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Updates from the AMA Meeting II


 

Barbara L. McAneny, M.D., Inaugurated as 173rd President of the AMA

First oncologist and fourth woman will lead the nation's largest physician organization

CHICAGO - Barbara L. McAneny, M.D., an oncologist from Albuquerque, N.M., has been sworn in as the 173rd president of the American Medical Association (AMA), the nation's premier physician organization. She will focus her tenure on the AMA's three strategic arcs: attacking the dysfunction in health care by removing obstacles and barriers that interfere with patient care; reimagining medical education, training and lifelong learning to help physicians adapt and grow in the digital age; and improving the health of the nation by confronting the increasing chronic disease burden.

"As healers we have everything we need to fix what ails our health care system. We have the most important ingredients in our hands - we have our patients' trust," said Dr. McAneny during her inaugural address. "We have the will, the expertise, and the view of our system at its most crucial point - inside the exam room with patients. And thanks to organizations such as the AMA, as well as state and specialty societies, we have a voice. We have a platform from which we can lead on any issue - and work to re-align our health care system so that patients and physicians are back in the center."

Dr. McAneny has spent her 35-year career as a practicing physician in New Mexico. She is also a successful businesswoman and co-founder and CEO of a multi-disciplinary oncology practice, New Mexico Oncology Hematology Consultants Ltd. She also built and manages the New Mexico Cancer Center, which provides comprehensive outpatient medical and radiation oncology care and imaging at several underserved rural areas across New Mexico, including sites in Albuquerque and Gallup.

Dr. McAneny has been an AMA board member since 2010, serving as board chair from 2015 to 2016. Prior to her election to the AMA board, Dr. McAneny served on the board for the American Society of Clinical Oncology (ASCO) and was the delegate to the AMA from ASCO. She has held many leadership roles in medicine including president of the New Mexico Medical Society (NMMS), president of the Greater Albuquerque Medical Association, and president of the New Mexico Chapter of the American College of Physicians. She served as chair of the AMA Council of Medical Service from 2009 to 2010.

A greatly respected leader at the state and local level, Dr. McAneny has received the New Mexico Woman on the Move Award in 2005 and Woman of Influence Award in 2009, and has been voted multiple times by her peers as Albuquerque The Magazine's "Top Doc" in her specialty. At the national level, she has established a reputation as an innovator after being awarded a federal grant in 2012 to develop the Community Oncology Medical Home Model that demonstrates improved outcomes and patient satisfaction with reduced hospitalizations and costs.

In her spare time, Dr. McAneny cultivates her rose garden and travels with her husband, Steve.


Georgia Physician Elected as AMA President-Elect

CHICAGO - Patrice A. Harris, M.D., a psychiatrist from Atlanta, Ga., was elected as the new president-elect of the American Medical Association (AMA) today by physicians gathered at the Annual Meeting of the AMA House of Delegates in Chicago.

Dr. Harris has diverse experience as a private practicing physician, public health administrator, patient advocate and physician spokesperson. During her entire career, Dr. Harris has been a leader in organized medicine to ensure the voice of physicians and patients is represented in health care transformation.

"It will be my honor to represent the nation's physicians at the forefront of discussions when policymaker and lawmakers search for practical solutions to the challenges in our nation's health system. I am committed to preserving the central role of the physician-patient relationship in our healing art," said Dr. Harris. "The American Medical Association has well-crafted policy concerning the changing health care environment in this country and I look forward to using my voice to help improve health care for patients and their physicians."

Dr. Harris is the first African-American woman to hold the office.

First elected to the AMA Board of Trustees in 2011, Dr. Harris has held the executive offices of AMA board secretary and AMA board chair. Dr. Harris will continue to serve as chair of the AMA Opioid Task Force, and has been active on several other AMA taskforces and committees on health information technology, payment and delivery reform, and private contracting. She has also chaired the influential AMA Council on Legislation and co-chaired the Women Physicians Congress.

Prior to her AMA service, she was elected to the American Psychiatric Association Board of Trustees and president of the Georgia Psychiatric Physicians Association. She was also the founding president of the Georgia Psychiatry Political Action Committee. In 2007, Dr. Harris was selected Psychiatrist of the Year by the Georgia Psychiatric Physicians Association.

As chief health officer for Fulton County, Ga., Dr. Harris spearheaded efforts to integrate public health, behavioral health and primary care services. Dr. Harris also served as medical director for the Fulton County Department of Behavioral Health and Developmental Disabilities.

Currently, Dr. Harris continues in private practice and consults with both public and private organizations on health service delivery and emerging trends in practice and health policy. She is an adjunct assistant professor in the Emory Department of Psychiatry and Behavioral Sciences.

Dr. Harris received her medical degree from the West Virginia University School of Medicine and completed a psychiatry residency and child psychiatry fellowship at Emory University School of Medicine. She was inducted in 2007 to the West Virginia University Academy of Distinguished Alumni.

Following a year-long term as AMA president-elect, Dr. Harris will be installed as the AMA president in June 2019.


AMA Plans Advocacy Outreach to Expand Colorectal Screening

CHICAGO -- Building on the efficacy of colorectal cancer screening, the American Medical Association endorsed a plan at its annual meeting to work with physicians and payers to make the screening more available and affordable.

Challenges with insurance coverage remain a barrier to colorectal cancer screening, despite extensive evidence that early screening decreases the likelihood of colorectal cancer and increases the likelihood of survival.

"One in three people is not up-to-date on their colorectal screening even though we know that if colorectal cancer is caught early, the five-year survival rate is 90 percent," said AMA Board Member Russ Kridel, M.D. "The AMA needs to help patients understand the value of screening and help them gain access to it."

Under the Affordable Care Act (ACA), private health insurance plans must cover colorectal cancer screening without imposing any cost-sharing on patients. Moreover, federal government guidance has clarified that ACA-compliant insurance plans cannot impose any patient cost sharing when a polyp is removed during a screening colonoscopy. Delegates endorsed an advocacy effort in support of Medicare coverage for colorectal cancer screenings consistent with ACA-compliant plan coverage requirements.

Medicare coverage differs critically from commercial coverage. Specifically, when a polyp or abnormal growth is removed during a colonoscopy, or when a biopsy is done of suspicious-looking tissue, the "screening" colonoscopy becomes "diagnostic," and although the Medicare Part B deductible is waived, beneficiaries are billed co-insurance of 20 percent of the cost of the procedure.

The differing coverage rules can lead to significant confusion, financial burden on patients, and finally, patients avoiding colorectal cancer screening.

Given the complicated coding and payment rules surrounding the screening, it is unsurprising that patients commonly find themselves billed for services they expected to be covered at no cost to them.

Delegates also called on the AMA to collaborate with physicians who specialize in colorectal screening to develop a coding guide to help physicians correctly bill various screening scenarios and promote common understanding among health care providers, payers, and patients so that all know what will be covered at given cost-sharing levels.


New AMA Policy Reflects Physician and Patient Frustration over Ongoing Drug Shortages

Physicians strengthen current AMA policy to combat national drug shortages

CHICAGO - Responding to ongoing national drug shortages that threaten patient care and safety, physicians gathered at the Annual Meeting of the American Medical Association (AMA) today adopted policy declaring drug shortages an urgent public health crisis. The new declaration strengthens existing AMA policy outlining the physician prescription for a comprehensive solution to ongoing drug shortages.

Many of the drugs currently in shortage are everyday products required for patient care in all medical settings, such as sterile intravenous products containing saline or other fluids. Shortages of these basic products, and their containers, increased following hurricane damage to production facilities in Puerto Rico, leaving the health care system scrambling for options that were either limited or risky.


In response to hazards that pose a threat to the resilience of drug production, the AMA will urge the Department of Health and Human Services and the Department of Homeland Security to examine drug shortages as a national security initiative. This would result in drug manufacturing sites being designated as critical infrastructure with vital importance to the nation's public health.

"Physicians strive to provide the best possible care to their patients, which means being able to obtain the right drugs at the right time," said AMA Board Member William E. Kobler, M.D. "The fact that drug shortages worsened when major hurricanes struck drug production facilities on Puerto Rico highlights the need to evaluate and plan for hazards that pose a threat to critical infrastructure for manufacturing pharmaceutical and medical products."

Managing risk to enhance the security and resilience of drug manufacturing sites needs to be a shared priority for the industry and government. However, many manufacturers are unwilling to share production locations for drugs and other medical products, even though information shared with officials at Health and Human Services and Homeland Security is protected by law from public disclosure and used only in the context of preparedness planning and response.

To facilitate industry and government collaboration in preparing for disasters and determining contingency plans to mitigate drug shortages, the AMA calls for greater manufacturer transparency regarding production location and problems than may lead to a drug shortage. Given uncertainty regarding these sites as alternative sources for drugs in short supply, the AMA also calls for more information on the quality of outsourcing compounding facilities.

The AMA's newly enhanced policy on drug shortages supports the recommendations of the 2017 drug shortage roundtable convened by the American Society of Health System Pharmacists. The AMA will continue to work in a collaborative fashion with other stakeholders to urgently implement these recommendations.


AMA Backs Steps to Protect and Sustain ACA Marketplaces

CHICAGO -Faced with federal and state actions that have the potential to cause instability in the Affordable Care Act marketplaces, the American Medical Association (AMA) announced its opposition to health insurance plans being sold in the individual and small group markets that do not guarantee critical patient protections under the ACA.

The AMA believes that all plans sold to individuals and small groups should guarantee pre-existing condition protections and coverage of essential health benefits and their associated protections against annual and lifetime limits, and out-of-pocket expenses. The exception is in the circumstance of short-term limited duration insurance offered for no more than three months.

"The AMA knows that insurers are more likely to participate in marketplaces with large and healthy risk pools. We need to take steps to ensure that healthy individuals stay enrolled in coverage offered in the ACA marketplaces and are not siphoned off into coverage that does not guarantee critical patient protections, leaving behind a sicker population facing higher premiums in ACA-compliant coverage," said AMA President David O. Barbe, M.D. "At some point, people who are currently healthy are going to have to seek medical care, and we need to make sure that they avoid sham coverage that does not provide them with the coverage and financial protection they counted on at the time of enrollment."

With threats to the ACA marketplaces emerging and concerns that insurers are going to pull out of some ACA marketplaces, the AMA agreed with the sentiment that a back-up plan needs to be available to ensure patients are not left without coverage options. In counties that lack a marketplace plan, the AMA supported requiring the largest two Federal Employees Health Benefits Program (FEHBP) insurers to offer at least one silver-level marketplace plan as a condition of FEHBP participation. Of note, this new policy would not allow individuals to buy-in to FEHBP plans. Rather, individuals in otherwise bare counties would have the choice of at least two silver plans that abide by ACA requirements, offered by the two largest FEHBP insurers in their county.


AMA Recommends Ways to Improve Affordability in the Health Insurance Exchanges

CHICAGO - Building on the progress of almost 12 million Americans having enrolled in coverage offered through health insurance exchanges this year, the American Medical Association endorsed policies that aim to increase that number while taking steps to make health insurance on the exchanges more affordable.

Premium increases are being announced at the state level for the 2019 plan year, though 83 percent of consumers who buy coverage through exchanges receive subsidies to lower their premiums and will be shielded from such increases because their premium contributions are pegged to a defined percentage of their income. At its Annual Meeting, the AMA supported the policy of extending eligibility for these premium subsidies to individuals and families with incomes up to 500 percent of the federal poverty line ($60,700 for an individual), allowing more people to afford and obtain health insurance coverage. Under the ACA, eligible individuals and families with incomes between 100 and 400 percent ($48,560 for an individual) of the federal poverty line are being provided with refundable and advanceable tax credits to purchase coverage on health insurance exchanges.

The AMA also recommended steps to improve the affordability of exchange coverage for young adults to incentivize them to enroll in exchange coverage. The AMA backed the idea of offering "enhanced" premium tax credits for those aged 19 to 35 who already are eligible for premium subsidies. Under such a plan, young adults could receive a credit in addition to the amount they already are eligible for.

"We must build on the gains of the Affordable Care Act and make coverage more affordable for Americans by extending the eligibility for premium tax credits and increasing tax credit amounts for young adults that will result in greater coverage," said AMA President David O. Barbe, M.D.

Looking ahead to 2019, as a result of the elimination of the individual mandate penalty, the Congressional Budget Office has projected that more individuals will become uninsured and premiums will increase.

In response to the loss of the federal individual mandate penalty, the AMA also encouraged state innovation, including considering state-level individual mandates, auto-enrollment and/or reinsurance, to maximize the number of individuals covered and stabilize health insurance premiums without undercutting any existing patient protections. To provide more of a lasting solution to stabilize premiums, the AMA also called for the establishment of a permanent federal reinsurance program.


AMA Adopts New Policy Urging Appropriate Placement of Transgender Prisoners

CHICAGO - In an effort to address health and safety problems of transgender prisoners, new policy adopted today at the American Medical Association's (AMA) Annual Meeting challenges the status quo of prisons and jails in the United States that house transgender prisoners according to their birth or biological sex. The AMA urges that housing policies be changed to allow transgender prisoners to be placed in correctional facilities that are reflective of their affirmed gender status.

"The problem facing the safety and health of transgender prisoners is severe and well documented," said AMA Immediate Past Chair Patrice A. Harris, M.D. "Transgender prisoners are disproportionately the victims of sexual assault, suffering higher rates of sexual assault than general population inmates. The new AMA policy acknowledges that the increased rate of violence largely stems from transgender prisoners being housed based on their birth sex, and not according to their affirmed gender."

To ameliorate the risks and hazards of sex-based housing for transgender prisoners, physicians voted to adopt policy directing the AMA to:

  • support the ability of transgender prisoners to be placed in facilities, if they so choose, that are reflective of their affirmed gender status, regardless of the prisoner's genitalia, chromosomal make-up, hormonal treatment, or non-, pre-, or post-operative status; and
  • support that the facilities housing transgender prisoners shall not be a form of administrative segregation or solitary confinement.

Birth sex-based housing policy in correctional institutions is taken for granted. This status quo is founded on the "gender binary," a social construct where only two genders are recognized: male or female.

One study showed that birth sex-based housing policy has allowed transgender prisoners to suffer from rape, harassment, and physical violence at a rate of 34 percent compared to 10 percent for the overall population. Another study of California prisons has shown that 59 percent of transgender prisoners experience sexual assault, versus only 4.4 percent of the overall prison population, with another study showing that the proportion of transgender prisoners in California experiencing sexual assault to be as high as 75 percent.

Under the status quo, many correctional institutions try to lessen the risks and hazards of sex-based housing by placing transgender prisoners in administrative segregation. Such segregation, in the interests of safety, isolates transgender prisoners from the general population, but the AMA does not consider this a viable solution. Administrative segregation often differs little from punitive segregation or solitary confinement. Such confinement acts as further punishment by removing prisoners from the companionship of others, denying prisoners access to prison programs, and is psychologically damaging.

The new position on correctional housing policies for transgender prisoners adds to several AMA policies aimed at protecting the health, welfare, safety and social equality for transgender individuals based on the gender identity.


AMA Adopts Ethical Guidance on Medical Tourism

CHICAGO - New ethical guidance on medical tourism was adopted today at the American Medical Association's (AMA) Annual Meeting to help physicians understand their fundamental responsibilities when interacting with patients who seek or have received medical care outside the U.S.

Every year, American patients cross borders to receive treatments and procedures outside the United States. Despite this growing trend, many aspects of medical tourism confound core ethical expectations regarding patients' rights, including informed consent, continuity of care, and access to medical records. Issues of safety and quality can loom large, especially when traveling for care that is unapproved or legally or ethically prohibited in their home system.

Many returning medical tourists do not have records of the procedures or medications they obtained while abroad, or contact information for the foreign health care professionals who provided services. Medical tourists often need to secure follow-up when they return, even if only to monitor the course of an uneventful recovery. Patients who develop complications may need extensive follow-up care when they return home.

"When asked to make right what went wrong as a result of medical travel, physicians can be confronted with a problematic position when they lack vital information to guide follow-up care," said AMA Immediate Past Chair Patrice A. Harris, M.D. "The AMA's new ethical policy will help guide physicians on the implications of medical tourism and their responsibilities with patients."

  • Among the key points of the new guidance, individual physicians should:
  • Familiarize themselves with issues in medical tourism to help support informed consent;
  • Help patients understand the nature of risks and likelihood of benefits, especially when patients desire an unapproved therapy;
  • Advise patients who consult them in advance whether the physician is willing to provide follow up care;
  • Offer their best professional guidance, as they would for any care decision; and
  • Respond compassionately to requests for follow-up care from returning patients who had not consulted the physician before seeking care abroad, and carefully consider the implications before declining to provide nonemergent follow-up care.

The new ethical policy provides companion guidance to AMA principles adopted in 2008 on medical tourism, which call for all medical care outside of the U.S. to be voluntary. The AMA principles address financial incentives, insurance coverage for care abroad, and the use of internationally accredited institutions. The principles also urge coordinated follow-up care, a transfer of medical records that adhere to HIPAA requirements, and the tracking of safety and quality data for procedures performed outside the U.S.


AMA Adopts New Policy to Address Rising Costs of Long-Term Services and Supports

CHICAGO - With national spending on long-term care services soaring - impacting retirement funds and Medicaid - the American Medical Association (AMA) House of Delegates today adopted policy during its Annual Meeting to make long-term care insurance simpler, more affordable, more innovative, and part of automatic enrollment for current employees and retirees. The new AMA policy also called for Medicare, Medicare Advantage, and Medigap plans to bolster their offerings with regard to benefits related to long-term care.

Long-term services and supports (LTSS) refers to the range of clinical health and social services that assist individuals in their daily activities, including eating, bathing, dressing, and instrumental tasks like medication management and meal preparation. In 2013, national spending for LTSS was $310 billion; by 2015, that figure grew to $331 billion. Medicaid spending accounts for over half of national spending for LTSS. Twelve million Americans needed LTSS in 2010, and, by 2050, that number is expected to be 27 million - an increase driven by aging Baby Boomers and advances in technology that allow people with chronic illness and disabling conditions to live longer. But, even as the need increases, a possible funding source for LTSS, long-term care insurance (LTCI), is too expensive and complex for most consumers.

Already, about 40 percent of state Medicaid budgets go toward LTSS. Medicaid pays for most of LTSS, while Medicare post-acute care pays for 23 percent of LTSS. The remaining sources of funding include out-of-pocket spending, long-term care insurance, other private sources, and other public sources. Because many middle-class people fail to anticipate and plan for their long-term care needs, Medicaid has effectively become the default payer instead of a safety net for the poorest individuals, creating an enormous strain in funding and threatening services for the poorest and most vulnerable.

"Rising costs of everything from home ownership to higher education are making it harder than ever for Americans to save for retirement and the long-services and supports that more and more people require," said AMA Board Member Stephen R. Permut, M.D., J.D. "Our hope is that the policies and recommendations we are making today will provide feasible steps forward to alleviating the financial strain on families and Medicaid of providing LTSS. With demand for LTSS likely doubling over the next 30 years, the time for action and forward-facing reforms is now."

In tackling the challenges of LTSS, the AMA announced several new policies supporting:

  • Standardizing and simplifying private LTCI to achieve increased coverage and improved affordability;
  • Adding transferrable and portable LTCI coverage as part of workplace automatic enrollment with an opt-out provision;
  • Innovations in LTCI product design, including the insurance of home and community-based services, and the marketing of long-term care products with health insurance, life insurance, and annuities;
  • Permitting Medigap plans to offer a limited LTSS benefit as an optional supplemental benefit or as a separate insurance policy;
  • Medicare Advantage plans offering LTSS in their benefits packages;
  • Permitting Medigap and Medicare Advantage plans to offer a respite care benefit as an optional benefit;
  • A back-end public catastrophic long-term care insurance program;
  • Incentivizing states to expand the availability of and access to home and community-based services; and
  • Better integration of health and social services and supports, including the Program of All-Inclusive Care for the Elderly

The AMA House of Delegates is the policy-making body at the center of American medicine, convening an inclusive group of physicians, residents and medical students representing every state and medical field. During the five-day meeting, 617 delegates work in a democratic process to create results-focused policies on topics in public health, science, ethics, business and government that enable physicians to answer a national imperative to measurably improve the health of the nation.


AMA President Calls for Common Sense, National Solutions to Reduce Gun Violence

Over next four days, Physicians in AMA House of Delegates to Debate Measures to Prevent a Leading Cause of Death

CHICAGO - In his remarks to the opening session of the American Medical Association (AMA) Annual Meeting today, AMA President David O. Barbe, M.D., issued an urgent call to action for physician leadership to reduce gun violence. Two years after the AMA declared gun violence a public health crisis, and as more than 30,000 Americans continue to die annually from gun violence, Dr. Barbe reiterated the AMA's decades of leadership on the issue and outlined why physicians have a responsibility to lead.

To watch or download video of Dr. Barbe's remarks on gun violence, click here.

The full text of Dr. Barbe's remarks on gun violence, as prepared for delivery, is below:

"At this meeting, we will have an opportunity to demonstrate physician leadership on a public health crisis that has, so far, defied solution: gun violence. At the start of our Annual Meeting in 2016, shocked by the massacre at the Pulse Nightclub in Orlando, this House acted. We led with a critical declaration: gun violence in America is a public health crisis.

"In the two years that have passed, we have been horrified by yet more carnage: in Parkland, Sutherland Springs, Santa Fe, and Las Vegas. And those are just a few of the incidents that made headlines. On average, gun violence claims the lives of nearly 100 people a day in the United States.

"People are dying of gun violence in our homes, churches, schools, on street corners, and at public gatherings.

"Colleagues, we, America's physicians, have the opportunity - but more than that, the responsibility - in coming days, to act on several resolutions that address this devastating crisis of our time.

"The AMA has demonstrated leadership on this issue for decades: we've recommended common-sense gun safety protections; waiting periods and background checks for those seeking to purchase a gun; and increased funding for mental health services.

"We've called on the Centers for Disease Control and Prevention to conduct epidemiological research on gun violence - perhaps the only leading cause of death where such research is not being conducted.

"Yet the fact that this problem continues to worsen has spurred a new sense of urgency in this House, even while Congress fails to act.

"To those who feel we should not address this as an organization because it is too controversial, I would ask:

  • Did we shy away from fighting discrimination against AIDS patients in the early days of that epidemic; even though much of society stigmatized those with HIV?

No, we let the science lead us.

  • Did we mute our opposition to smoking, because Big Tobacco defended it?

No, we let the science lead us.

  • And even now, have we backed away from our support of universal vaccinations or gains made through the Affordable Care Act because they are controversial?

No, we let the science lead us.

"Similarly, I would submit to you that the AMA must not back down from addressing gun violence. On the contrary, we must address it head on . . . scientifically, in an evidence-based, principled fashion, and with the health and safety of our communities, our fellow Americans, and our children as our chief concern.

"While we will not all agree on every proposal introduced on gun violence, we can all agree that the issue must be addressed . . . and that the only responsible way forward is for women and men of good faith to continue to search for and advocate science-based solutions.

"That is true physician leadership."


At Opening of Annual Meeting, AMA President Applauds Members Moving Medicine

Dr. Barbe also issues urgent call for physician leadership to help reduce gun violence in America

CHICAGO - In his address at the opening session of the American Medical Association (AMA) Annual Meeting, AMA President David O. Barbe, M.D. today celebrated the men and women of organized medicine who move medicine and shape a better future for patients, students, residents, and practicing physicians.

In addition to outlining physician victories on behalf of patients from the past year - from protecting health insurance coverage gains to fighting prior authorization processes that delay patient care - Dr. Barbe spotlighted a number of physician leaders and their contributions to medicine. This includes Surgeon General Dr. Jerome Adam's commitment to ending the nation's opioid epidemic and medical students' fight to protect those with Deferred Action for Childhood Arrivals (DACA) status.

"We must remember that it is important that we keep fighting, all the time, and not lose momentum or become discouraged because of temporary setbacks or because nothing seems to be happening," said Dr. Barbe. "So, yes, it takes leadership, it takes a team that is persistent, but it also takes innovative, dedicated individuals."

Dr. Barbe's full remarks, as prepared for delivery, are below:

Members Moving Medicine

AMA Annual Meeting
Hyatt Regency, Chicago
Saturday, June 9, 2018

David O. Barbe, MD, MHA
President
American Medical Association

Madame Speaker, Members of the Board, delegates, colleagues and guests . . . it is truly a privilege and pleasure to speak to you today as my presidency nears an end.

My sincere thanks to all of you for your support and encouragement during my time as your president.

Over the past year, I have spoken to this House about the critical importance of physician leadership. . .

  • To advocate in today's political environment,
  • To describe and shape the future of health care,
  • And, to mentor those who will one day follow us in this profession.

Now, as my time winds down and we prepare to transition the AMA presidency to the very capable hands of Barbara McAneny, I'd like to share some parting thoughts about physician leadership, AMA physician leadership in particular, and the important gains we have made, and the work that remains.

A year ago, I asked us all to consider this question: "What kind of leaders will we be?"

I challenged us to be the kind of leaders

  • Who bring consensus solutions to difficult issues.
  • Who use our creativity and drive to shape the future of medicine.
  • Who mentor our next generation of physicians.

Then, at our Interim meeting in November, we looked at the kind of leadership needed to bring together a winning team.

Like other winning teams, the AMA:

  • Shares a common vision and works aggressively to achieve it. The AMA led the way on health system reform last year because of our shared vision of maintaining and expanding health coverage for Americans.
  • Winning teams create partnerships that make us stronger. Let me give you a surprising example: Anthem - the health insurance company. Who would have imagined that a few months ago we would have not only convinced Anthem to back off its plan for a 50 percent cut whenever CPT Modifier 25 is used . . . but that we could extend the dialogue to work on patient literacy, right-sizing prior authorization and other payment issues?
  • And winning teams chart a course for a better future. The AMA continues its aggressive advocacy to reform the crippling prior authorization processes that delay patient care. . . to reduce the regulatory burdens on physicians... and to improve EHR and other information technologies - all things that currently take too much of our time away from patients and waste precious resources.

We have carried that strong momentum into the first half of 2018.

To the casual observer, it might seem that Congress only works in the dark of night, at the last minute, and up against a deadline.

But even those late-night deals - such as the two-year budget deal in February - are the culmination of months, and even years, of hard work and negotiation.

Kudos to our Advocacy team--and all of you - physician advocates--for several wins on key issues for the AMA.

  • We have long fought for improvements to electronic health records and an easing of unrealistic federal requirements. The budget deal eliminated a mandate making EHR standards more stringent.
  • We have long fought for repeal of the Independent Payment Advisory Board, or IPAB, which gave too much power to unelected officials to cut Medicare. The budget deal repealed IPAB.
  • We have long fought for federal safety net programs like the Children's Health Insurance Program. The budget deal extended the CHIP program, for 10 years.
  • We have long fought for changes in the MACRA law to provide greater flexibility for physicians participating in Medicare and to encourage the development of alternative payment models. The budget deal included important improvements to MACRA.

Along with these provisions, the AMA was also able to stop a very bad proposal that was initially included in the package:

  • A "mis-valued codes" policy that would have led to across the board Medicare payment cuts and a conversion factor lower than it was when the SGR was repealed.

These "wins" were only possible because our winning team put in the hard work of advocacy: taking a stand, educating policymakers, and activating our grassroots physicians to speak with their legislators.

This process can take days (as in the case of the mis-valued codes policy), months, or even years (as in the case of IPAB).

So we must remember that it is important that we keep fighting, all the time, and not lose momentum or become discouraged because of temporary setbacks or because nothing seems to be happening.

So, yes, it takes leadership... it takes a team that is persistent... but it also takes innovative, dedicated individuals.

The AMA is fortunate to count among its members some of the most talented individuals in the country who are leading the way on a variety of health care issues.

Nelson Mandela, former president of South Africa, said, "There are times when a leader must move out ahead of the flock, go off in a new direction, confident that he is leading his people the right way."

It's that concept of leadership I'd like to share with you today... How some of our individual AMA Members are Moving Medicine in a new direction.

The opioid crisis continues to reverberate through our communities and is now the leading cause of death --- the LEADING cause of death --- among Americans under the age of 50.

That's a national tragedy. It demands that our profession work to end it. And that is exactly what we are doing.

Due to the hard work of our Opioid Task Force and other organizations in recent years we are making headway on several fronts:

  • More physicians are becoming certified to provide medication-assisted treatment;
  • More physicians are registering for and using their state PDMPs and completing education on safe opioid prescribing practices;

And perhaps the best news of all:

  • Opioid prescribing has decreased for the fifth year in a row: down by 22 percent from 2013 - 2017;

Despite these efforts, deaths from opioid overdose continue to climb.

Addiction is a fierce adversary. No one understands this better than Dr. Jerome Adams, our Surgeon General, and AMA member, who has made fighting the opioid epidemic his top priority.

Dr. Adams understands the devastating toll addiction has on individuals, families and communities. He is very open about his younger brother's struggle with substance use disorder that has even led to time in prison.

He encourages all of us to fight the stigma around substance use disorders. As he has written, ". . . we must also acknowledge that addiction is a chronic disease that changes the brain, not a moral failure."

As Indiana's state health commissioner from 2014 until last year, he fought for and implemented a wide range of interventions, including needle-exchange programs, wider availability of naloxone, and better access to evidence-based and comprehensive treatment.

Dr. Adams recently issued an advisory--the first advisory from the Surgeon General's office in more than a decade!--an Advisory on Naloxone and Opioid Abuse.

The advisory urges those at high risk for opioid overdose - and their family members and friends...

  • To ask their physicians or pharmacists for naloxone;
  • To learn the signs of opioid overdose;
  • And to get trained to administer naloxone in case of an overdose emergency.

We strongly endorse the advisory and applaud Dr. Adams for issuing it.

And we look forward to hearing from him directly as he addresses this House on Monday.

Dr. Adams, thank you for being an AMA Member Moving Medicine.

Another top advocacy priority in recent years was repeal of the Sustainable Growth Rate formula and then helping physicians make a successful transition to the new MACRA Quality Payment Program.

We have worked diligently with the Centers for Medicare and Medicaid Services (CMS) both to reduce physician burdens under the new law, and to create new physician-focused payment pathways, called Alternative Payment Models, which reward physicians for their creativity in improving health care quality and reducing costs.

Understandably, there is some fear, and some resistance, to moving to these new models.

Thankfully there are AMA members like Dr. Larry Kosinski to show us the way.

Dr. Kosinski is a gastroenterologist from Elgin, Illinois who has developed a specialty medical home for patients with Crohn's disease.

Several years ago, he analyzed claims data of Crohn's patients, and found that hospitalization for the treatment of complications drove much of the excess cost.

But, he also learned that fewer than 1/3 of patients who ended up in the hospital had any contact with their health provider in the preceding 30 days.

He developed a system called "Sonar" to "intervene with patients before they even realize they need it."

The way Dr. Kosinski describes it - patients are like submarines - they are out there underwater but only come in when they are in trouble.

Now, instead of waiting for patients to call when their condition worsens, Dr. Kosinski's office "pings" each Crohn's patient every month with a few structured questions. That way, he can intervene quickly if a patient's responses suggest his or her condition is worsening.

This "sonar" program has cut hospitalizations in half, reduced spending, and improved patient satisfaction. Last year, the Physician Technical Advisory Committee, or PTAC, recommended that the Medicare program test the Sonar model.

Think of the patients who will benefit because they can avoid hospitalization!

And all because one physician had a really good idea and pushed hard to make it happen.

Dr. Kosinski, thank you for being an AMA Member Moving Medicine.

Another group of members I would like to recognize today are the medical students who are fighting to protect DACA-status individuals.

You will recall that the DACA program shields hundreds of thousands of undocumented young people who came to this country as children and allows them to work.

Dozens of medical schools have considered - and many have admitted - DACA-status students, understanding the value they bring to the health care system.

Research tells us that DACA-status individuals can help us alleviate physician shortages, especially in high-need areas, and provide culturally competent care.

Some of our AMA members have DACA-status. These are our colleagues. Protecting them is a priority that has increased in urgency in light of actions to terminate the DACA program.

During our 2016 Interim meeting, one of our members confided in another member fears of being deported.

That friend and other supporters within the Medical Student Section immediately sprang into action. They stayed up all night writing a resolution calling on the AMA to go beyond studying the issue and to take a stand . . . to go on the record in staunch support of health care professionals with DACA-status.

To his credit, Dr. Bob Goldberg, a member of the AMA's Council on Medical Education, introduced the resolution and it was adopted with overwhelming support from the entire House.

Led by the Medical Student Section, the AMA continues to pressure Congress to enact both short and long-term solutions for DACA-status individuals in the medical community.

To the leaders on the DACA issue in the Medical Student Section - people like (Pra-TIS-ta Koi-RA-la) Pratistha Koirala, Ruth Howe, and countless others, and the people supporting them like Dr. Goldberg--- thank you all for being AMA Members Moving Medicine.

The final group of physicians who are moving medicine forward are sitting in this room today: you... the delegates, alternate delegates, and trustees of the AMA.

Today, I challenge each of us to think about the significant wins we achieved by working together as a winning team, about the individual AMA Members Moving Medicine whose examples I've shared, and about the significant work there is still left to do as we strive to shape a better future for students, residents, practicing physicians and our patients.

Let us each ask ourselves:

How can we get even more involved, become even more effective, and actively encourage more of our colleagues to join this transformational organization that is our AMA so we can truly continue moving medicine forward?

At this meeting, we will have an opportunity to demonstrate physician leadership on a public health crisis that has, so far, defied solution: gun violence.

At the start of our Annual Meeting in 2016, shocked by the massacre at the Pulse Nightclub in Orlando, this House acted. We led with a critical declaration: gun violence in America is a public health crisis.

In the two years that have passed, we have been horrified by yet more carnage: in Parkland, Sutherland Springs, Santa Fe, and Las Vegas. And those are just a few of the incidents that made headlines. On average, gun violence claims the lives of nearly 100 people a day in the United States.

People are dying of gun violence in our homes, churches, schools, on street corners, and at public gatherings.

Colleagues, we, America's physicians, have the opportunity - but more than that, the responsibility - in coming days, to act on several resolutions that address this devastating crisis of our time.

The AMA has demonstrated leadership on this issue for decades: we've recommended common-sense gun safety protections; waiting periods and background checks for those seeking to purchase a gun; and increased funding for mental health services.

We've called on the Centers for Disease Control and Prevention to conduct epidemiological research on gun violence - perhaps the only leading cause of death where such research is not being conducted.

Yet the fact that this problem continues to worsen has spurred a new sense of urgency in this House, even while Congress fails to act.

To those who feel we should not address this as an organization because it is too controversial, I would ask:

  • Did we shy away from fighting discrimination against AIDS patients in the early days of that epidemic; even though much of society stigmatized those with HIV?

No, we let the science lead us.

  • Did we mute our opposition to smoking, because Big Tobacco defended it?

No, we let the science lead us.

  • And even now, have we backed away from our support of universal vaccinations or gains made through the Affordable Care Act because they are controversial?

No, we let the science lead us.

Similarly, I would submit to you that the AMA must not back down from addressing gun violence. On the contrary, we must address it head on . . . scientifically, in an evidence-based, principled fashion, and with the health and safety of our communities, our fellow Americans, and our children as our chief concern.

While we will not all agree on every proposal introduced on gun violence, we can all agree that the issue must be addressed . . . and that the only responsible way forward is for women and men of good faith to continue to search for and advocate science-based solutions.

That is true physician leadership. That is our AMA!

 
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