2015 AMA Annual Meeting: Report from the AMA HOD

2015 AMA Annual Meeting - June 5-10, 2015 – Hyatt Regency Chicago

Delegates
Maryanne Bombaugh
Theodore Calianos
Alain Chaoui
Mario Motta
Richard Pieters
David Rosman (credentialed for the meeting)
Thomas Sullivan
Lynda Young

Alternate Delegates
Andrew Colucci
Dennis Dimitri
Ronald Dunlap
Michael Lew
Glenn Markenson
Christie Morgan
Nicholas Woolf

Five ambassadors shadowing our delegation at this meeting.  Drs. Melody Eckardt, Kathryn Hughes, Paula Jo Carbone, Michael Medlock, and Helen Cajigas. In addition, we had many specialty representatives, OMSS, medical student, resident, young physician, senior physician and IMG representatives.

Link to the full meeting - 
http://www.ama-assn.org/sub/meeting/index.html

MA AMA Delegation sponsored 6 resolutions at this meeting which in turn were supported by the New England Delegation.

  • 127 Controlling Rapidly Escalating Generic Medication Prices – adopted as amended
  • 234 Preserving Free Speech and Confidentiality in the Physician-Patient Relationship -adopted
  • 525 Medical Consequences of Nuclear War and the Need to Abolish Nuclear Weapons – adopted as amended
  • 526 Recycling Pharmaceutical Profits to NIH Funding – referred for decision
  • 601 Engaging and Empowering our Members – NOT ADOPTED
  • 711 Protecting Against Forced Network Exclusivity of Specialist Physicians – adopted as amended

Dr. Wah began the meeting by addressing the HOD and reminding us – as if we would forget, that the most important victory for physicians over the past year was undoubtedly the elimination of Medicare’s sustainable growth rate (SGR) formula.  He stated - “Working together, we finally ended an era of uncertainty for Medicare patients and their physicians and opened new avenues to provide better care at a lower cost,  It wasn’t a ‘doc fix’ …. It was Medicare that needed fixing—not doctors.”

Of the issues reviewed during the week, the top 10 are:

1. More transparent, physician-friendly MOC focus of new policy

Physicians took on the maintenance of certification (MOC) process at the 2015 AMA Annual Meeting Monday, calling for more transparency and education surrounding the process.
 
2. “Innovation ecosystem” shaping medicine’s future
The AMA is improving the health of the nation by crafting an “innovation ecosystem,” AMA Executive Vice President and CEO James L. Madara, MD, said in his address. This includes the launch of the AMA’s STEPS Forward website, which offers a free series of physician-developed, proven solutions to make physician practices thrive.

3. Doctors call for two-year grace period for ICD-10 implementation
With less than four months to go before the deadline for implementing the ICD-10 code set, physicians agreed to seek a two-year grace period to avoid financial disruptions, facilitating a smoother transition that would allow them to continue providing quality care to their patients.

4. From Rx monitoring to treatment: Solutions for overdose epidemic
As the nation continues to grapple with its epidemic of opioid misuse, overdose and death, physicians supported additional steps to address this pressing public health issue.

5. Facing challenges strengthens physician-patient bond: AMA president
In his final address as AMA president, Robert M. Wah, MD, congratulated physicians on undertaking numerous challenges this year, including accelerating change in medical education and improving health outcomes for patients with prediabetes and high blood pressure.

6. New public health policies patients need to know—and why
Many of today’s precautions for public health and safety had their start with physicians at the AMA. Public health issues that doctors want to tackle next range from barring people younger than 21 from purchasing e-cigarettes to protecting youths with concussions.
 
7. GME funding, doc shortage tackled in new policy
Physicians passed policy to address insufficient funding for graduate medical education (GME) ahead of a predicted shortage of 46,000-90,000 physicians over the next decade.

8. A story of hope: New AMA president points to power of physicians
For each story of frustration in the medical profession, “there is a story of vision, perseverance and success,” AMA President Steven J. Stack, MD, said in his inaugural address. “When it comes to something as important as shaping a better, healthier future, it will take every single one of us.”

9. Medical reasons should be the only exemptions from vaccinations
As the debate around vaccinations continues to rage in the public, outbreaks of dangerous preventable diseases have continued to increase. For public health experts, the question has become, “Should individuals be given exemptions from required immunizations for non-medical reasons?” Physicians provided some answers with policy passed Monday.
 
10. New AMA policy calls for research on violence against physicians
Policy adopted Tuesday supports a new study on methods that will prevent violence against health care professionals while in the workplace. Attacks at hospital and social service settings account for almost 70 percent of nonfatal workplace assaults.

In addition, the AMA identified three ways they are working to make practicing easier for all of us so that we can focus more on our patients and relieve some of our stress.
 
1. Improved technology
It's no secret that electronic health record (EHR) systems are a huge frustration for physicians, from the technology itself to the regulatory requirements around it, such as the meaningful use program.
 
To mitigate these problems, the AMA is pushing for better EHR usability, based on a framework it developed with practicing physicians and health IT experts. The AMA also has urged the government to make three key changes to improve the EHR certification process to make the technology easier to use.
 
It also is aggressively advocating for changes to meaningful use and was successful in securing more flexibility for physicians in Stages 1 and 2.
 
2. Help with payment models
New models, such as accountable care organizations, appear to be succeeding, but it depends on how you measure success, Tutty said. How are practicing physicians actually handling these new models?
 
To find out, the AMA and the RAND Corporation studied physician practices undertaking these new models. The results of that study revealed physicians need help managing and responding to the many quality programs and metrics from payers to ensure long-term sustainability. Read the details of the study at AMA Wire®.
 
The report's findings will guide the AMA's work in improving alternative payment models and securing the help physicians need to make them successful.
 
“The lessons learned [from the study] are clear: Changing payment models alone will not get physicians' desired outcomes,” Tutty said.
 
3. Guidance for professional relationships
In some areas, physicians and hospitals may be feeling pulled—or pushed—together, said J. James Rohack, MD, a Texas cardiologist and former AMA president who is an advisor for the AMA’s Professional Satisfaction and Practice Sustainability initiative.
 
To make it a smoother integration, the AMA and the American Hospital Association developed guidelines on how to bring clinical skills and business insights together at the leadership level.
 
“[Integration] is not for all practices or all places in the country,” Dr. Rohack said. “But there are some that would like to come together and just don't know where to start.”

ICD-10

In addition, with less than four months to go before the deadline for implementing the ICD-10 code set, physicians agreed to seek a two-year grace period for physicians to avoid financial disruptions to facilitate a smoother transition that would allow physicians to continue providing quality care to their patients.
 
Physicians at the 2015 AMA Annual Meeting passed policy calling on the Centers for Medicare & Medicaid Services (CMS) not to withhold claim payments based on coding errors, mistakes or malfunctions in the system for two years directly following implementation. 
 
Related policy pushes the AMA to advocate for physician voices to be part of the group that manages the International Classification of Diseases (ICD). Currently, the four cooperating parties that manage ICD code sets are the Centers for Disease Control National Centers for Health Statistics, CMS, the American Hospital Association and the American Health Information Management Association. A physician group is necessary in these conversations because none of the current groups “represent providers who have licensed authority to define, diagnose, describe and document patient conditions and treatments.”
 
The new policy also directs the AMA to seek data on how ICD-10 implementation has affected patients and changed physician practice patterns, such as physician retirement or moving to all-cash practices.
 
“The bottom line is that ICD-10 will significantly overwhelm physician practices with a 400 percent increase in the number of codes physicians must use for diagnosis, which will take time away from the valuable one-on-one patient-physician interface that is the hallmark of taking the best care of patients,” said AMA Russell W.H. Kridel, MD, member of the AMA Board of Trustees. “We continue to press both Congress and the administration to take necessary steps to avoid widespread disruption to physician practices created by this overly complex and burdensome mandate. Coding and billing protocols should never get in the way of patients receiving high quality care.”  
 
CMS has acknowledged that the transition to ICD-10 will have an impact on physician payment processes. The agency estimates that “in the early stages of implementation, denial rates will rise by 100-200 percent,” according to a 2013 report from the Healthcare Financial Management Association. 
 
A 2014 AMA study (log in) conducted by Nachisom Advisors on the cost of implementing ICD-10 estimated that a small practice could see payment disruptions ranging from $22,579 to $100,349 during the first year of ICD-10 implementation. The study also estimates that a small practice could incur a 5 percent drop in revenue because of productivity loss during and after the change.
 
While the AMA continues to urge regulators to ease the burden of ICD-10 implementation on physicians, you should act now to make sure your practice is prepared.

Wrap-up

Within our own ranks, our delegation worked hard and well together.  Dr. Motta, Vice Chair, worked with our Ambassadors and had a special breakfast mid-week to “take a temperature” check to make sure their experience was a good one and to see if we could improve upon it moving forward.  As it was, each ambassador had a different “mentor” assigned to them throughout the week so they could get a feel for the meeting through a different set of eyes. 

I engaged our state elected delegates and alternates on Tuesday afternoon for a meeting, following the elections, to further discuss political issues and strategies moving forward.

And finally, Tuesday night we attended the Inauguration of Kentucky physician Steven J. Stack, MD, the first emergency physician to hold the post and the youngest president in 160 years.  He’s 43 years old.

Dr. Stack’s emergency medicine experience has given him the opportunity to witness many life-changing moments—“the moments we went to medical school for …. the moments for which we forego nights with our families,” he said during his inaugural address. “These are the moments that sustain us.”

“Above all, it takes a team,” Dr. Stack said. “Each one of us has a role to play. Each one of us contributes something the other cannot. The same can be said of health care in this country. When it comes to something as important as shaping a better, healthier future, it will take every single one of us.”
We, in your AMA delegation, also know it takes a team – and that is how we function.
Respectfully submitted,

Alain Chaoui, MD, Chair, MA AMA Delegation 

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