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ACS delegation shapes policy at AMA HOD meeting
The American Medical Association (AMA) Interim Meeting of the House of Delegates (HOD) took place November 11–14, 2017, in Honolulu, HI. A total of 532 delegates were in attendance to debate the policy implications of 36 reports and 99 resolutions.
The American College of Surgeons (ACS) sent a six-member delegation to the meeting. The ACS also participates in AMA activities in other capacities, including in the AMA Young Physician Section Assembly, the AMA Resident and Fellow Section Assembly, and the AMA Council on Medical Education. These three groups met in conjunction with the HOD meeting. See the sidebar on page 74 for the list of ACS delegates and their other AMA roles.
ACS cosponsored issues
The AMA HOD brings together a variety of perspectives in medicine, and the job of the ACS delegation is to shape AMA policy consistent with College priorities. One way the ACS achieves this objective is by cosponsoring resolutions that have been submitted by other delegations and that are relevant to the College Fellowship. The ACS delegation cosponsored the following three resolutions at the November meeting—two on scope-of-practice issues and one on physician payment—all of which were adopted.
Resolution 214, Advanced Practice Registered Nurse (APRN) Compact, was initiated by the American Society of Anesthesiologists and strengthened with amendments. AMA policy opposes enactment of the Advanced APRN Multistate Compact because of its potential to supersede state laws that require APRNs to practice under physician supervision, as well as legislation that authorizes the independent practice of medicine by any individual who has not completed the state’s requirement for licensure to practice medicine. The AMA will convene an in-person meeting of relevant physician stakeholders to create a consistent national strategy to prevent fulfillment of the APRN Compact.
Resolution 230, Oppose Physician Assistant Independent Practice, with support from a spectrum of state medical and national specialty societies, continued the theme of opposition to legislation or regulation that allows physician extenders—in this case physician assistants—to practice independently. Another resolution addressed the emerging advanced physician assistant degree known as doctor of medical science. The AMA opposes holders of this degree from being recognized as a new category of health care practitioners licensed for the independent practice of medicine.
Resolution 808, Opposition to Reduced Payment for the 25-Modifier, was offered by the American Academy of Dermatology. The resolution was a response to private insurers discounting evaluation and management (E/M) codes by 50 percent when linked through the 25-modifier to a procedure on the same day. This resolution passed as simplified by amendment to have AMA aggressively and immediately advocate, through any legal means possible (such as direct payor negotiations, regulations, legislation, or litigation), for non-reduced allowable payment of appropriately reported 25-modifier E/M codes when linked with procedures.
Other HOD-adopted resolutions of interest
BOT (Board of Trustees) Report 5, Effective Peer Review, amended the AMA Physician and Medical Staff Member Bill of Rights to add “protection from any retaliatory actions” to the list of immunity rights when physicians participate in good faith peer-review activities. In testimony at the reference committee, the delegation highlighted the value of the new ACS “red book,” Optimal Resources for Surgical Quality and Safety, for establishing peer-review standards in surgical care.
Council on Science and Public Health Report 2, Targeted Education to Increase Organ Donation, amended the AMA policy, Methods to Increase the U.S. Organ Donor Pool. As a result, the AMA supports studies that evaluate the effectiveness of mandated choice and presumed consent models for increasing organ donation and urges development of effective methods to inform populations with historically low participation rates about donating.
Resolution 953, Fees for Taking Maintenance of Certification (MOC) Examination, amended AMA MOC policy to assert that the MOC process should reflect the cost of development and administration of the MOC components, ensure a fair fee structure, and not hinder patient care. The AMA will advocate that value in MOC includes cost-effectiveness with full financial transparency, respect for physicians’ time and patient care commitments, alignment of MOC requirements with other regulator and payor requirements, and adherence to an evidence basis for both MOC content and processes.
Not every item was viewed favorably at the AMA meeting. Council on Ethical and Judicial Affairs (CEJA) Report 1, Competence, Self-Assessment and Self-Awareness, sought to provide guidance for physicians in determining their own competence when practicing medicine. The council observed, “As an ethical responsibility, competence encompasses more than medical knowledge and skill. It requires physicians to understand that as a practical matter in the care of actual patients, competence is fluid and dependent on context.” Considerable testimony emphasized a lack of reliable tools and available resources to assist physicians in self-assessment. Thus, the report was referred back to CEJA for more work.
Surgical caucus
In addition to facilitating an agenda review and business meeting for surgeons, anesthesiologists, and emergency physicians, the caucus sponsored a popular education session, Hazards of the Deep: Trauma in Paradise. Michael Hayashi, MD, FACS, Chair of the Hawaii Committee on Trauma, discussed system challenges in caring for injured patients from geographically remote and less populated areas. Lieutenant Matthew Brown, MC, USN, an undersea/diving medical officer stationed at Pearl Harbor, HI, shared insights about injuries and medical conditions experienced by scuba divers, swimmers, surfers, and other beach enthusiasts.
Leadership transition
After extended service on the delegation, including eight years as Chair, Dr. Armstrong bid “aloha” to the HOD as a retiring delegate. Dr. Turner has accepted the role as Chair, maintaining continued College leadership in the HOD.
Next meeting
The next meeting of the AMA HOD is scheduled for June 9–13 in Chicago, IL. In addition to debate on numerous issues, elections for AMA officers, trustees, and councils will be held at the meeting. Surgeons with suggestions for potential resolutions or questions about ACS activities at the AMA HOD should e-mail ahp@facs.org
ACS Delegation at the AMA HOD
John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Tampa, FL
Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
Jacob Moalem, MD, FACS, general surgery, Rochester, NY
Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Chair, ACS Board of Regents
Naveen F. Sangji, MD (also Resident and Fellow Section delegate), general surgery resident, Boston, MA
Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; member and immediate past-chair, AMA Council on Medical EducationDr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, Tampa, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member, ACS Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.
The American Medical Association (AMA) Interim Meeting of the House of Delegates (HOD) took place November 11–14, 2017, in Honolulu, HI. A total of 532 delegates were in attendance to debate the policy implications of 36 reports and 99 resolutions.
The American College of Surgeons (ACS) sent a six-member delegation to the meeting. The ACS also participates in AMA activities in other capacities, including in the AMA Young Physician Section Assembly, the AMA Resident and Fellow Section Assembly, and the AMA Council on Medical Education. These three groups met in conjunction with the HOD meeting. See the sidebar on page 74 for the list of ACS delegates and their other AMA roles.
ACS cosponsored issues
The AMA HOD brings together a variety of perspectives in medicine, and the job of the ACS delegation is to shape AMA policy consistent with College priorities. One way the ACS achieves this objective is by cosponsoring resolutions that have been submitted by other delegations and that are relevant to the College Fellowship. The ACS delegation cosponsored the following three resolutions at the November meeting—two on scope-of-practice issues and one on physician payment—all of which were adopted.
Resolution 214, Advanced Practice Registered Nurse (APRN) Compact, was initiated by the American Society of Anesthesiologists and strengthened with amendments. AMA policy opposes enactment of the Advanced APRN Multistate Compact because of its potential to supersede state laws that require APRNs to practice under physician supervision, as well as legislation that authorizes the independent practice of medicine by any individual who has not completed the state’s requirement for licensure to practice medicine. The AMA will convene an in-person meeting of relevant physician stakeholders to create a consistent national strategy to prevent fulfillment of the APRN Compact.
Resolution 230, Oppose Physician Assistant Independent Practice, with support from a spectrum of state medical and national specialty societies, continued the theme of opposition to legislation or regulation that allows physician extenders—in this case physician assistants—to practice independently. Another resolution addressed the emerging advanced physician assistant degree known as doctor of medical science. The AMA opposes holders of this degree from being recognized as a new category of health care practitioners licensed for the independent practice of medicine.
Resolution 808, Opposition to Reduced Payment for the 25-Modifier, was offered by the American Academy of Dermatology. The resolution was a response to private insurers discounting evaluation and management (E/M) codes by 50 percent when linked through the 25-modifier to a procedure on the same day. This resolution passed as simplified by amendment to have AMA aggressively and immediately advocate, through any legal means possible (such as direct payor negotiations, regulations, legislation, or litigation), for non-reduced allowable payment of appropriately reported 25-modifier E/M codes when linked with procedures.
Other HOD-adopted resolutions of interest
BOT (Board of Trustees) Report 5, Effective Peer Review, amended the AMA Physician and Medical Staff Member Bill of Rights to add “protection from any retaliatory actions” to the list of immunity rights when physicians participate in good faith peer-review activities. In testimony at the reference committee, the delegation highlighted the value of the new ACS “red book,” Optimal Resources for Surgical Quality and Safety, for establishing peer-review standards in surgical care.
Council on Science and Public Health Report 2, Targeted Education to Increase Organ Donation, amended the AMA policy, Methods to Increase the U.S. Organ Donor Pool. As a result, the AMA supports studies that evaluate the effectiveness of mandated choice and presumed consent models for increasing organ donation and urges development of effective methods to inform populations with historically low participation rates about donating.
Resolution 953, Fees for Taking Maintenance of Certification (MOC) Examination, amended AMA MOC policy to assert that the MOC process should reflect the cost of development and administration of the MOC components, ensure a fair fee structure, and not hinder patient care. The AMA will advocate that value in MOC includes cost-effectiveness with full financial transparency, respect for physicians’ time and patient care commitments, alignment of MOC requirements with other regulator and payor requirements, and adherence to an evidence basis for both MOC content and processes.
Not every item was viewed favorably at the AMA meeting. Council on Ethical and Judicial Affairs (CEJA) Report 1, Competence, Self-Assessment and Self-Awareness, sought to provide guidance for physicians in determining their own competence when practicing medicine. The council observed, “As an ethical responsibility, competence encompasses more than medical knowledge and skill. It requires physicians to understand that as a practical matter in the care of actual patients, competence is fluid and dependent on context.” Considerable testimony emphasized a lack of reliable tools and available resources to assist physicians in self-assessment. Thus, the report was referred back to CEJA for more work.
Surgical caucus
In addition to facilitating an agenda review and business meeting for surgeons, anesthesiologists, and emergency physicians, the caucus sponsored a popular education session, Hazards of the Deep: Trauma in Paradise. Michael Hayashi, MD, FACS, Chair of the Hawaii Committee on Trauma, discussed system challenges in caring for injured patients from geographically remote and less populated areas. Lieutenant Matthew Brown, MC, USN, an undersea/diving medical officer stationed at Pearl Harbor, HI, shared insights about injuries and medical conditions experienced by scuba divers, swimmers, surfers, and other beach enthusiasts.
Leadership transition
After extended service on the delegation, including eight years as Chair, Dr. Armstrong bid “aloha” to the HOD as a retiring delegate. Dr. Turner has accepted the role as Chair, maintaining continued College leadership in the HOD.
Next meeting
The next meeting of the AMA HOD is scheduled for June 9–13 in Chicago, IL. In addition to debate on numerous issues, elections for AMA officers, trustees, and councils will be held at the meeting. Surgeons with suggestions for potential resolutions or questions about ACS activities at the AMA HOD should e-mail ahp@facs.org
ACS Delegation at the AMA HOD
John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Tampa, FL
Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
Jacob Moalem, MD, FACS, general surgery, Rochester, NY
Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Chair, ACS Board of Regents
Naveen F. Sangji, MD (also Resident and Fellow Section delegate), general surgery resident, Boston, MA
Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; member and immediate past-chair, AMA Council on Medical EducationDr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, Tampa, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member, ACS Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.
The American Medical Association (AMA) Interim Meeting of the House of Delegates (HOD) took place November 11–14, 2017, in Honolulu, HI. A total of 532 delegates were in attendance to debate the policy implications of 36 reports and 99 resolutions.
The American College of Surgeons (ACS) sent a six-member delegation to the meeting. The ACS also participates in AMA activities in other capacities, including in the AMA Young Physician Section Assembly, the AMA Resident and Fellow Section Assembly, and the AMA Council on Medical Education. These three groups met in conjunction with the HOD meeting. See the sidebar on page 74 for the list of ACS delegates and their other AMA roles.
ACS cosponsored issues
The AMA HOD brings together a variety of perspectives in medicine, and the job of the ACS delegation is to shape AMA policy consistent with College priorities. One way the ACS achieves this objective is by cosponsoring resolutions that have been submitted by other delegations and that are relevant to the College Fellowship. The ACS delegation cosponsored the following three resolutions at the November meeting—two on scope-of-practice issues and one on physician payment—all of which were adopted.
Resolution 214, Advanced Practice Registered Nurse (APRN) Compact, was initiated by the American Society of Anesthesiologists and strengthened with amendments. AMA policy opposes enactment of the Advanced APRN Multistate Compact because of its potential to supersede state laws that require APRNs to practice under physician supervision, as well as legislation that authorizes the independent practice of medicine by any individual who has not completed the state’s requirement for licensure to practice medicine. The AMA will convene an in-person meeting of relevant physician stakeholders to create a consistent national strategy to prevent fulfillment of the APRN Compact.
Resolution 230, Oppose Physician Assistant Independent Practice, with support from a spectrum of state medical and national specialty societies, continued the theme of opposition to legislation or regulation that allows physician extenders—in this case physician assistants—to practice independently. Another resolution addressed the emerging advanced physician assistant degree known as doctor of medical science. The AMA opposes holders of this degree from being recognized as a new category of health care practitioners licensed for the independent practice of medicine.
Resolution 808, Opposition to Reduced Payment for the 25-Modifier, was offered by the American Academy of Dermatology. The resolution was a response to private insurers discounting evaluation and management (E/M) codes by 50 percent when linked through the 25-modifier to a procedure on the same day. This resolution passed as simplified by amendment to have AMA aggressively and immediately advocate, through any legal means possible (such as direct payor negotiations, regulations, legislation, or litigation), for non-reduced allowable payment of appropriately reported 25-modifier E/M codes when linked with procedures.
Other HOD-adopted resolutions of interest
BOT (Board of Trustees) Report 5, Effective Peer Review, amended the AMA Physician and Medical Staff Member Bill of Rights to add “protection from any retaliatory actions” to the list of immunity rights when physicians participate in good faith peer-review activities. In testimony at the reference committee, the delegation highlighted the value of the new ACS “red book,” Optimal Resources for Surgical Quality and Safety, for establishing peer-review standards in surgical care.
Council on Science and Public Health Report 2, Targeted Education to Increase Organ Donation, amended the AMA policy, Methods to Increase the U.S. Organ Donor Pool. As a result, the AMA supports studies that evaluate the effectiveness of mandated choice and presumed consent models for increasing organ donation and urges development of effective methods to inform populations with historically low participation rates about donating.
Resolution 953, Fees for Taking Maintenance of Certification (MOC) Examination, amended AMA MOC policy to assert that the MOC process should reflect the cost of development and administration of the MOC components, ensure a fair fee structure, and not hinder patient care. The AMA will advocate that value in MOC includes cost-effectiveness with full financial transparency, respect for physicians’ time and patient care commitments, alignment of MOC requirements with other regulator and payor requirements, and adherence to an evidence basis for both MOC content and processes.
Not every item was viewed favorably at the AMA meeting. Council on Ethical and Judicial Affairs (CEJA) Report 1, Competence, Self-Assessment and Self-Awareness, sought to provide guidance for physicians in determining their own competence when practicing medicine. The council observed, “As an ethical responsibility, competence encompasses more than medical knowledge and skill. It requires physicians to understand that as a practical matter in the care of actual patients, competence is fluid and dependent on context.” Considerable testimony emphasized a lack of reliable tools and available resources to assist physicians in self-assessment. Thus, the report was referred back to CEJA for more work.
Surgical caucus
In addition to facilitating an agenda review and business meeting for surgeons, anesthesiologists, and emergency physicians, the caucus sponsored a popular education session, Hazards of the Deep: Trauma in Paradise. Michael Hayashi, MD, FACS, Chair of the Hawaii Committee on Trauma, discussed system challenges in caring for injured patients from geographically remote and less populated areas. Lieutenant Matthew Brown, MC, USN, an undersea/diving medical officer stationed at Pearl Harbor, HI, shared insights about injuries and medical conditions experienced by scuba divers, swimmers, surfers, and other beach enthusiasts.
Leadership transition
After extended service on the delegation, including eight years as Chair, Dr. Armstrong bid “aloha” to the HOD as a retiring delegate. Dr. Turner has accepted the role as Chair, maintaining continued College leadership in the HOD.
Next meeting
The next meeting of the AMA HOD is scheduled for June 9–13 in Chicago, IL. In addition to debate on numerous issues, elections for AMA officers, trustees, and councils will be held at the meeting. Surgeons with suggestions for potential resolutions or questions about ACS activities at the AMA HOD should e-mail ahp@facs.org
ACS Delegation at the AMA HOD
John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Tampa, FL
Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
Jacob Moalem, MD, FACS, general surgery, Rochester, NY
Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Chair, ACS Board of Regents
Naveen F. Sangji, MD (also Resident and Fellow Section delegate), general surgery resident, Boston, MA
Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; member and immediate past-chair, AMA Council on Medical EducationDr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, Tampa, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member, ACS Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.
ACS delegation influences AMA policy at HOD meeting
The American Medical Association (AMA) annual House of Delegates (HOD) meeting took place June 10–14, in Chicago, IL. The agenda included 62 reports from the AMA board and councils and 186 resolutions from state medical associations, specialty societies, and AMA sections.
The uncertain mood of the HOD was shaped by congressional activity on the Affordable Care Act and a competitive election for AMA president-elect. At the start of the meeting’s final day, the HOD paused to remember the lives lost and changed one year earlier at the Pulse nightclub in Orlando, FL. The HOD also noted the value of American College of Surgeons (ACS) Stop the Bleed® training in response to the shooting June 14 at the Republican congressional baseball team practice in Alexandria, VA.
In the AMA House of Delegates, which is composed of 545 members, the College was represented by its six-member delegation.
The meeting has eight reference committees that focus on the following issues: bylaws and medical ethics, health care system, legislation, medical education, public health, medical science and technology, governance, and medical practice. John H. Armstrong, MD, FACS, co-author of this article, chaired Reference Committee A, which reviewed items pertaining to the health care system. This article provides an overview of several issues of relevance to ACS members.
Medical education
The priority issue for the ACS at this meeting was protecting the profession’s autonomy in defining the standards of lifelong learning through Maintenance of Certification (MOC). Five items related to MOC and Continuing Medical Education (CME) resulted in considerable debate. Internists and medical specialists were particularly frustrated by their experiences with their certifying boards. While acknowledging opportunities to improve MOC, the College delegation took the lead in collaborating with other specialty and state societies to argue against referring MOC to the state legislatures and in creating a new solely CME-based certification system.
• Council on Medical Education Report 2, Update on Maintenance of Certification and Osteopathic Continuous Certification, provided an overview of board-specific MOC innovations that increase relevance and reduce cost. The report was amended to have the AMA advocate that physicians who participate in programs related to quality improvement and/or patient safety should receive credit for MOC Part IV.
• Resolution 302, Comprehensive Review of CME Process, directed the AMA, in collaboration with the Accreditation Council for Continuing Medical Education, to conduct a comprehensive review of the CME process on a national level, with the goal of decreasing costs and simplifying the process of providing CME.
• Resolution 316, Action Steps Regarding Maintenance of Certification, sponsored by the largest state delegations in the HOD (Arizona, California, Florida, Georgia, New York, Pennsylvania, and Texas), sought to extend AMA model state legislation against MOC by barring hospitals, health care insurers, and state licensing boards from linking nonparticipation in the American Board of Medical Specialties (ABMS) MOC process to exclusion from credentialing. Further, it sought to create AMA policy that would replace MOC with high-quality CME under the purview of a physician’s specialty society solely as the demonstration of lifelong learning in hospital, insurance, and licensing credentialing. The HOD conversation shifted from restricting how hospitals, licensing boards, and insurers can use MOC, to redefining MOC.
To address this challenge to professional autonomy while emphasizing the need for responsiveness to concerns across boards, the ACS Delegation applied a strategy that involved prepared talking points; caucus presentations by ACS Executive Director David B. Hoyt, MD, FACS, and Dr. Armstrong; reference committee testimony from Dr. Hoyt and Vice-Chair of the ACS Board of Regents Leigh A. Neumayer, MD, FACS, and ACS Regent James Denneny, MD, FACS, executive director, American Academy of Otolaryngology-Head and Neck Surgery; as well as hallway conversations and HOD floor discussion. As a result, the AMA affirmed that lifelong learning is a fundamental obligation of the profession and recognizes that, for a physician, it is best achieved through ongoing participation in a program of high-quality CME appropriate to the physician’s medical practice as determined by the relevant specialty society. The concept of the AMA lobbying hospital associations, health care insurers, and state licensing boards to not use the ABMS-sponsored MOC process with lifelong interval high stakes testing for credentialing, in addition to the idea of the AMA partnering with state medical associations and specialty societies to undertake a study to establish a separate program of certification by 2020, were referred for further consideration. The ACS will continue to emphasize that a core element of professionalism is self-regulation of lifelong learning through standard-setting.
• Resolution 318, Oppose Direct-to-Consumer Advertising of the ABMS MOC Product, asked the AMA to oppose direct-to-consumer marketing of the ABMS MOC product in print media, social media, apps, and websites that specifically target patients and their families, including but not limited to the promotion of false or misleading claims linking MOC participation with improved patient health outcomes and experiences where limited evidence exists. This item was referred for further study.
• Resolution 319, Public Access to Initial Board Certification Status of Time-Limited ABMS Diplomates, was adopted. The AMA now advocates that the initial certification status of time-limited diplomates be listed and publicly available on all ABMS and ABMS member board websites and physician certification databases and that the names and initial certification status of time-limited diplomates remain on ABMS and ABMS member board websites or physician certification databases, even if the diplomate opts out of MOC participation.
Health system
• Council on Medical Service Report 6, Expansion of U.S. Veterans’ Health Care Choices, was adopted with an amendment offered by the ACS delegation. The AMA will encourage the Veterans Health Administration (VHA) to engage with VHA physicians to explore and develop solutions to improve the health care choices of veterans. The AMA also will continue to support efforts to improve the Veterans Choice Program (VCP) and make it permanent, advocate for new funding to support expansion of the VCP, and encourage the acceleration of interoperability of electronic personal and health records and the exchange of medical records between VHA and non-VHA physicians.
• Substitute Resolution 115, Out-of-Network Care, combined four resolutions on the subject of greatest interest in the Reference Committee A hearing—surprise (unanticipated) billing for out-of-network care. It was adopted with eight AMA principles regarding unanticipated out-of-network care and AMA development of model state legislation addressing the coverage of and payment for unexpected unanticipated out-of-network care.
Public health
• Resolution 419, Improving Physicians’ Ability to Discuss Firearm Safety, was adopted with minor amendments. As a result, the AMA is working with appropriate stakeholders to develop state-specific guidance for physicians on how to counsel patients to reduce their risk for firearm-related injury or death by suicide, including guidance on when and how to ask sensitive questions about firearm ownership, access, and use; and clarification on the circumstances under which physicians are permitted or may be required to disclose the content of such conversations to family members, law enforcement, or other third parties.
Medical practice
• Substitute Resolution 706, Concurrent and Overlapping Surgery, was adopted. The AMA will work with interested national medical specialty societies on issues related to concurrent and overlapping surgery.
AMA elections
The June meeting is when AMA officers, trustees, and councilors are elected. Barbara McAneny, MD, an oncologist from New Mexico, was elected AMA president-elect. Three ACS-endorsed candidates were successful in their bids to serve on the Council on Medical Education. Liana Puscas, MD, MHS, FACS, associate professor of surgery, Duke University School of Medicine, Durham, NC, and Luke Selby, MD, a general surgery resident, University of Colorado School of Medicine, Denver, were reelected; Krystal Tomei, MD, assistant professor of neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, was elected.
Surgical Caucus
The Surgical Caucus hosted a well-attended educational session, Cultivating and Protecting Your Digital Presence: Do’s and Don’ts of Social Media. Speakers included Deanna Attai, MD, FACS, a breast surgeon and assistant clinical professor of surgery, David Geffen School of Medicine, University of California, Los Angeles, and Ravi Goel, MD, an ophthalmologist in private practice in Cherry Hill, NJ, and delegate from the American Academy of Ophthalmology. Both presentations emphasized that surgeons need to manage their online reputation in practice reviews and other web content. Drs. Attai and Goel provided constructive ideas for personal and professional branding through social media, as well as practical ways for surgeons to build and protect their social media reputation. Both presentations are available on the Surgical Caucus web page at facs.org/advocacy/ama-house-of-delegates/surgical-caucus.
The ACS delegation successfully put forth the College’s priorities at the June AMA HOD meeting. The delegation is now working with the ACS Division of Advocacy and Health Policy, the Health Policy and Advocacy Group, and other committees to develop next steps in shaping AMA policy consistent with College principles.
The next AMA meeting is the Interim Meeting in Honolulu, HI, November 11–14. The College’s delegation welcomes input from Fellows regarding issues of importance to surgeons. Comments and questions should be directed to jsutton@facs.org.
ACS delegation at the AMA HOD
John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL
Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
Jacob Moalem, MD, FACS, general surgery, Rochester, NY
Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents
Naveen F. Sangji, MD, (also Resident and Fellow Section delegate), general surgery resident, Boston, MA
Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education
Dr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.
The American Medical Association (AMA) annual House of Delegates (HOD) meeting took place June 10–14, in Chicago, IL. The agenda included 62 reports from the AMA board and councils and 186 resolutions from state medical associations, specialty societies, and AMA sections.
The uncertain mood of the HOD was shaped by congressional activity on the Affordable Care Act and a competitive election for AMA president-elect. At the start of the meeting’s final day, the HOD paused to remember the lives lost and changed one year earlier at the Pulse nightclub in Orlando, FL. The HOD also noted the value of American College of Surgeons (ACS) Stop the Bleed® training in response to the shooting June 14 at the Republican congressional baseball team practice in Alexandria, VA.
In the AMA House of Delegates, which is composed of 545 members, the College was represented by its six-member delegation.
The meeting has eight reference committees that focus on the following issues: bylaws and medical ethics, health care system, legislation, medical education, public health, medical science and technology, governance, and medical practice. John H. Armstrong, MD, FACS, co-author of this article, chaired Reference Committee A, which reviewed items pertaining to the health care system. This article provides an overview of several issues of relevance to ACS members.
Medical education
The priority issue for the ACS at this meeting was protecting the profession’s autonomy in defining the standards of lifelong learning through Maintenance of Certification (MOC). Five items related to MOC and Continuing Medical Education (CME) resulted in considerable debate. Internists and medical specialists were particularly frustrated by their experiences with their certifying boards. While acknowledging opportunities to improve MOC, the College delegation took the lead in collaborating with other specialty and state societies to argue against referring MOC to the state legislatures and in creating a new solely CME-based certification system.
• Council on Medical Education Report 2, Update on Maintenance of Certification and Osteopathic Continuous Certification, provided an overview of board-specific MOC innovations that increase relevance and reduce cost. The report was amended to have the AMA advocate that physicians who participate in programs related to quality improvement and/or patient safety should receive credit for MOC Part IV.
• Resolution 302, Comprehensive Review of CME Process, directed the AMA, in collaboration with the Accreditation Council for Continuing Medical Education, to conduct a comprehensive review of the CME process on a national level, with the goal of decreasing costs and simplifying the process of providing CME.
• Resolution 316, Action Steps Regarding Maintenance of Certification, sponsored by the largest state delegations in the HOD (Arizona, California, Florida, Georgia, New York, Pennsylvania, and Texas), sought to extend AMA model state legislation against MOC by barring hospitals, health care insurers, and state licensing boards from linking nonparticipation in the American Board of Medical Specialties (ABMS) MOC process to exclusion from credentialing. Further, it sought to create AMA policy that would replace MOC with high-quality CME under the purview of a physician’s specialty society solely as the demonstration of lifelong learning in hospital, insurance, and licensing credentialing. The HOD conversation shifted from restricting how hospitals, licensing boards, and insurers can use MOC, to redefining MOC.
To address this challenge to professional autonomy while emphasizing the need for responsiveness to concerns across boards, the ACS Delegation applied a strategy that involved prepared talking points; caucus presentations by ACS Executive Director David B. Hoyt, MD, FACS, and Dr. Armstrong; reference committee testimony from Dr. Hoyt and Vice-Chair of the ACS Board of Regents Leigh A. Neumayer, MD, FACS, and ACS Regent James Denneny, MD, FACS, executive director, American Academy of Otolaryngology-Head and Neck Surgery; as well as hallway conversations and HOD floor discussion. As a result, the AMA affirmed that lifelong learning is a fundamental obligation of the profession and recognizes that, for a physician, it is best achieved through ongoing participation in a program of high-quality CME appropriate to the physician’s medical practice as determined by the relevant specialty society. The concept of the AMA lobbying hospital associations, health care insurers, and state licensing boards to not use the ABMS-sponsored MOC process with lifelong interval high stakes testing for credentialing, in addition to the idea of the AMA partnering with state medical associations and specialty societies to undertake a study to establish a separate program of certification by 2020, were referred for further consideration. The ACS will continue to emphasize that a core element of professionalism is self-regulation of lifelong learning through standard-setting.
• Resolution 318, Oppose Direct-to-Consumer Advertising of the ABMS MOC Product, asked the AMA to oppose direct-to-consumer marketing of the ABMS MOC product in print media, social media, apps, and websites that specifically target patients and their families, including but not limited to the promotion of false or misleading claims linking MOC participation with improved patient health outcomes and experiences where limited evidence exists. This item was referred for further study.
• Resolution 319, Public Access to Initial Board Certification Status of Time-Limited ABMS Diplomates, was adopted. The AMA now advocates that the initial certification status of time-limited diplomates be listed and publicly available on all ABMS and ABMS member board websites and physician certification databases and that the names and initial certification status of time-limited diplomates remain on ABMS and ABMS member board websites or physician certification databases, even if the diplomate opts out of MOC participation.
Health system
• Council on Medical Service Report 6, Expansion of U.S. Veterans’ Health Care Choices, was adopted with an amendment offered by the ACS delegation. The AMA will encourage the Veterans Health Administration (VHA) to engage with VHA physicians to explore and develop solutions to improve the health care choices of veterans. The AMA also will continue to support efforts to improve the Veterans Choice Program (VCP) and make it permanent, advocate for new funding to support expansion of the VCP, and encourage the acceleration of interoperability of electronic personal and health records and the exchange of medical records between VHA and non-VHA physicians.
• Substitute Resolution 115, Out-of-Network Care, combined four resolutions on the subject of greatest interest in the Reference Committee A hearing—surprise (unanticipated) billing for out-of-network care. It was adopted with eight AMA principles regarding unanticipated out-of-network care and AMA development of model state legislation addressing the coverage of and payment for unexpected unanticipated out-of-network care.
Public health
• Resolution 419, Improving Physicians’ Ability to Discuss Firearm Safety, was adopted with minor amendments. As a result, the AMA is working with appropriate stakeholders to develop state-specific guidance for physicians on how to counsel patients to reduce their risk for firearm-related injury or death by suicide, including guidance on when and how to ask sensitive questions about firearm ownership, access, and use; and clarification on the circumstances under which physicians are permitted or may be required to disclose the content of such conversations to family members, law enforcement, or other third parties.
Medical practice
• Substitute Resolution 706, Concurrent and Overlapping Surgery, was adopted. The AMA will work with interested national medical specialty societies on issues related to concurrent and overlapping surgery.
AMA elections
The June meeting is when AMA officers, trustees, and councilors are elected. Barbara McAneny, MD, an oncologist from New Mexico, was elected AMA president-elect. Three ACS-endorsed candidates were successful in their bids to serve on the Council on Medical Education. Liana Puscas, MD, MHS, FACS, associate professor of surgery, Duke University School of Medicine, Durham, NC, and Luke Selby, MD, a general surgery resident, University of Colorado School of Medicine, Denver, were reelected; Krystal Tomei, MD, assistant professor of neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, was elected.
Surgical Caucus
The Surgical Caucus hosted a well-attended educational session, Cultivating and Protecting Your Digital Presence: Do’s and Don’ts of Social Media. Speakers included Deanna Attai, MD, FACS, a breast surgeon and assistant clinical professor of surgery, David Geffen School of Medicine, University of California, Los Angeles, and Ravi Goel, MD, an ophthalmologist in private practice in Cherry Hill, NJ, and delegate from the American Academy of Ophthalmology. Both presentations emphasized that surgeons need to manage their online reputation in practice reviews and other web content. Drs. Attai and Goel provided constructive ideas for personal and professional branding through social media, as well as practical ways for surgeons to build and protect their social media reputation. Both presentations are available on the Surgical Caucus web page at facs.org/advocacy/ama-house-of-delegates/surgical-caucus.
The ACS delegation successfully put forth the College’s priorities at the June AMA HOD meeting. The delegation is now working with the ACS Division of Advocacy and Health Policy, the Health Policy and Advocacy Group, and other committees to develop next steps in shaping AMA policy consistent with College principles.
The next AMA meeting is the Interim Meeting in Honolulu, HI, November 11–14. The College’s delegation welcomes input from Fellows regarding issues of importance to surgeons. Comments and questions should be directed to jsutton@facs.org.
ACS delegation at the AMA HOD
John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL
Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
Jacob Moalem, MD, FACS, general surgery, Rochester, NY
Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents
Naveen F. Sangji, MD, (also Resident and Fellow Section delegate), general surgery resident, Boston, MA
Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education
Dr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.
The American Medical Association (AMA) annual House of Delegates (HOD) meeting took place June 10–14, in Chicago, IL. The agenda included 62 reports from the AMA board and councils and 186 resolutions from state medical associations, specialty societies, and AMA sections.
The uncertain mood of the HOD was shaped by congressional activity on the Affordable Care Act and a competitive election for AMA president-elect. At the start of the meeting’s final day, the HOD paused to remember the lives lost and changed one year earlier at the Pulse nightclub in Orlando, FL. The HOD also noted the value of American College of Surgeons (ACS) Stop the Bleed® training in response to the shooting June 14 at the Republican congressional baseball team practice in Alexandria, VA.
In the AMA House of Delegates, which is composed of 545 members, the College was represented by its six-member delegation.
The meeting has eight reference committees that focus on the following issues: bylaws and medical ethics, health care system, legislation, medical education, public health, medical science and technology, governance, and medical practice. John H. Armstrong, MD, FACS, co-author of this article, chaired Reference Committee A, which reviewed items pertaining to the health care system. This article provides an overview of several issues of relevance to ACS members.
Medical education
The priority issue for the ACS at this meeting was protecting the profession’s autonomy in defining the standards of lifelong learning through Maintenance of Certification (MOC). Five items related to MOC and Continuing Medical Education (CME) resulted in considerable debate. Internists and medical specialists were particularly frustrated by their experiences with their certifying boards. While acknowledging opportunities to improve MOC, the College delegation took the lead in collaborating with other specialty and state societies to argue against referring MOC to the state legislatures and in creating a new solely CME-based certification system.
• Council on Medical Education Report 2, Update on Maintenance of Certification and Osteopathic Continuous Certification, provided an overview of board-specific MOC innovations that increase relevance and reduce cost. The report was amended to have the AMA advocate that physicians who participate in programs related to quality improvement and/or patient safety should receive credit for MOC Part IV.
• Resolution 302, Comprehensive Review of CME Process, directed the AMA, in collaboration with the Accreditation Council for Continuing Medical Education, to conduct a comprehensive review of the CME process on a national level, with the goal of decreasing costs and simplifying the process of providing CME.
• Resolution 316, Action Steps Regarding Maintenance of Certification, sponsored by the largest state delegations in the HOD (Arizona, California, Florida, Georgia, New York, Pennsylvania, and Texas), sought to extend AMA model state legislation against MOC by barring hospitals, health care insurers, and state licensing boards from linking nonparticipation in the American Board of Medical Specialties (ABMS) MOC process to exclusion from credentialing. Further, it sought to create AMA policy that would replace MOC with high-quality CME under the purview of a physician’s specialty society solely as the demonstration of lifelong learning in hospital, insurance, and licensing credentialing. The HOD conversation shifted from restricting how hospitals, licensing boards, and insurers can use MOC, to redefining MOC.
To address this challenge to professional autonomy while emphasizing the need for responsiveness to concerns across boards, the ACS Delegation applied a strategy that involved prepared talking points; caucus presentations by ACS Executive Director David B. Hoyt, MD, FACS, and Dr. Armstrong; reference committee testimony from Dr. Hoyt and Vice-Chair of the ACS Board of Regents Leigh A. Neumayer, MD, FACS, and ACS Regent James Denneny, MD, FACS, executive director, American Academy of Otolaryngology-Head and Neck Surgery; as well as hallway conversations and HOD floor discussion. As a result, the AMA affirmed that lifelong learning is a fundamental obligation of the profession and recognizes that, for a physician, it is best achieved through ongoing participation in a program of high-quality CME appropriate to the physician’s medical practice as determined by the relevant specialty society. The concept of the AMA lobbying hospital associations, health care insurers, and state licensing boards to not use the ABMS-sponsored MOC process with lifelong interval high stakes testing for credentialing, in addition to the idea of the AMA partnering with state medical associations and specialty societies to undertake a study to establish a separate program of certification by 2020, were referred for further consideration. The ACS will continue to emphasize that a core element of professionalism is self-regulation of lifelong learning through standard-setting.
• Resolution 318, Oppose Direct-to-Consumer Advertising of the ABMS MOC Product, asked the AMA to oppose direct-to-consumer marketing of the ABMS MOC product in print media, social media, apps, and websites that specifically target patients and their families, including but not limited to the promotion of false or misleading claims linking MOC participation with improved patient health outcomes and experiences where limited evidence exists. This item was referred for further study.
• Resolution 319, Public Access to Initial Board Certification Status of Time-Limited ABMS Diplomates, was adopted. The AMA now advocates that the initial certification status of time-limited diplomates be listed and publicly available on all ABMS and ABMS member board websites and physician certification databases and that the names and initial certification status of time-limited diplomates remain on ABMS and ABMS member board websites or physician certification databases, even if the diplomate opts out of MOC participation.
Health system
• Council on Medical Service Report 6, Expansion of U.S. Veterans’ Health Care Choices, was adopted with an amendment offered by the ACS delegation. The AMA will encourage the Veterans Health Administration (VHA) to engage with VHA physicians to explore and develop solutions to improve the health care choices of veterans. The AMA also will continue to support efforts to improve the Veterans Choice Program (VCP) and make it permanent, advocate for new funding to support expansion of the VCP, and encourage the acceleration of interoperability of electronic personal and health records and the exchange of medical records between VHA and non-VHA physicians.
• Substitute Resolution 115, Out-of-Network Care, combined four resolutions on the subject of greatest interest in the Reference Committee A hearing—surprise (unanticipated) billing for out-of-network care. It was adopted with eight AMA principles regarding unanticipated out-of-network care and AMA development of model state legislation addressing the coverage of and payment for unexpected unanticipated out-of-network care.
Public health
• Resolution 419, Improving Physicians’ Ability to Discuss Firearm Safety, was adopted with minor amendments. As a result, the AMA is working with appropriate stakeholders to develop state-specific guidance for physicians on how to counsel patients to reduce their risk for firearm-related injury or death by suicide, including guidance on when and how to ask sensitive questions about firearm ownership, access, and use; and clarification on the circumstances under which physicians are permitted or may be required to disclose the content of such conversations to family members, law enforcement, or other third parties.
Medical practice
• Substitute Resolution 706, Concurrent and Overlapping Surgery, was adopted. The AMA will work with interested national medical specialty societies on issues related to concurrent and overlapping surgery.
AMA elections
The June meeting is when AMA officers, trustees, and councilors are elected. Barbara McAneny, MD, an oncologist from New Mexico, was elected AMA president-elect. Three ACS-endorsed candidates were successful in their bids to serve on the Council on Medical Education. Liana Puscas, MD, MHS, FACS, associate professor of surgery, Duke University School of Medicine, Durham, NC, and Luke Selby, MD, a general surgery resident, University of Colorado School of Medicine, Denver, were reelected; Krystal Tomei, MD, assistant professor of neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, was elected.
Surgical Caucus
The Surgical Caucus hosted a well-attended educational session, Cultivating and Protecting Your Digital Presence: Do’s and Don’ts of Social Media. Speakers included Deanna Attai, MD, FACS, a breast surgeon and assistant clinical professor of surgery, David Geffen School of Medicine, University of California, Los Angeles, and Ravi Goel, MD, an ophthalmologist in private practice in Cherry Hill, NJ, and delegate from the American Academy of Ophthalmology. Both presentations emphasized that surgeons need to manage their online reputation in practice reviews and other web content. Drs. Attai and Goel provided constructive ideas for personal and professional branding through social media, as well as practical ways for surgeons to build and protect their social media reputation. Both presentations are available on the Surgical Caucus web page at facs.org/advocacy/ama-house-of-delegates/surgical-caucus.
The ACS delegation successfully put forth the College’s priorities at the June AMA HOD meeting. The delegation is now working with the ACS Division of Advocacy and Health Policy, the Health Policy and Advocacy Group, and other committees to develop next steps in shaping AMA policy consistent with College principles.
The next AMA meeting is the Interim Meeting in Honolulu, HI, November 11–14. The College’s delegation welcomes input from Fellows regarding issues of importance to surgeons. Comments and questions should be directed to jsutton@facs.org.
ACS delegation at the AMA HOD
John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL
Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
Jacob Moalem, MD, FACS, general surgery, Rochester, NY
Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents
Naveen F. Sangji, MD, (also Resident and Fellow Section delegate), general surgery resident, Boston, MA
Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education
Dr. Armstrong is affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, and former Florida Surgeon General and Secretary of Health (2012–2016). He is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy.
Post-election health policy takes center stage at AMA HOD meeting
The American Medical Association (AMA) Interim House of Delegates (HOD) meeting took place November 12–15, 2016, in Orlando, FL. A total of 530 state medical society and specialty society delegates, including the six members of the American College of Surgeons’ (ACS) delegation, debated the policy implications of 32 reports and 101 resolutions. Occurring within a week of the national elections, a central focus of the meeting was the uncertainty about the future of the Affordable Care Act (ACA). On the other hand, the Stop the Bleed® program received an enthusiastic reception.
ACS delegation sponsors Stop the Bleed skills course
AMA meetings provide an opportunity for the ACS delegates to share College initiatives with physician leaders from a breadth of geographic locations, specialties, and career stages. In this spirit, ACS delegates, all of whom are Stop the Bleed instructors, along with Leonard J. Weireter, MD, FACS, Vice-Chair, ACS Committee on Trauma, presented the skills course to 125 practicing physicians, residents, and medical student delegates. Through four half-hour sessions, participants refreshed their hands-on skills in bleeding control and became advocates for bringing the course back to their communities. Course success was recognized before the entire HOD.
Surgical Caucus focuses on mass casualty readiness
The Surgical Caucus sponsored a one-hour educational session, The Hartford Consensus: Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events. Dr. Weireter shared an overview of the Hartford Consensus recommendations for effective response to active shooter and mass casualty events and highlighted the value of the Stop the Bleed course in improving survival of casualties from these events.
Orlando trauma surgeon Michael Cheatham, MD, FACS, gave a synopsis of the Orlando Regional Medical Center response to the Pulse nightclub shooting in June 2016. In addition to conducting relevant readiness drills, he emphasized the importance of including casualty family assistance and post-event hospital staff counseling in mass casualty plans.
At this meeting, the AMA endorsed recommendations from a 2015 call to action by eight health professional organizations and the American Bar Association to reduce the public health consequences of firearm-related injury.
U.S. elections put health care system in spotlight
Five resolutions covering a spectrum of opinions about AMA engagement in ACA reform were discussed. The five proposals were consolidated into one adopted resolution, which calls for the AMA, in collaboration with state and specialty medical societies, to actively discuss the future of health care reform with the new presidential administration and Congress. AMA executive vice-president James Madera, MD, sent a letter to congressional leaders on January 3 emphasizing the AMA’s interest in proposals that “make coverage more affordable, provide greater choice, and increase the number of those insured.”
The ACS delegation focused on the ACS Health Care Reform General Principles, which promote a systems-based approach to health care quality and safety, patient access to surgical care, reduction of health care costs, and medical liability reform.
Maintenance of Certification
General disaffection with Maintenance of Certification (MOC) requirements persists in multiple specialties, with particular concerns related to its use in credentialing and privileging decisions. The HOD adopted a policy that directs the AMA to increase efforts to ensure that MOC does not become a requirement for insurance panel participation, state medical licensure, and medical staff membership (initial and ongoing).
Medical student and resident training
Delegates agreed with a need for formal leadership training during medical school. The AMA now advocates for the creation of leadership programs that emphasize experiential learning of skills necessary to lead inter-professional teams. Delegates also recognized the importance of having training program policies that support residents who are breastfeeding. As a result, the AMA will now work with appropriate professional regulatory organizations to put policies for protected times and locations for breastfeeding into program requirements.
Surgeon management of patients with perioperative pain
A resolution intended to reduce perioperative opioid consumption was introduced, calling for hospitals to adopt practices for perioperative pain management, which include services dedicated to acute pain management. This proposal generated a great deal of concern among surgical and anesthesiology delegates. The HOD appreciated that surgeons are trained to manage the perioperative pain of their patients and may consult for additional services as needed. Thus, existing AMA efforts to promote appropriate clinical use of opioid analgesics were reaffirmed in lieu of the resolution.
Next meeting
The next meeting of the AMA HOD is scheduled for June 10–14 in Chicago. This meeting will be the first since the inauguration of President Donald Trump, and the ACS delegates anticipate that national health care policy will again dominate the discussion. ACS members with suggestions for potential resolutions should forward them to Jon Sutton at jsutton@facs.org.
ACS Delegation at the AMA HOD
• John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL
• Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
• Jacob Moalem, MD, FACS (also Young Physicians Section delegate), general surgery, Rochester, NY
• Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents
• Naveen F. Sangji, MD, general surgery resident, Boston, MA
• Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education
Dr. Armstrong is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.
The American Medical Association (AMA) Interim House of Delegates (HOD) meeting took place November 12–15, 2016, in Orlando, FL. A total of 530 state medical society and specialty society delegates, including the six members of the American College of Surgeons’ (ACS) delegation, debated the policy implications of 32 reports and 101 resolutions. Occurring within a week of the national elections, a central focus of the meeting was the uncertainty about the future of the Affordable Care Act (ACA). On the other hand, the Stop the Bleed® program received an enthusiastic reception.
ACS delegation sponsors Stop the Bleed skills course
AMA meetings provide an opportunity for the ACS delegates to share College initiatives with physician leaders from a breadth of geographic locations, specialties, and career stages. In this spirit, ACS delegates, all of whom are Stop the Bleed instructors, along with Leonard J. Weireter, MD, FACS, Vice-Chair, ACS Committee on Trauma, presented the skills course to 125 practicing physicians, residents, and medical student delegates. Through four half-hour sessions, participants refreshed their hands-on skills in bleeding control and became advocates for bringing the course back to their communities. Course success was recognized before the entire HOD.
Surgical Caucus focuses on mass casualty readiness
The Surgical Caucus sponsored a one-hour educational session, The Hartford Consensus: Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events. Dr. Weireter shared an overview of the Hartford Consensus recommendations for effective response to active shooter and mass casualty events and highlighted the value of the Stop the Bleed course in improving survival of casualties from these events.
Orlando trauma surgeon Michael Cheatham, MD, FACS, gave a synopsis of the Orlando Regional Medical Center response to the Pulse nightclub shooting in June 2016. In addition to conducting relevant readiness drills, he emphasized the importance of including casualty family assistance and post-event hospital staff counseling in mass casualty plans.
At this meeting, the AMA endorsed recommendations from a 2015 call to action by eight health professional organizations and the American Bar Association to reduce the public health consequences of firearm-related injury.
U.S. elections put health care system in spotlight
Five resolutions covering a spectrum of opinions about AMA engagement in ACA reform were discussed. The five proposals were consolidated into one adopted resolution, which calls for the AMA, in collaboration with state and specialty medical societies, to actively discuss the future of health care reform with the new presidential administration and Congress. AMA executive vice-president James Madera, MD, sent a letter to congressional leaders on January 3 emphasizing the AMA’s interest in proposals that “make coverage more affordable, provide greater choice, and increase the number of those insured.”
The ACS delegation focused on the ACS Health Care Reform General Principles, which promote a systems-based approach to health care quality and safety, patient access to surgical care, reduction of health care costs, and medical liability reform.
Maintenance of Certification
General disaffection with Maintenance of Certification (MOC) requirements persists in multiple specialties, with particular concerns related to its use in credentialing and privileging decisions. The HOD adopted a policy that directs the AMA to increase efforts to ensure that MOC does not become a requirement for insurance panel participation, state medical licensure, and medical staff membership (initial and ongoing).
Medical student and resident training
Delegates agreed with a need for formal leadership training during medical school. The AMA now advocates for the creation of leadership programs that emphasize experiential learning of skills necessary to lead inter-professional teams. Delegates also recognized the importance of having training program policies that support residents who are breastfeeding. As a result, the AMA will now work with appropriate professional regulatory organizations to put policies for protected times and locations for breastfeeding into program requirements.
Surgeon management of patients with perioperative pain
A resolution intended to reduce perioperative opioid consumption was introduced, calling for hospitals to adopt practices for perioperative pain management, which include services dedicated to acute pain management. This proposal generated a great deal of concern among surgical and anesthesiology delegates. The HOD appreciated that surgeons are trained to manage the perioperative pain of their patients and may consult for additional services as needed. Thus, existing AMA efforts to promote appropriate clinical use of opioid analgesics were reaffirmed in lieu of the resolution.
Next meeting
The next meeting of the AMA HOD is scheduled for June 10–14 in Chicago. This meeting will be the first since the inauguration of President Donald Trump, and the ACS delegates anticipate that national health care policy will again dominate the discussion. ACS members with suggestions for potential resolutions should forward them to Jon Sutton at jsutton@facs.org.
ACS Delegation at the AMA HOD
• John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL
• Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
• Jacob Moalem, MD, FACS (also Young Physicians Section delegate), general surgery, Rochester, NY
• Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents
• Naveen F. Sangji, MD, general surgery resident, Boston, MA
• Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education
Dr. Armstrong is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.
The American Medical Association (AMA) Interim House of Delegates (HOD) meeting took place November 12–15, 2016, in Orlando, FL. A total of 530 state medical society and specialty society delegates, including the six members of the American College of Surgeons’ (ACS) delegation, debated the policy implications of 32 reports and 101 resolutions. Occurring within a week of the national elections, a central focus of the meeting was the uncertainty about the future of the Affordable Care Act (ACA). On the other hand, the Stop the Bleed® program received an enthusiastic reception.
ACS delegation sponsors Stop the Bleed skills course
AMA meetings provide an opportunity for the ACS delegates to share College initiatives with physician leaders from a breadth of geographic locations, specialties, and career stages. In this spirit, ACS delegates, all of whom are Stop the Bleed instructors, along with Leonard J. Weireter, MD, FACS, Vice-Chair, ACS Committee on Trauma, presented the skills course to 125 practicing physicians, residents, and medical student delegates. Through four half-hour sessions, participants refreshed their hands-on skills in bleeding control and became advocates for bringing the course back to their communities. Course success was recognized before the entire HOD.
Surgical Caucus focuses on mass casualty readiness
The Surgical Caucus sponsored a one-hour educational session, The Hartford Consensus: Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events. Dr. Weireter shared an overview of the Hartford Consensus recommendations for effective response to active shooter and mass casualty events and highlighted the value of the Stop the Bleed course in improving survival of casualties from these events.
Orlando trauma surgeon Michael Cheatham, MD, FACS, gave a synopsis of the Orlando Regional Medical Center response to the Pulse nightclub shooting in June 2016. In addition to conducting relevant readiness drills, he emphasized the importance of including casualty family assistance and post-event hospital staff counseling in mass casualty plans.
At this meeting, the AMA endorsed recommendations from a 2015 call to action by eight health professional organizations and the American Bar Association to reduce the public health consequences of firearm-related injury.
U.S. elections put health care system in spotlight
Five resolutions covering a spectrum of opinions about AMA engagement in ACA reform were discussed. The five proposals were consolidated into one adopted resolution, which calls for the AMA, in collaboration with state and specialty medical societies, to actively discuss the future of health care reform with the new presidential administration and Congress. AMA executive vice-president James Madera, MD, sent a letter to congressional leaders on January 3 emphasizing the AMA’s interest in proposals that “make coverage more affordable, provide greater choice, and increase the number of those insured.”
The ACS delegation focused on the ACS Health Care Reform General Principles, which promote a systems-based approach to health care quality and safety, patient access to surgical care, reduction of health care costs, and medical liability reform.
Maintenance of Certification
General disaffection with Maintenance of Certification (MOC) requirements persists in multiple specialties, with particular concerns related to its use in credentialing and privileging decisions. The HOD adopted a policy that directs the AMA to increase efforts to ensure that MOC does not become a requirement for insurance panel participation, state medical licensure, and medical staff membership (initial and ongoing).
Medical student and resident training
Delegates agreed with a need for formal leadership training during medical school. The AMA now advocates for the creation of leadership programs that emphasize experiential learning of skills necessary to lead inter-professional teams. Delegates also recognized the importance of having training program policies that support residents who are breastfeeding. As a result, the AMA will now work with appropriate professional regulatory organizations to put policies for protected times and locations for breastfeeding into program requirements.
Surgeon management of patients with perioperative pain
A resolution intended to reduce perioperative opioid consumption was introduced, calling for hospitals to adopt practices for perioperative pain management, which include services dedicated to acute pain management. This proposal generated a great deal of concern among surgical and anesthesiology delegates. The HOD appreciated that surgeons are trained to manage the perioperative pain of their patients and may consult for additional services as needed. Thus, existing AMA efforts to promote appropriate clinical use of opioid analgesics were reaffirmed in lieu of the resolution.
Next meeting
The next meeting of the AMA HOD is scheduled for June 10–14 in Chicago. This meeting will be the first since the inauguration of President Donald Trump, and the ACS delegates anticipate that national health care policy will again dominate the discussion. ACS members with suggestions for potential resolutions should forward them to Jon Sutton at jsutton@facs.org.
ACS Delegation at the AMA HOD
• John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL
• Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
• Jacob Moalem, MD, FACS (also Young Physicians Section delegate), general surgery, Rochester, NY
• Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents
• Naveen F. Sangji, MD, general surgery resident, Boston, MA
• Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education
Dr. Armstrong is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.
AMA House of Delegates addressed surgery issues
The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 15-19 in Chicago, IL. More than 550 delegates as well as alternate delegates converged on the Windy City to consider and adopt policy for the AMA. Issues such as health care policy were discussed, educational sessions were presented, and elections took place.
Reports and resolutions
The HOD reviewed more than 160 resolutions and 65 reports, including the following centered on issues of relevance to surgeons:
Invasive procedures: As originally submitted to the HOD, this report from the AMA Board of Trustees called for revising the current AMA, definition of surgery and guidelines on invasive procedures for the treatment of chronic pain, including procedures using fluoroscopy. Efforts to bridge the definitions for surgery and procedures fell short. A revised report was adopted that retained the current AMA definition of surgery but focused only on invasive pain management procedures.
Recognition of obesity as a disease: The ACS and 10 other medical/specialty societies cosponsored this resolution, which called on the AMA to recognize obesity as a disease with multiple pathophysiological aspects requiring a range of interventions to advance treatment and prevention. Evidence presented demonstrated that obesity is a metabolic disease that occurs as a result of unhealthy behaviors related to food and beverage consumption; lack of sufficient physical activity; and work, school, and messaging environments. The resolution further noted that obesity leads to chronic diseases, such as hypertension, heart disease, diabetes, and arthritis. The ACS delegation emphasized that metabolic (bariatric) surgeons are on the front lines of treating severe obesity with life-improving and lifesaving results. The resolution passed with a 60 percent majority of the delegates.
Payment variations across outpatient sites of service: Cost transparency across sites of service was a major point of discussion, which received positive comments in reference committee testimony. In addition to adopting recommendations from the AMA Council on Medical Service to reaffirm some existing AMA policies related to Medicare payments across outpatient settings, the HOD adopted a recommendation that the AMA work with states to advocate for third party payors to:
• Assess equal or lower facility coinsurance for lower-cost sites of service (hospital outpatient department, ambulatory surgical center, or office-based facility);
• Publish and routinely update pertinent information related to patient cost-sharing; and
• Allow their plan’s participating physicians to perform outpatient procedures at an appropriate site of service as chosen by the physician and the patient.
AMA support for states in their development of legislation to support physician-led, team-based care: With a focus on physician-led, team-based care, this resolution was adopted and directed the AMA to assist state medical societies and specialty organizations with seeking passage of legislation that would define the valued role of mid-level and other health care professionals within a physician-led team that promotes optimal quality patient care and patient safety. The resolution also called on the AMA to actively oppose health care teams that are led by nonphysician health care practitioners.
An update on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL): A major topic of discussion was MOC, OCC, and MOL requirements. Many resolutions introduced reflected concerns regarding the implementation, cost, and additional exam burdens on physicians that these requirements pose. These resolutions largely recommended that the Council on Medical Education continue to monitor the requirements and engage in ongoing dialogues with medical and licensing boards.
Government interference in the practice of medicine and the patient-physician relationship: The AMA HOD passed several resolutions that led to the adoption of a Statement of Principles concerning the roles of federal and state governments in health care and the patient-physician relationship. These principles include:
• Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors or disclosing information to patients, including proprietary information on exposure to potentially dangerous chemicals or biological agents that may affect their health or the health of their families, sexual partners, and other individuals with whom they have been in contact.
• All parties involved in the provision of health care, including government, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.
• The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.
• Laws and regulations should not mandate the provision of care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, is either unnecessary or ill-suited for a particular patient at the time services are rendered.
In addition, the AMA will oppose any government regulation or legislative action on the content of the individual clinical encounter between a patient and physician without a compelling and evidence-based benefit to the patient, a substantial public health justification, or both.
For a complete list of HOD actions, go to http://www.ama-assn.org/ams/pub/meeting/index.shtml.
Elections
AMA officers, trustees, and council members are elected during the annual meeting. This year, three members of the College were elected to serve on AMA councils and in other leadership positions. Maya Babu, MD, a neurosurgery resident at the Mayo Clinic, Rochester, MN, was elected to serve in the resident/fellow trustee position on the AMA Board of Trustees; Andrew Gurman, MD, FACS, a hand surgeon who practices in Altoona, PA, was re-elected as speaker of the HOD; and Liana Puscas, MD, FACS, an otolaryngologist and assistant professor of surgery, Duke University Medical School, in Durham, NC, was elected to the AMA Council on Medical Education.
Ardis Dee Hoven, MD, assumed the presidency of the AMA. An internal medicine and infectious disease specialist from Lexington, KY, she is the 168th president of the organization and only the third woman to hold this office.
Other officers elected are as follows:
President-elect – Robert M. Wah, MD, reproductive endocrinologist from Bethesda, MD.
Board of Trustees – Gerald E. Harmon, MD, a family physician from Pawleys Island, SC; and David O. Barbe, MD, re-elected, a family physician in Mountain Grove, MO.
Vice-speaker of the HOD – Susan R. Bailey, MD, re-elected, an allergist in Fort Worth, TX.
Surgical Caucus
The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding relevant AMA resolutions that affect surgical interventions. The Caucus held a one-hour program titled "Visiting the Surgical Home." Speakers provided a description of the concept of the surgical home, discussed how the surgical home improves coordination of patient care and relates to other models of coordinated care, and reviewed some of the benefits of implementing the surgical home.
ACS Delegation
The College was well represented by five delegates. New to the delegation was Leigh Neumayer, MD, FACS, a general surgeon from Salt Lake City, UT, and a member of the ACS Board of Regents. She joined four seasoned veterans of the HOD, including: John H. Armstrong, MD, FACS, trauma surgeon, chair of the delegation, and Surgeon General/Secretary of Health for the State of Florida; Jacob Moalem, MD, FACS, an endocrine surgeon from Rochester, NY; Richard Reiling, MD, FACS, a general surgeon from Charlotte, NC; and Patricia L. Turner, MD, FACS, a general surgeon and Director of the ACS Division of Member Services.
In addition, the College Delegation was assisted by Timothy Kresowik, MD, FACS, a vascular surgeon from Iowa City, IA. and an alternate delegate from the Society for Vascular Surgery, and Kenneth Louis, MD, FACS, a neurosurgeon from Tampa, FL, and an alternate delegate for the Florida Medical Association.
The delegation is open to comments and feedback on issues before the HOD as well as suggestions for resolutions. The November Interim HOD meeting will take place November 16-19 in National Harbor, MD. For those surgeons who would like to become familiar with pending issues and policies, items of business will be posted in early November on the AMA website at http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates.page. Fellows who follow this activity and have thoughts, comments, or questions may contact the ACS Delegation at jsutton@facs.org.
Dr. Armstrong is Surgeon General and Secretary, Florida Department of Health, Tallahassee, FL. He serves on the ACS Board of Governors and the ACS Health Policy and Advocacy Group.
Mr. Sutton is Manager of State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.
The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 15-19 in Chicago, IL. More than 550 delegates as well as alternate delegates converged on the Windy City to consider and adopt policy for the AMA. Issues such as health care policy were discussed, educational sessions were presented, and elections took place.
Reports and resolutions
The HOD reviewed more than 160 resolutions and 65 reports, including the following centered on issues of relevance to surgeons:
Invasive procedures: As originally submitted to the HOD, this report from the AMA Board of Trustees called for revising the current AMA, definition of surgery and guidelines on invasive procedures for the treatment of chronic pain, including procedures using fluoroscopy. Efforts to bridge the definitions for surgery and procedures fell short. A revised report was adopted that retained the current AMA definition of surgery but focused only on invasive pain management procedures.
Recognition of obesity as a disease: The ACS and 10 other medical/specialty societies cosponsored this resolution, which called on the AMA to recognize obesity as a disease with multiple pathophysiological aspects requiring a range of interventions to advance treatment and prevention. Evidence presented demonstrated that obesity is a metabolic disease that occurs as a result of unhealthy behaviors related to food and beverage consumption; lack of sufficient physical activity; and work, school, and messaging environments. The resolution further noted that obesity leads to chronic diseases, such as hypertension, heart disease, diabetes, and arthritis. The ACS delegation emphasized that metabolic (bariatric) surgeons are on the front lines of treating severe obesity with life-improving and lifesaving results. The resolution passed with a 60 percent majority of the delegates.
Payment variations across outpatient sites of service: Cost transparency across sites of service was a major point of discussion, which received positive comments in reference committee testimony. In addition to adopting recommendations from the AMA Council on Medical Service to reaffirm some existing AMA policies related to Medicare payments across outpatient settings, the HOD adopted a recommendation that the AMA work with states to advocate for third party payors to:
• Assess equal or lower facility coinsurance for lower-cost sites of service (hospital outpatient department, ambulatory surgical center, or office-based facility);
• Publish and routinely update pertinent information related to patient cost-sharing; and
• Allow their plan’s participating physicians to perform outpatient procedures at an appropriate site of service as chosen by the physician and the patient.
AMA support for states in their development of legislation to support physician-led, team-based care: With a focus on physician-led, team-based care, this resolution was adopted and directed the AMA to assist state medical societies and specialty organizations with seeking passage of legislation that would define the valued role of mid-level and other health care professionals within a physician-led team that promotes optimal quality patient care and patient safety. The resolution also called on the AMA to actively oppose health care teams that are led by nonphysician health care practitioners.
An update on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL): A major topic of discussion was MOC, OCC, and MOL requirements. Many resolutions introduced reflected concerns regarding the implementation, cost, and additional exam burdens on physicians that these requirements pose. These resolutions largely recommended that the Council on Medical Education continue to monitor the requirements and engage in ongoing dialogues with medical and licensing boards.
Government interference in the practice of medicine and the patient-physician relationship: The AMA HOD passed several resolutions that led to the adoption of a Statement of Principles concerning the roles of federal and state governments in health care and the patient-physician relationship. These principles include:
• Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors or disclosing information to patients, including proprietary information on exposure to potentially dangerous chemicals or biological agents that may affect their health or the health of their families, sexual partners, and other individuals with whom they have been in contact.
• All parties involved in the provision of health care, including government, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.
• The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.
• Laws and regulations should not mandate the provision of care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, is either unnecessary or ill-suited for a particular patient at the time services are rendered.
In addition, the AMA will oppose any government regulation or legislative action on the content of the individual clinical encounter between a patient and physician without a compelling and evidence-based benefit to the patient, a substantial public health justification, or both.
For a complete list of HOD actions, go to http://www.ama-assn.org/ams/pub/meeting/index.shtml.
Elections
AMA officers, trustees, and council members are elected during the annual meeting. This year, three members of the College were elected to serve on AMA councils and in other leadership positions. Maya Babu, MD, a neurosurgery resident at the Mayo Clinic, Rochester, MN, was elected to serve in the resident/fellow trustee position on the AMA Board of Trustees; Andrew Gurman, MD, FACS, a hand surgeon who practices in Altoona, PA, was re-elected as speaker of the HOD; and Liana Puscas, MD, FACS, an otolaryngologist and assistant professor of surgery, Duke University Medical School, in Durham, NC, was elected to the AMA Council on Medical Education.
Ardis Dee Hoven, MD, assumed the presidency of the AMA. An internal medicine and infectious disease specialist from Lexington, KY, she is the 168th president of the organization and only the third woman to hold this office.
Other officers elected are as follows:
President-elect – Robert M. Wah, MD, reproductive endocrinologist from Bethesda, MD.
Board of Trustees – Gerald E. Harmon, MD, a family physician from Pawleys Island, SC; and David O. Barbe, MD, re-elected, a family physician in Mountain Grove, MO.
Vice-speaker of the HOD – Susan R. Bailey, MD, re-elected, an allergist in Fort Worth, TX.
Surgical Caucus
The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding relevant AMA resolutions that affect surgical interventions. The Caucus held a one-hour program titled "Visiting the Surgical Home." Speakers provided a description of the concept of the surgical home, discussed how the surgical home improves coordination of patient care and relates to other models of coordinated care, and reviewed some of the benefits of implementing the surgical home.
ACS Delegation
The College was well represented by five delegates. New to the delegation was Leigh Neumayer, MD, FACS, a general surgeon from Salt Lake City, UT, and a member of the ACS Board of Regents. She joined four seasoned veterans of the HOD, including: John H. Armstrong, MD, FACS, trauma surgeon, chair of the delegation, and Surgeon General/Secretary of Health for the State of Florida; Jacob Moalem, MD, FACS, an endocrine surgeon from Rochester, NY; Richard Reiling, MD, FACS, a general surgeon from Charlotte, NC; and Patricia L. Turner, MD, FACS, a general surgeon and Director of the ACS Division of Member Services.
In addition, the College Delegation was assisted by Timothy Kresowik, MD, FACS, a vascular surgeon from Iowa City, IA. and an alternate delegate from the Society for Vascular Surgery, and Kenneth Louis, MD, FACS, a neurosurgeon from Tampa, FL, and an alternate delegate for the Florida Medical Association.
The delegation is open to comments and feedback on issues before the HOD as well as suggestions for resolutions. The November Interim HOD meeting will take place November 16-19 in National Harbor, MD. For those surgeons who would like to become familiar with pending issues and policies, items of business will be posted in early November on the AMA website at http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates.page. Fellows who follow this activity and have thoughts, comments, or questions may contact the ACS Delegation at jsutton@facs.org.
Dr. Armstrong is Surgeon General and Secretary, Florida Department of Health, Tallahassee, FL. He serves on the ACS Board of Governors and the ACS Health Policy and Advocacy Group.
Mr. Sutton is Manager of State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.
The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 15-19 in Chicago, IL. More than 550 delegates as well as alternate delegates converged on the Windy City to consider and adopt policy for the AMA. Issues such as health care policy were discussed, educational sessions were presented, and elections took place.
Reports and resolutions
The HOD reviewed more than 160 resolutions and 65 reports, including the following centered on issues of relevance to surgeons:
Invasive procedures: As originally submitted to the HOD, this report from the AMA Board of Trustees called for revising the current AMA, definition of surgery and guidelines on invasive procedures for the treatment of chronic pain, including procedures using fluoroscopy. Efforts to bridge the definitions for surgery and procedures fell short. A revised report was adopted that retained the current AMA definition of surgery but focused only on invasive pain management procedures.
Recognition of obesity as a disease: The ACS and 10 other medical/specialty societies cosponsored this resolution, which called on the AMA to recognize obesity as a disease with multiple pathophysiological aspects requiring a range of interventions to advance treatment and prevention. Evidence presented demonstrated that obesity is a metabolic disease that occurs as a result of unhealthy behaviors related to food and beverage consumption; lack of sufficient physical activity; and work, school, and messaging environments. The resolution further noted that obesity leads to chronic diseases, such as hypertension, heart disease, diabetes, and arthritis. The ACS delegation emphasized that metabolic (bariatric) surgeons are on the front lines of treating severe obesity with life-improving and lifesaving results. The resolution passed with a 60 percent majority of the delegates.
Payment variations across outpatient sites of service: Cost transparency across sites of service was a major point of discussion, which received positive comments in reference committee testimony. In addition to adopting recommendations from the AMA Council on Medical Service to reaffirm some existing AMA policies related to Medicare payments across outpatient settings, the HOD adopted a recommendation that the AMA work with states to advocate for third party payors to:
• Assess equal or lower facility coinsurance for lower-cost sites of service (hospital outpatient department, ambulatory surgical center, or office-based facility);
• Publish and routinely update pertinent information related to patient cost-sharing; and
• Allow their plan’s participating physicians to perform outpatient procedures at an appropriate site of service as chosen by the physician and the patient.
AMA support for states in their development of legislation to support physician-led, team-based care: With a focus on physician-led, team-based care, this resolution was adopted and directed the AMA to assist state medical societies and specialty organizations with seeking passage of legislation that would define the valued role of mid-level and other health care professionals within a physician-led team that promotes optimal quality patient care and patient safety. The resolution also called on the AMA to actively oppose health care teams that are led by nonphysician health care practitioners.
An update on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL): A major topic of discussion was MOC, OCC, and MOL requirements. Many resolutions introduced reflected concerns regarding the implementation, cost, and additional exam burdens on physicians that these requirements pose. These resolutions largely recommended that the Council on Medical Education continue to monitor the requirements and engage in ongoing dialogues with medical and licensing boards.
Government interference in the practice of medicine and the patient-physician relationship: The AMA HOD passed several resolutions that led to the adoption of a Statement of Principles concerning the roles of federal and state governments in health care and the patient-physician relationship. These principles include:
• Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors or disclosing information to patients, including proprietary information on exposure to potentially dangerous chemicals or biological agents that may affect their health or the health of their families, sexual partners, and other individuals with whom they have been in contact.
• All parties involved in the provision of health care, including government, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.
• The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.
• Laws and regulations should not mandate the provision of care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, is either unnecessary or ill-suited for a particular patient at the time services are rendered.
In addition, the AMA will oppose any government regulation or legislative action on the content of the individual clinical encounter between a patient and physician without a compelling and evidence-based benefit to the patient, a substantial public health justification, or both.
For a complete list of HOD actions, go to http://www.ama-assn.org/ams/pub/meeting/index.shtml.
Elections
AMA officers, trustees, and council members are elected during the annual meeting. This year, three members of the College were elected to serve on AMA councils and in other leadership positions. Maya Babu, MD, a neurosurgery resident at the Mayo Clinic, Rochester, MN, was elected to serve in the resident/fellow trustee position on the AMA Board of Trustees; Andrew Gurman, MD, FACS, a hand surgeon who practices in Altoona, PA, was re-elected as speaker of the HOD; and Liana Puscas, MD, FACS, an otolaryngologist and assistant professor of surgery, Duke University Medical School, in Durham, NC, was elected to the AMA Council on Medical Education.
Ardis Dee Hoven, MD, assumed the presidency of the AMA. An internal medicine and infectious disease specialist from Lexington, KY, she is the 168th president of the organization and only the third woman to hold this office.
Other officers elected are as follows:
President-elect – Robert M. Wah, MD, reproductive endocrinologist from Bethesda, MD.
Board of Trustees – Gerald E. Harmon, MD, a family physician from Pawleys Island, SC; and David O. Barbe, MD, re-elected, a family physician in Mountain Grove, MO.
Vice-speaker of the HOD – Susan R. Bailey, MD, re-elected, an allergist in Fort Worth, TX.
Surgical Caucus
The Surgical Caucus of the AMA brings together surgeons, anesthesiologists, and emergency physicians for focused discussions regarding relevant AMA resolutions that affect surgical interventions. The Caucus held a one-hour program titled "Visiting the Surgical Home." Speakers provided a description of the concept of the surgical home, discussed how the surgical home improves coordination of patient care and relates to other models of coordinated care, and reviewed some of the benefits of implementing the surgical home.
ACS Delegation
The College was well represented by five delegates. New to the delegation was Leigh Neumayer, MD, FACS, a general surgeon from Salt Lake City, UT, and a member of the ACS Board of Regents. She joined four seasoned veterans of the HOD, including: John H. Armstrong, MD, FACS, trauma surgeon, chair of the delegation, and Surgeon General/Secretary of Health for the State of Florida; Jacob Moalem, MD, FACS, an endocrine surgeon from Rochester, NY; Richard Reiling, MD, FACS, a general surgeon from Charlotte, NC; and Patricia L. Turner, MD, FACS, a general surgeon and Director of the ACS Division of Member Services.
In addition, the College Delegation was assisted by Timothy Kresowik, MD, FACS, a vascular surgeon from Iowa City, IA. and an alternate delegate from the Society for Vascular Surgery, and Kenneth Louis, MD, FACS, a neurosurgeon from Tampa, FL, and an alternate delegate for the Florida Medical Association.
The delegation is open to comments and feedback on issues before the HOD as well as suggestions for resolutions. The November Interim HOD meeting will take place November 16-19 in National Harbor, MD. For those surgeons who would like to become familiar with pending issues and policies, items of business will be posted in early November on the AMA website at http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates.page. Fellows who follow this activity and have thoughts, comments, or questions may contact the ACS Delegation at jsutton@facs.org.
Dr. Armstrong is Surgeon General and Secretary, Florida Department of Health, Tallahassee, FL. He serves on the ACS Board of Governors and the ACS Health Policy and Advocacy Group.
Mr. Sutton is Manager of State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.