mentoring Dr. Raj Desai who will be assuming this role of AMA Delegate this year. Special thanks to Dr. McCaffree for his unselfish service in this capacity and for his mentorship of Dr. Desai. I hope that you enjoy this and future CHEST® Physician articles summarizing and reflecting on the activities pertinent to CHEST at the AMA.

John Studdard, MD, FCCP

CHEST President

Collaborating with societies: CHEST and AMA

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST^® Physician. One of the authors (DRM) has been the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new delegate.

• Create thriving physician practices.
• Create the medical school of the future.
• Improve health outcomes.

We will expand on these in future articles.

The AMA is both an individual member organization and a federation of geographic, ie, county and state, societies and specialty societies, as well as the uniformed services and the VA. It is this federation that comprises the House of Delegates (HOD or House), which is the principle policy-making body of the AMA. The number of delegates from each member organization (now numbering more than 170 organizations) depends on the number of individual AMA members among that organization’s members. Due to recent bylaws changes, CHEST now has two delegates. The HOD meets twice per year to establish policy on health, medical, professional, and governance matters, as well as the principles within which the AMA’s business activities are conducted.

• 119 national medical specialties
• 2 professional interest medical associations
• 5 military service groups

An association must first be represented in the SSS for 3 years and meet the required number of AMA members before it is eligible to seek admission to the HOD.

The American College of Chest Physicians (CHEST) is an active member of the SSS but also joins with other societies of similar interests in the Section Council on Chest and Allergic Diseases. This caucus includes the ATS, SCCM, ASSM, and several allergy societies. Through the HOD, the SSS, and the Section Council, CHEST can partner with the AMA and other societies, such as ATS, to support each other’s resolutions or important regulatory issues.

In summary, the AMA plays an important role in many areas of interest to our members. And, it can be a useful forum for connecting with societies with similar interests in directing advocacy and setting policy. We plan to continue this update in future issues of CHEST® Physician.
 

References

1. https://www.ama-assn.org/content/ama-house-delegates Accessed: January 28, 2018

2. https://www.ama-assn.org/practice-management/ama-steps-forward-practice-improvement-strategies Accessed: January 28, 2018

As many who read CHEST® Physician may know, we have a nucleus of dedicated volunteers who give unselfishly of their time and talent to represent our members in the area of “regulatory advocacy” and “policy advocacy” in the areas of pulmonary, critical care, and sleep medicine. It is our goal to recognize and support this valuable group of individuals who represent us in the space of coding and reimbursement, RUC activities, relationships with organizations like the ACP and the AMA, as well as our sister societies, such as ATS, SCCM, NAMDRC, CCNA, APSR, ALAT, and ERS, among others.

One of our goals, in addition to recognizing this group, is to identify and mentor the next generation of representatives. A great example of this mentorship is reflected in our involvement with the AMA. Dr. Bob McCaffree has represented CHEST for 22 years and is now mentoring Dr. Raj Desai who will be assuming this role of AMA Delegate this year. Special thanks to Dr. McCaffree for his unselfish service in this capacity and for his mentorship of Dr. Desai. I hope that you enjoy this and future CHEST® Physician articles summarizing and reflecting on the activities pertinent to CHEST at the AMA.

John Studdard, MD, FCCP

CHEST President

Collaborating with societies: CHEST and AMA

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST^® Physician. One of the authors (DRM) has been the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new delegate.

• Create thriving physician practices.
• Create the medical school of the future.
• Improve health outcomes.

We will expand on these in future articles.

The AMA is both an individual member organization and a federation of geographic, ie, county and state, societies and specialty societies, as well as the uniformed services and the VA. It is this federation that comprises the House of Delegates (HOD or House), which is the principle policy-making body of the AMA. The number of delegates from each member organization (now numbering more than 170 organizations) depends on the number of individual AMA members among that organization’s members. Due to recent bylaws changes, CHEST now has two delegates. The HOD meets twice per year to establish policy on health, medical, professional, and governance matters, as well as the principles within which the AMA’s business activities are conducted.

• 119 national medical specialties
• 2 professional interest medical associations
• 5 military service groups

An association must first be represented in the SSS for 3 years and meet the required number of AMA members before it is eligible to seek admission to the HOD.

The American College of Chest Physicians (CHEST) is an active member of the SSS but also joins with other societies of similar interests in the Section Council on Chest and Allergic Diseases. This caucus includes the ATS, SCCM, ASSM, and several allergy societies. Through the HOD, the SSS, and the Section Council, CHEST can partner with the AMA and other societies, such as ATS, to support each other’s resolutions or important regulatory issues.

In summary, the AMA plays an important role in many areas of interest to our members. And, it can be a useful forum for connecting with societies with similar interests in directing advocacy and setting policy. We plan to continue this update in future issues of CHEST® Physician.
 

References

1. https://www.ama-assn.org/content/ama-house-delegates Accessed: January 28, 2018

2. https://www.ama-assn.org/practice-management/ama-steps-forward-practice-improvement-strategies Accessed: January 28, 2018

As many who read CHEST® Physician may know, we have a nucleus of dedicated volunteers who give unselfishly of their time and talent to represent our members in the area of “regulatory advocacy” and “policy advocacy” in the areas of pulmonary, critical care, and sleep medicine. It is our goal to recognize and support this valuable group of individuals who represent us in the space of coding and reimbursement, RUC activities, relationships with organizations like the ACP and the AMA, as well as our sister societies, such as ATS, SCCM, NAMDRC, CCNA, APSR, ALAT, and ERS, among others.

One of our goals, in addition to recognizing this group, is to identify and mentor the next generation of representatives. A great example of this mentorship is reflected in our involvement with the AMA. Dr. Bob McCaffree has represented CHEST for 22 years and is now mentoring Dr. Raj Desai who will be assuming this role of AMA Delegate this year. Special thanks to Dr. McCaffree for his unselfish service in this capacity and for his mentorship of Dr. Desai. I hope that you enjoy this and future CHEST® Physician articles summarizing and reflecting on the activities pertinent to CHEST at the AMA.

John Studdard, MD, FCCP

CHEST President

Collaborating with societies: CHEST and AMA

While the American Medical Association (AMA) is the oldest and largest national medical association, many physicians, both members and nonmembers, have limited understanding of the policies, processes, and strategic foci of the AMA. It is our goal to inform our membership about the workings of the AMA and how those interact with the goals of CHEST and our members. We hope to do this by publishing periodic articles in CHEST^® Physician. One of the authors (DRM) has been the CHEST delegate to the AMA for more than 20 years, and the other (NRD) is CHEST’s new delegate.

• Create thriving physician practices.
• Create the medical school of the future.
• Improve health outcomes.

We will expand on these in future articles.

The AMA is both an individual member organization and a federation of geographic, ie, county and state, societies and specialty societies, as well as the uniformed services and the VA. It is this federation that comprises the House of Delegates (HOD or House), which is the principle policy-making body of the AMA. The number of delegates from each member organization (now numbering more than 170 organizations) depends on the number of individual AMA members among that organization’s members. Due to recent bylaws changes, CHEST now has two delegates. The HOD meets twice per year to establish policy on health, medical, professional, and governance matters, as well as the principles within which the AMA’s business activities are conducted.

• 119 national medical specialties
• 2 professional interest medical associations
• 5 military service groups

An association must first be represented in the SSS for 3 years and meet the required number of AMA members before it is eligible to seek admission to the HOD.

The American College of Chest Physicians (CHEST) is an active member of the SSS but also joins with other societies of similar interests in the Section Council on Chest and Allergic Diseases. This caucus includes the ATS, SCCM, ASSM, and several allergy societies. Through the HOD, the SSS, and the Section Council, CHEST can partner with the AMA and other societies, such as ATS, to support each other’s resolutions or important regulatory issues.

In summary, the AMA plays an important role in many areas of interest to our members. And, it can be a useful forum for connecting with societies with similar interests in directing advocacy and setting policy. We plan to continue this update in future issues of CHEST® Physician.
 

References

1. https://www.ama-assn.org/content/ama-house-delegates Accessed: January 28, 2018

2. https://www.ama-assn.org/practice-management/ama-steps-forward-practice-improvement-strategies Accessed: January 28, 2018