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AMA Annual Meeting Roundup

(L-R): Barbara L. McAneny, M.D., Patrice A. Harris, M.D., M.A., and Susan R. Bailey, M.D. PHOTO CREDIT: American Medical Association

In Historic First, AMA to Have Three Consecutive Female Presidents

Following the election of Susan R. Bailey, M.D., an allergist and immunologist from Fort Worth, Texas, as American Medical Association (AMA) president-elect, the nation's premier physician organization will for the first time in its history have three consecutive female physicians as president.

AMA Adopts New Public Health Policies to Improve Health of Nation

The American Medical Association (AMA), the premier national physician organization in the country, voted this week to adopt new policies aimed at improving the health of the nation. The new policies, which include supporting plans to end the HIV epidemic, decriminalizing HIV status non-disclosure, and supporting access to contraception for incarcerated persons, were approved during the voting session of the AMA's Annual Meeting.

The policies adopted by the House of Delegates include:

Advocating to End the HIV Epidemic, Decriminalize HIV Status Non-disclosure

The AMA adopted new policy aimed at supporting plans to end the HIV epidemic. Under the new policy, the AMA will strongly advocate for the funding of plans that focus on: (1) diagnosing individuals with HIV infection as early as possible, (2) treating HIV infection to achieve sustained viral suppression, (3) preventing at-risk individuals from acquiring HIV infection, including through the use of pre-exposure prophylaxis (PrEP); and (4) rapidly detecting and responding to emerging clusters of HIV infection to prevent transmission.

An additional policy was adopted, calling on the AMA to advocate for repealing state laws that criminalize non-disclosure of HIV status for people living with the virus. The new policy also calls on the AMA to work with other stakeholders to develop a program whose primary goal is to destigmatize HIV infection through educating the public, physicians, and other health care professionals on current medical advances in HIV treatment that minimize the risk of transmission due to viral load suppression and the availability of PrEP.

"The AMA is committed to helping put an end to the HIV epidemic by supporting plans that will help with early diagnosis, treatment, and prevention of HIV," said AMA Board Member E. Scott Ferguson, M.D. "It is also time that non-disclosure of HIV status is decriminalized. Current criminalization laws are outdated and do not reflect the current science of HIV transmission or the fact that HIV is a chronic, but manageable medical condition--particularly since non-disclosure of other infectious diseases are not criminalized."

The new policies adopted this week build on AMA efforts to bolster education and training to combat HIV/AIDS and to increase multi-layer collaboration to increase public awareness. These policies include supporting improved education of physicians on the effective use of PrEP to prevent HIV acquisition in high-risk individuals, and advocating that all insurers be required to cover the costs associated with the administration of PrEP.

Earlier this week, the U.S. Preventive Services Task Force (Task Force) published its latest recommendation statements on HIV screening and HIV prevention. Based on its review of the evidence, the Task Force recommends that clinicians screen for HIV in everyone age 15 to 65 years and all pregnant people. Younger adolescents and older adults at increased risk for HIV should also be screened. The Task Force also recommends that clinicians offer PrEP to people at high risk of HIV.

Supporting Access to Contraception for Persons who are Incarcerated

According to the U.S. Bureau of Justice Statistics, more than 200,000 women are incarcerated in U.S. correctional facilities and the majority of these women are within reproductive age. The AMA adopted policy today aimed at supporting persons who are incarcerated in accessing contraceptive care. The policy specifically calls for persons who are incarcerated to have access to evidence-based contraception education, access to reversible contraceptive methods, as well as autonomy over the decision-making process without coercion.

"The majority of incarcerated women face multiple barriers in accessing health care, including reproductive care. It is important that we help ensure incarcerated women have access to contraceptive care, and the information they need to make their own health decisions concerning contraception prior to transitioning back into the community," said AMA Board Member E. Scott Ferguson, M.D.

AMA Adopts Policy to Further Advocate for Eliminating Non-medical Vaccine Exemptions

Building on the AMA's efforts to protect the public against vaccine-preventable diseases, the AMA adopted policy during its Annual meeting to expand its existing policy to actively advocate for legislation, regulations, programs and policies that incentivize states to eliminate non-medical exemptions from mandated pediatric immunizations.

"Getting vaccinated not only keeps individuals from becoming ill with vaccine-preventable diseases, such as the measles, but also helps prevent further spread to loved ones, neighbors, co-workers and others in close contact," said AMA Board Member E. Scott Ferguson, M.D. "As evident from the measles outbreaks currently impacting communities in several states, when individuals are not immunized as a matter of personal preference or misinformation, they put themselves and others at risk of disease. The AMA strongly supports efforts to eliminate non-medical exemptions from immunization, and we will continue to actively urge policymakers to do so."

The overwhelming scientific evidence shows that vaccines are among the most effective and safest interventions to both prevent individual illness and protect the health of the public. The AMA has long-supported eliminating all non-medical exemptions from required childhood vaccines and provided testimony on legislation in several states, including Arizona, Maine, Oregon and Washington.

According to the Centers for Disease Control and Prevention (CDC), the U.S. currently has the highest number of measles cases that the country has seen since the disease was considered eradicated. In fact, there have been more cases of measles in the first five months of 2019 than all of 1992, the last year that the U.S. experienced a major outbreak.

AMA Announces Board of Trustees for 2019-2020

The American Medical Association (AMA) today introduced the 21 members of its Board of Trustees for the coming year following elections held during the Annual Meeting of the AMA House of Delegates. For the first time, the three highest elected AMA officers are women physicians.

Patrice A. Harris, M.D., M.A., a psychiatrist from Atlanta, was sworn in as the 174th president of the AMA. Dr. Harris is the first African-American woman to lead the nation's largest physician organization.

Susan R. Bailey, M.D., an allergist and immunologist from Fort Worth, Texas, is the AMA's new president-elect, while Barbara L. McAneny, M.D., an oncologist from Albuquerque, N.M., assumed the office of the AMA's immediate past president.

The new chair of the AMA Board of Trustees is Jesse M. Ehrenfeld, M.D., M.P.H, an anesthesiologist from Nashville, Tenn. Russell W.H. Kridel, M.D., a facial plastic surgeon from Houston, Texas, was chosen as the new chair-elect of the AMA Board of Trustees.

The other executive officers on the AMA Board of Trustees for 2019-2020 are:

  • Bobby Mukkamala, M.D., an otolaryngologist from Flint, Mich., the newly elected secretary.
  • Jack Resneck, Jr., M.D., a dermatologist from San Rafael, Calif., the newly installed immediate past chair.
  • Bruce A. Scott, M.D., an otolaryngologist from Louisville, Ky., the newly elected speaker of the AMA House of Delegates.

The newly elected members of the AMA Board of Trustees are:

  • Grayson W. Armstrong, M.D., M.P.H., an ophthalmology medical resident at Harvard Medical School in Cambridge, Mass.
  • Lisa Bohman Egbert, M.D., an OB-GYN from Dayton, Ohio, is also the newly elected vice speaker of the AMA House of Delegates.
  • Sarah Mae Smith, a medical student at University of California, Irvine's School of Medicine.
  • Michael Suk, M.D., J.D., M.P.H., M.B.A., an orthopaedic surgeon based in Danville, Penn.
  • Willie Underwood, III, M.D., M.P.H., a urologist based in Buffalo, N.Y.

The returning members of the AMA Board of Trustees are:

  • Willarda V. Edwards, M.D., M.B.A., an internist from Baltimore, Md.
  • Scott Ferguson, M.D., a diagnostic radiologist from West Memphis, Ark.
  • Sandra A. Fryhofer, M.D., an internist from Atlanta, Ga.
  • Gerald E. Harmon, M.D., a family physician from Pawleys Island, S.C.
  • William E. Kobler, M.D., a family physician from Rockford, Ill.
  • William A. McDade, M.D., Ph.D., an anesthesiologist from Chicago, Ill.
  • Mario A. Motta, M.D., a cardiologist from Salem, Mass.
  • Kevin W. Williams, M.S.A., a former senior executive at General Motors from Nashville, Tenn., the public member of the AMA Board.

Members of the AMA Board of Trustees are elected by physicians and medical students representing more than 190 state and specialty medical societies who gathered in Chicago this week for the Annual Meeting of the House of Delegates, the AMA's policy-making body. The mission of the AMA is the promotion of the art and science of medicine and the betterment of public health.

AMA Adopts Policy to Prevent Further Spread of Vector-borne Diseases

New policy aimed at protecting public health by advocating for adequate resources and funding to improve the prevention, diagnosis, and treatment of vector-borne diseases

With an increasing number of people in the U.S. becoming ill from vector-borne diseases--or infections spread through mosquito, tick and flea bites--the American Medical Association (AMA) today adopted policy to further its efforts to address this emerging health care concern. Due to the increasing threat and limited capacity to respond to vector-borne diseases in the U.S., the AMA's new policy calls for the AMA to advocate for improved surveillance for vector-borne diseases to better understand the geographic distribution of infectious vectors and where people are at risk.

The policy also calls for the development and funding of comprehensive and coordinated vector-borne disease prevention and control programs at the federal, state, and local levels, investments that strengthen our nation's public health infrastructure and the public health workforce, and education and training for health care professionals and the public about the risk of vector-borne diseases. Under the new policy, the AMA will support prevention efforts as well as the dissemination of available information. Additionally, the policy calls for increased and sustained funding to address the growing burden of vector-borne diseases in the U.S.

"Our country currently has limited capacity to properly control mosquitoes, ticks and other sources of vector-borne disease that are causing more and more people to become ill. In fact, approximately 80 percent of vector control organizations lack the resources they need to prevent and control vector-borne diseases," said AMA Board Member E. Scott Ferguson, M.D. "In order to protect our citizens from illness, we must ensure that health departments and other vector control organizations are equipped with funding and resources necessary to prevent and control vector-borne diseases. It is also vitally important that we educate health professionals and the public about existing and emerging vector-borne diseases as it will be critical to addressing both prevention and treatment efforts."

Furthermore, the policy acknowledges that clinical research will be needed to improve the diagnosis and treatment of vector-borne diseases, noting specifically that Lyme disease should be an area of focus. Additionally, because no licensed vaccines for humans are currently available for any vector-borne disease pathogen present in the U.S., the new policy calls for vaccine development for vector-borne diseases.

According to a May 2018 report by the Centers for Disease Control and Prevention (CDC), cases of vector-borne disease tripled across the country between 2004 and 2016, and nine new germs spread by mosquitoes and ticks were discovered during this same time period.

AMA Adopts New Policy Aimed at Increasing Diversity in Physician Workforce

Builds on AMA's efforts to ensure medical schools are building a diverse pipeline of physicians whose racial and ethnic backgrounds reflect the actual needs of patients

CHICAGO - The American Medical Association (AMA) adopted policy at its Annual meeting aimed at ensuring greater diversity in the physician workforce. Through the new policy, the AMA will work toward establishing best practices for the sustainability and success of health care career pipeline programs, or "pathway programs"--designed to draw students from diverse backgrounds into the field of medicine. One of the ways the AMA will accomplish this is through the publication of a white paper chronicling these programs, which will focus not only on helping identify best practices but also tracking participant outcomes.

"Studies show that patients prefer receiving health care from and have better health outcomes when they can relate to, understand, and share similar backgrounds with their doctors. That's why the AMA is committed to efforts aimed at ensuring medical schools are building a diverse pipeline of physicians whose racial and ethnic backgrounds reflect the actual needs of patients," said AMA Board Member S. Bobby Mukkamala, M.D. "One big way to advance health equity is to promote greater diversity among medical school applicants and enrollees. We will continue to support and improve pipeline programs because we know they are an effective way to help ensure there are enough physicians being trained to better reflect patients in the communities they serve."

To help identify whether a medical school applicant has previously participated in a pipeline program, the new policy calls for the AMA to help develop a relevant question that will be included on the Association of American Medical College's (AAMC) electronic medical school application. As part of this policy, the AMA will work with AAMC and other stakeholders to create a plan to analyze the resulting data to help determine the effectiveness of various pipeline programs.

While reports indicate that communities of color are growing much more quickly in the U.S. than whites, African-American/Blacks, Hispanics/Latinos, and Native Americans, continue to be a very small percentage of medical students and the physician workforce. In fact, fewer than 10 percent of physicians throughout the U.S. are from an underrepresented minority group, including African American/black, Native American, Alaska Native, or Hispanic.

The new policy extends the AMA's work to achieve health equity and increase diversity in the physician workforce, both of which are key goals of the AMA's Accelerating Change in Medical Education Consortium. As part of their work with the AMA's 37-medical school consortium, Morehouse College of Medicine is sharing their success with the extensive pipeline programs that they have with local colleges--providing mentoring support from current students and alumni. Additionally, as part of their work with the consortium, University of California, Davis, School of Medicine collaborated with Kaiser Permanente to develop a three-year education track for students committed to primary care careers, with an emphasis on addressing medically underserved populations, workforce diversity and workforce gaps. This program currently enrolls 50 percent of its students from traditionally underrepresented communities in medicine.

Most recently, the AMA convened two meetings of medical education experts from the 37 medical-school consortium. Both focused on improving diversity and inclusion in physician training. One meeting worked on issues related to creating an inclusive educational environment where physicians-in-training from diverse backgrounds will thrive. The other worked on selection and retention issues that will lead to a more diverse physician workforce.

AMA Adopts New Policies at 2019 Annual Meeting

The American Medical Association (AMA) voted this week at its Annual Meeting to adopt new policies related to Medicaid coverage for postpartum, use of body-worn cameras for law enforcement, educating physicians on the human health effects of climate change, and increasing access to health care in rural and underserved areas.

The AMA's House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.

The policies adopted by the House of Delegates include:

Extending Medicaid Coverage for Postpartum

Medicaid is currently required to cover pregnant women for only 60 days postpartum, after which many women have no access to coverage. Yet, health challenges from pregnancy and childbirth often persist up to a year postpartum. Many cases of pregnancy-related death occur during this period, and one study estimated that more than 60 percent of those deaths were preventable. With the nation's maternal mortality rate rising, there is a clear need for additional coverage. The House of Delegates directed the AMA to support extension of Medicaid coverage to 12 months postpartum.

"Medicaid covers nearly half of all births and plays a critical role in ensuring the health of mothers and babies. As physicians, we know new mothers' medical needs extend beyond Medicaid's current coverage period, and a longer coverage period would offer a healthier start for America's families," said Willarda V. Edwards, M.D., MBA, a member of the AMA Board of Trustees.

Support for Increased Use of Body-Worn Cameras by Law Enforcement Officers

The AMA will support state laws and regulations to implement body-worn camera programs for law enforcement officers.

Excessive force between law enforcement officers and the public, particularly within minority communities, can be a public health issue. Evidence suggests use of body-worn cameras may improve policing behavior toward minorities and foster greater trust between law enforcement and the public.

Still, privacy issues can arise when body cameras are worn in health care settings, such as when law enforcement officers enter facilities to interview witnesses. The AMA cautions that use of body-worn cameras must not interfere in the patient-physician relationship.

"We believe that law enforcement should adopt body-worn cameras to improve policing and demonstrate transparency to the community. Doing so will have a positive impact on our communities, especially minority communities, and help address health disparities," said Willarda V. Edwards, M.D., MBA, a member of the AMA Board of Trustees.

Educating Physicians and Medical Students on the Adverse Health Effects of Climate Change

The AMA adopted policy to ensure physicians and physicians-in-training have a basic knowledge of the science of climate change and an awareness of the associated health risks. Specifically, the policy calls for the AMA to make available a prototype presentation and lecture notes that can be used to teach physicians, medical students and residents about the intersection of climate change and health.

"It is important that current and future physicians are able to describe the risks that climate change poses to human health so that they can counsel their patients on how to protect themselves from the health risks posed by climate change," said AMA Board Member S. Bobby Mukkamala, M.D.

Increasing Access to Health Care in Rural, Underserved Areas

With a maldistribution of physicians in needed specialties and regions across the United States, the AMA adopted policy today aimed at improving patient access to care in communities without access to specialty physicians--namely child and adolescent psychiatrists. Specifically, the policy calls for the AMA to increase awareness of two training models that use videoconferencing to allow primary care physicians in medically underserved areas to remotely learn skills and procedures from physician specialists across the nation. Under the new policy, the AMA will encourage implementation of both Project ECHO (Extension for Community Healthcare Outcomes) and the Child Psychiatry Access Project (CPAP) among academic health centers and community-based primary care physicians.

"These training models offer a unique solution to specialty physician shortages by expanding the competencies and skills of physicians who are already providing patient care in our communities, rather than looking exclusively at increasing the physician workforce as the answer," said AMA Board Member S. Bobby Mukkamala, M.D. "The AMA supports multiple methods to help ease existing and predicted shortages, and we will continue to work toward ensuring more people have access to high quality health care."

In a recent letter sent to the U.S. Department of Health and Human Services, the AMA pointed to Project ECHO as an example of a promising strategy used to improve pain care. Aligning with the new policy, the AMA has also expressed its support to CMS for health care payers to offer additional payment or incentive payments for physicians who participate in clinical practice improvement activities, such as Project ECHO and the CPAP.

AMA Passes Opioid Policies to End Barriers to Non-Opioid Treatment

The American Medical Association (AMA) approved several opioid-related policies at its Annual Meeting that are intended to put the focus of pain treatment back on patients and away from arbitrary third-party controls.

The resolutions take aim at obstacles to effective treatment that were enacted by state and federal authorities, as well as insurers, pharmacy benefit management companies (PBMs) and national pharmacy chains. The barriers include tactics such as prior authorization and step therapy - which can delay treatment - and misguided laws and other policies setting hard thresholds for prescriptions.

One report recommends developing sound treatment plans based on individual patient needs, rather than a one-size-fits-all approach of hard thresholds. Also, the AMA opposes pharmacies, PBMs and insurers using "high prescriber" lists -- without due process - to keep physicians from writing prescriptions for controlled substances and preventing patients from filling prescriptions at their pharmacy of choice.

Another report underscores recent comments from the Centers for Disease Control and Prevention (CDC) about the inappropriate use of its opioid prescribing guidelines and assertions that the guidelines have harmed patients. The report urges state legislatures, PBMs and insurers to remove barriers, including prior authorization, to non-opioid pain care. Any opioid restrictions should have exceptions for physicians to exceed the limits if physicians determine that is medically necessary.

"Physicians have a responsibility to help end the opioid epidemic, and they are taking steps: more judicious prescribing that has resulted in a dramatic decline in opioid prescriptions, enhanced education, and lobbying for policies based on clinical evidence," said AMA President Patrice A. Harris, M.D., M.A., chair of the AMA Opioid Task Force. "Physicians can't be expected to fight the epidemic with one hand tied behind their back, handicapped by policies that limit choices for patients and have no basis in science."

The new reports mirror the common-sense proposals approved recently by the U.S. Department of Health and Human Services Interagency Pain Task Force. The recommendations balanced the need to effectively manage patients' pain while also advancing policies to end the epidemic of opioid-related harm. The task force called for multidisciplinary, multimodal approaches to treating patients with acute and chronic pain; reversing harmful policies such as arbitrary limits on prescribed pain medications; providing individualized treatment that accounts for co-morbidities and severity; encouraging better health insurance coverage of affordable, evidence-based non-opioid medications and non-pharmacologic treatments for pain and eliminating obstacles to treatment such as fail-first policies; recognizing the urgent need to address stigma as a barrier to care.

In April, the CDC said that its opioid guidelines had been widely misapplied. The guidelines have been treated as hard and fast rules. Meanwhile, some patients with acute or chronic pain can benefit from taking prescription opioid analgesics at doses that may be greater than the guidelines or hard thresholds. The AMA praised the CDC for recognizing the individual nature of pain treatment.

Surgeon General Jerome Adams, M.D., attending the AMA meeting, pointed to the problems created by what he called "the misapplication" of CDC guidelines.

Finally, delegates approved a resolution urging that the funds paid to states from settlements in litigation against opioid manufacturers and distributors be used exclusively for research, education, prevention and treatment of overdoses, opioid use disorder and pain.

AMA Expands its Efforts Aimed at Preventing Medical Student and Physician Suicide

The American Medical Association (AMA) adopted policy during its Annual meeting today aimed at better understanding the incidence of depression and suicide among physicians and physicians-in-training. With reports showing a lack of systematic reporting and inconsistencies in available data, the new policy offers recommendations on studying and collecting data that better reflect the actual incidence of and risk factors for physician, medical student and resident suicide in the U.S.

Specifically, the policy calls for the AMA to explore the viability and cost-effectiveness of regularly collecting National Death Index (NDI) data, as well as confidentially maintaining manner of death information, for physicians, residents, and medical students listed as deceased in the AMA Physician Masterfile for long-term studies. Accordingly, the AMA plans to partner with a leading academic medical institution to conduct a pilot study using NDI to initially identify manner of death for a subset of the AMA Masterfile population

"While it has been reported that the incidence of depression and suicide is greater in medical students, residents, and physicians than the general population, it is vitally important that we take action now to fully understand the actual impact of suicide on our physician workforce. Our goal is to have access to data that will help us identify the systemic patterns and risk factors that lead to suicide, and ultimately help us prevent it," said AMA Board Member S. Bobby Mukkamala, M.D. "We will continue working to reduce burnout and increase access to mental health services for physicians and physicians-in-training--improving their well-being and leading to better health outcomes for their patients."

The new policy also supports educating faculty members, residents and medical students to help them recognize the signs and symptoms of burnout and depression and supports access to free, confidential, and immediately available stigma-free mental health and substance use disorder services.

In alignment with the policy adopted today, the AMA recently developed an education module that will help physicians, residents, and medical students learn about the risks of physician suicide, identify characteristics to look for in patients who may be at risk of harming themselves, and recognize the warning signs of potential suicide risk in colleagues. The new module is available on the AMA Ed HubTM.

The policy adopted today builds on the AMA's continued efforts to prevent physician burnout and improve wellness, and support physicians throughout their career journey. Through the AMA's Professional Satisfaction and Practice Sustainability initiative launched in 2013, the AMA is partnering with physicians, leaders, and policymakers to reduce the complexity and costs of practicing medicine so physicians can continue to put patients first. As part of this work, the AMA's Steps Forward program offers a series of practice transformation modules designed to improve the health and well-being of patients by improving the health and well-being of physicians and their practices. These online modules focus on improving physician wellness, preventing burnout, and increasing resilience.

AMA Strengthens its Policies Promoting Naloxone Access and Education

CHICAGO - Physicians and medical students acted today to strengthen existing AMA policy promoting increased access to naloxone, the opioid overdose-reversing drug. The added policy, adopted today at the AMA Annual Meeting, supports implementation of naloxone rescue stations in public areas where the life-saving drug can be stored and accessed.

Current AMA policy already urges that all forms of naloxone should be readily available to prevent opioid overdose fatalities, and calls for manufacturers or drug sponsors to pursue over-the-counter approval of naloxone with the Food and Drug Administration. The widespread availability of naloxone in public locations can only be successfully accomplished when this happens.

"Physicians and public health advocates all recognize that naloxone is a vital tool in our fight against opioid overdose deaths," said AMA President Patrice A. Harris, M.D, M.A. "Greater access to naloxone is a national priority and the AMA will support widespread implementation of naloxone rescue stations where this opioid overdose treatment can be easily accessed to prevent a fatality."

Physicians also adopted new policy supporting collaboration between the AMA, the American Heart Association and other interested parties to include naloxone use in training available through the Basic Life Support Certification Program.

In other related action, physicians adopted new policy calling for the AMA to disseminate educational materials aimed at dispelling the myths and fear caused by reports of bystander overdose from dermal contact or inhaled exposure with fentanyl or other synthetic derivatives. Fentanyl is very poorly absorbed through the skin, a fact that is often misrepresented, and the resulting fear has increased first-responder reluctance to intervene in a timely manner when an opioid overdose is suspected.

The American College of Medical Toxicology (ACMT) and the American Academy of Clinical Toxicology (AACT) issued a position paper and guidelines on the topic in 2017. ACMT and AACT note that inhalation and dermal exposure risk for fentanyl and other synthetic analogues is extremely low in the absence of mucous membrane exposure, incidental dermal absorption is unlikely to cause opioid toxicity, and nitrile gloves provide sufficient dermal protection for routine handling of the drug.

AMA: Build on the Success of Affordable Care Act to Help Patients Still Lacking Insurance

The American Medical Association (AMA) reaffirmed its commitment today to covering the uninsured by supporting critical improvements to the Affordable Care Act (ACA).

The policy recommendations -- adopted by the House of Delegates at its Annual Meeting -- originated in a report that noted "the ACA is not broken, but it is imperfect." An improved ACA would emphasize providing coverage to the uninsured population, rather than upending the health insurance coverage of most Americans, including the more than 156 million enrolled in employer-sponsored coverage.

"Since the ACA was enacted into law in 2010, millions of Americans have gained health insurance. The policy question now is how to improve the law to insure even more," said AMA President Barbara L. McAneny, M.D. "We need policies to make coverage more affordable for millions of Americans - both in the premiums they pay, as well as their cost-sharing responsibilities."

As such, the AMA's House of Delegates adopted the following new policies:

  • Increasing the amount of and expanding eligibility for premium tax credits, including removing the "subsidy cliff;"
  • Increasing amounts of cost-sharing reductions received by individuals who qualify for them; and
  • Extending eligibility for cost-sharing reductions beyond 250 % of the family poverty level.

The report raised concerns about the recent uptick in the uninsured rate, as well as future coverage impacts of zeroing out the federal individual mandate penalty, the expanded availability of short-term limited duration plans, and other proposals that have been put forward that could undermine the progress made in covering the uninsured. Expanding health insurance coverage and choice have been long-standing goals of the AMA. The AMA's health system reform proposal -- the result of 20 years of policy development.

Before today's vote, the AMA had extensive policy that would result in coverage to millions of the uninsured and believes that:

  • Individuals caught in the "family glitch" and unable to afford coverage offered through their employers for their families should become eligible for ACA financial assistance based on the premium for family coverage of their employer plan.
  • Young adults facing high premiums should be eligible for "enhanced" tax credits based on income.
  • A permanent federal reinsurance program should be established to address the impact of high-cost patients on premiums.
  • Initiatives to expand Medicaid programs in additional states should be supported. To incentivize expansion decisions, states that now expand Medicaid should still be eligible for three years of full federal funding.
  • To maximize coverage rates, the AMA will continue to support reinstating a federal individual mandate penalty, as well as state efforts to maximize coverage, including individual mandate penalties and auto-enrollment mechanisms.
  • To improve coverage rates of individuals eligible for either ACA financial assistance or Medicaid/CHIP but remain uninsured, the AMA would support investments in outreach and enrollment assistance activities.

"The AMA is pursuing sustainable, practical solutions. Building on the ACA would help cover the uninsured without disrupting the coverage of most of Americans. We will continue to put our patients first as we engage in these debates moving forward," McAneny said.

The AMA acknowledged that equitable access to medical care is a core component of a basic human right to health care, and the AMA holds that physicians have an ethical responsibility to ensure that all persons have access to needed care. There are many pathways to providing patients with equitable access to medical care and the AMA support a pluralistic approach to ensure that all people have access to health care.

AMA Adopts New Principles for Advancing Gender Equity in Medicine

Recognizing that inequity in medicine is a complex, pervasive issue that requires a multilayered approach, the American Medical Association (AMA) today adopted a set of Principles for Advancing Gender Equity in Medicine. The new principles come as a number of studies continue to show significant gaps in pay and leadership disparities for women in medicine.

According to the 2018 Medscape Physician Compensation Report, female physicians in primary care earn nearly 18 percent less than their male counterparts. Among all physicians, the pay disparity is even more pronounced, with female physicians earning 36 percent less than male physicians. Similar disparities also exist in academic medicine, not just in terms of pay but in terms of leadership opportunities as well. Although women accounted for 41 percent of full-time medical school faculty in 2018, they made up only 25 percent of tenured faculty (of all ranks) and only 25 percent of full professors and 38 percent of associate professors.

"The statistics on pay and leadership disparities in medicine are jarring, but sadly, unsurprising," said AMA Board Chair Jesse M. Ehrenfeld, M.D., M.P.H. "Even as the number of women in medicine increases - and women now outnumber men as physicians-in-training - more must be done to spur change and eliminate the bias and discrimination that adversely affect women and, consequently, our profession. These Principles for Advancing Gender Equity in Medicine are a step in the right direction for the AMA, women in medicine, and toward achieving our goal of improving the health of the nation."

The new policy and principles, adopted at the Annual Meeting of the House of Delegates, state:

Our AMA:

  • Declares it is opposed to any exploitation and discrimination in the workplace based on personal characteristics;
  • Affirms the concept of equal rights for all physicians and that the concept of equity of rights under the law shall not be denied or abridged by the U.S. government or by any state on account of gender;
  • Endorses the principle of equal opportunity of employment and practice in the medical field;
  • Affirms its commitment to the full involvement of women in leadership roles throughout the federation, and encourages all components of the federation to vigorously continue their efforts to recruit women members into organized medicine;
  • Acknowledges that mentorship and sponsorship are integral components of one's career advancement, and encourages physicians to engage in such activities;
  • Declares that compensation should be equitable and based on demonstrated competencies/expertise and not based on personal characteristics;
  • Recognizes the importance of part-time work options, job sharing, flexible scheduling, re-entry, and contract negotiations as options for physicians to support work-life balance;
  • Affirms that transparency in pay scale and promotion criteria is necessary to promote gender equity, and as such academic medical centers, medical schools, hospitals, group practices and other physician employers should conduct periodic reviews of compensation and promotion rates by gender and evaluate protocols for advancement to determine whether criteria are discriminatory; and
  • Affirms that medical schools, institutions and professional associations should provide training on leadership development , contract and salary negotiations and career advancement strategies that include an analysis of the influence of gender in these skill areas.

AMA Urges Support for, Creation of APMs Focused on At-Risk, Vulnerable Populations

CHICAGO - As part of the ongoing implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), current advanced Alternative Payment Models (APMs) may inadvertently be creating disincentives for physicians to care for vulnerable or high-risk populations. To counter this outcome and work toward the American Medical Association (AMA) Health Equity Center's goal of enabling optimal health for all, the AMA today adopted new policies at its Annual Meeting to support APMs that link quality measures and payments to outcomes specific to vulnerable and high-risk populations and reductions in health care disparities.

"We know that disparities in health outcomes are commonly related to non-medical factors, including geography and socioeconomic status, which are among the factors in the social determinants of health. To affect change and truly realize optimal health for all, we must encourage care to specifically meet the needs of vulnerable populations," said William E. Kobler, M.D., an AMA board of trustees member. "If patients' basic needs are not met, they are unlikely to stay healthy, regardless of the quality of care received. Because APMs are typically designed to be flexible to compensate for care that is not traditionally reimbursed, they present an opportunity to better care for and serve vulnerable populations."

To address these concerns and incentivize care for vulnerable and high-risk populations, the AMA adopted three new policies:

  • That the AMA support APMs that link quality measures and payment to outcomes specific to vulnerable and high-risk populations and reductions in health care disparities;
  • That the AMA continue to encourage the development and implementation of physician-focused APMs that provide services to improve the health of vulnerable and high-risk populations;
  • That the AMA continue to advocate for appropriate risk adjustment of performance results based on clinical and social determinants of health to avoid penalizing physicians whose performance and aggregated data are impacted by factors outside of the physician's control

Ohio-based OB-GYN Elected as Vice Speaker of the AMA

The American Medical Association (AMA), the nation's largest physician organization, today announced the election of Lisa Bohman Egbert, M.D., an OB-GYN from Dayton, Ohio, as the vice speaker of the AMA's House of Delegates.

"It is both an honor and a privilege to be elected by my peers to serve as Vice Speaker of the AMA House of Delegates," said Dr. Egbert. "I am excited to embrace this opportunity to help advance the AMA's work to shape the future of medicine and improve patient care."

Dr. Egbert has been an active AMA member since medical school and has held several leadership positions within the AMA over the years. She previously served on the governing councils of both the Resident Physicians Section and the Young Physicians Section, as well as chair of the Young Physicians Section. Additionally, she has served on the AMPAC Board of Directors and the Women in Medicine Advisory Panel. She is currently serving her second term on the Council on Medical Service.

Also an active participant at the state and local levels, Dr. Egbert currently serves as Parliamentarian for the Ohio State Medical Association (OSMA) and as District 2 Councilor on the OSMA Governing Council. Previously, she was president of the Montgomery County Medical Association.

Additionally, Dr. Egbert is an experienced parliamentarian and a member of the National Association of Parliamentarians and the American Institute of Parliamentarians.

Dr. Egbert has been a general OB-GYN in solo practice in Dayton, Ohio for more than 20 years, and a fellow of the American College of Obstetricians and Gynecologists. She received both her undergraduate and medical degrees from The Ohio State University.

Texas Allergist Chosen as AMA President-Elect
For the first time, three consecutive woman physicians have held the office of AMA president-elect

CHICAGO - Physicians and medical students gathered at the Annual Meeting of the American Medical Association (AMA) today voted for Susan R. Bailey, MD, an allergist and immunologist from Fort Worth, Texas, as the new president-elect of the nation's premier physician organization. Following a year-long term as president-elect, Dr. Bailey will assume the office of AMA president in June 2020.

In her acceptance speech, Dr. Bailey said, "It is a deep honor and privilege to be named president-elect of an organization that is committed to helping the medical profession and the patients we serve. Challenging times remain for the health care system and as AMA president-elect, I pledge to serve as a strong voice and dedicated advocate for patients and physicians on the pressing health care issues confronting our nation."

Dr. Bailey's election marks the third consecutive time that the office of AMA president-elect has been held by a woman physician, and illustrates the AMA's commitment to the full involvement of women in leadership roles. Dr. Bailey was preceded as AMA president-elect by Barbara L. McAneny, M.D., an oncologist from Albuquerque N.M., and Patrice A. Harris, M.D., a psychiatrist from Atlanta, Ga..

Dr. Bailey brings more than 30 years of clinical practice and experience into her new role as AMA president-elect. Since 1988, she has been in the private practice of allergy and clinical immunology in Fort Worth, Texas.

First elected to the AMA Board of Trustees in 2011, Dr. Bailey served as vice-speaker and speaker of the House of Delegates, the AMA's primary policy-making body. Dr. Bailey has held numerous leadership positions at the AMA over the years including two terms on the AMA Council on Medical Education, culminating as chair of this influential advisory council. She was a member of the AMA's Advisory Panel to the Women in Medicine Project and the AMA's Ad Hoc Committee on Women Physicians, the precursors to today's AMA Women Physicians Section. Dr. Bailey also has represented the AMA in the American Board of Medical Specialties Assembly, the board of directors of the Accreditation Council for Continuing Medical Education, and currently serves on the board of directors of COLA, a national laboratory accreditation organization.

Prior to becoming an AMA officer, Dr. Bailey served as president of both the Texas Medical Association and Tarrant County Medical Society. She also served as vice speaker and speaker of the more than 500-member Texas Medical Association House of Delegates as well as for the American College of Allergy, Asthma and Immunology House of Delegates.

An honor graduate of Texas A&M University College of Medicine, Dr. Bailey was the first female Texas A&M graduate to become a regent for the Texas A&M University System and has been recognized as a Distinguished Alumnus of Texas A&M University as well as the College of Medicine.

She completed her residency and fellowship training at the Mayo Graduate School of Medicine and is certified by the American Board of Pediatrics and the American Board of Allergy and Immunology, and is a distinguished fellow of the American College of Allergy, Asthma, and Immunology.

Kentucky Physician Elected to Preside over AMA Policy-Making Body

Physicians and medical students gathered at the Annual Meeting of the American Medical Association (AMA) today voted for Bruce A. Scott, M.D., an otolaryngologist from Louisville, Ky., as the new speaker of the AMA House of Delegates. In this position, Dr. Scott will preside over 640 physicians and medical students who comprise the policy-making body of the nation's largest physician organization.

"It is a deep honor and privilege to preside over the policy-making forum at the center of American medicine and help craft results-focused policies that enable physicians to answer a national imperative to improve the health of the nation," said Dr. Scott.

During the last four years, Dr. Scott has served as vice-speaker of the AMA House of Delegates and as a member of the AMA Board of Trustees. He has extensive experience in AMA leadership positions and has previously served as chair of the AMA Resident and Fellow Section, delegate for the AMA Young Physicians Section, and was the young physician member on the AMA Board of Trustees. Dr. Scott has also served as president and board member of the AMA Foundation.

Outside of the AMA, he is currently president of the Kentucky Medical Association (KMA) and serves on the board of trustees for both the KMA and the Greater Louisville Medical Society.

Dr. Scott brings more than 25 years of clinical practice and experience into his new role as speaker of the AMA House of Delegates. Dr. Scott is an actively practicing physician in a five-physician independent private practice, the medical director of a multispecialty ambulatory surgery center and a clinical assistant professor at the University of Louisville School of Medicine.

A graduate of Vanderbilt University, he completed medical school and residency at the University of Texas Medical Branch at Galveston, before returning to his home town of Louisville to practice otolaryngology.

Married to his college sweetheart for 30 years, Dr. Scott is the proud father of three young adults.

Physicians Taking Steps to Reverse Opioid Epidemic but Mortality Continues to Rise

A new AMA report on opioids highlights the limited effects of mandates to stem an epidemic that claims about 130 people every day -- underscoring the immediate need for policymakers to focus on removing barriers to evidence-based treatment.

The 2019 Opioid Progress Report found that physicians and other health care professionals are taking significant actions in the face of the epidemic, and some reports suggest that prescription opioid-related mortality may be leveling off. Yet, death from heroin and illicitly manufactured fentanyl and fentanyl analogs are at historic levels.

This is the third annual AMA report on actions physicians have taken.

"The opioid epidemic is at a crossroads," said AMA President-elect Patrice A. Harris, M.D., M.A., who chairs the AMA Opioid Task Force. "While physicians must continue to demonstrate leadership by taking action, it is clear that these significant reductions in opioid prescribing, increases in prescription drug monitoring program (PDMP) use and taking more education--by themselves--will not stop people from dying."

To end the epidemic, the AMA Opioid Task Force is calling on policymakers and other stakeholders to eliminate all barriers to evidence-based treatment and to take specific steps such as removing prior authorization for medication-assisted treatment (MAT) for the treatment of opioid use disorder, enforcing state and federal laws that require insurance parity for mental health and substance use disorders, and ending health insurance company barriers to comprehensive multimodal, multidisciplinary pain care, including non-opioid alternatives.

Key findings from the report include:

  • Opioid prescriptions decrease. Opioid prescriptions decreased 33 percent between 2013-2018, including a 12.4 percent decrease between 2017-2018; (IQVIA)
  • PDMP use increases. Physicians and other health care professionals used state prescription drug monitoring programs more than 460 million times in 2018--an increase of 167 million from 2017, and 390 million more queries than in 2014; (AMA survey of the nation's state PDMP administrators)
  • Education increases. Physicians and other health care professionals completed continued medical education courses, reviewed education and training resources and accessed other opioid prescribing, pain management, opioid use and substance use disorder treatment and other related areas more than 700,000 times in 2018--an increase of 150,000 from 2017; (AMA survey of the nation's medical societies)
  • More physicians certified to treat opioid use disorder. More than 66,000 physicians (as well as a growing number of nurse practitioners and physician assistants) now are certified to treat patients in-office with buprenorphine--an increase of more than 28,000 from 2016; (SAMHSA)
  • Naloxone co-prescribing increases. Nearly 600,000 naloxone prescriptions were dispensed in 2018--almost a threefold increase from the 136,000 dispensed in 2016. (IQVIA)

"Progress has been made, but much more work remains. It is time for states to end prior authorization and other barriers to medication-assisted treatment for opioid use disorder; and time for payers, PBMs and pharmacy chains to re-evaluate all policies restricting access evidence-based care for pain and substance use disorders," Dr. Harris said. "If it weren't for naloxone, it is likely that tens of thousands more Americans would be dead. The report shows that to save many more lives, policymakers, payers, PBMs and pharmacy chains must remove all barriers to evidence-based care."

Created in 2014, the AMA Opioid Task Force is comprised of more than 25 national, state, specialty and other health care associations to coordinate efforts within organized medicine to help end the opioid epidemic. Additional information on the AMA Opioid Task Force is available here. Real-time updates on the AMA's work on opioids is accessible here.


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