AMA House of Delegates adopts several dermatology-related resolutions


cyndi_yag_howard.jpgBy Cyndi Yag-Howard
AAD delegate to the AMA, co-chair of the AMA Dermatology Section Council, and chair of the AMA Council on Constitution and Bylaws

The American Medical Association (AMA) held its Annual meeting of the House of Delegates (HOD) June 11-15th in Chicago, IL. During that meeting, the Dermatology Section Council (DSC) met, deliberated, contributed to the policy discussions and voted on numerous critical health policy and AMA governance matters, many of which pertain to dermatology.

Dermatology Section Council Resolutions

This year, the DSC introduced four resolutions and one stand-alone amendment for consideration by the HOD, which represents all 50 states and approximately 130 specialties and service societies. After significant debate and collaboration with state and specialty delegates in the HOD, all of the resolutions were adopted by the HOD. This success in the AMA HOD is remarkable, and is due to the stellar dedication and collaborative efforts of our DSC members and staff.

The DSC resolutions were as follows:

  • MACRA: AMA to advocate that CMS 1) implement MIPS and APMs as is consistent with congressional intent when MACRA was enacted; 2) provide for a stable transition period for the implementation of MACRA, which includes assurances that CMS has conducted appropriate testing, including physicians’ ability to participate and validation of accuracy of scores or ratings, and has necessary resources to implement provisions regarding MIPS and APMs; and 3) provide for a stable transition period for the implementation of MACRA that includes a suitable reporting period.
  • Text messaging between physicians, patients and medical staff: AMA to study the medicolegal implications of text messaging and other non-HIPAA-compliant electronic messaging between physicians, patients, and members of the health care team, with a report back at the 2017 Annual Meeting. Additionally, that the AMA develop patient-oriented educational materials about text-messaging and other non- HIPAA-compliant electronic messaging communication between physicians, patients, and members of the health care team.
  • Sunscreen use at schools and summer camps: AMA to work with state and specialty medical societies and patient advocacy groups to provide advocacy resources and model legislation for use in state advocacy campaigns seeking the removal of sunscreen-related bans at schools and summer camp programs.
  • Compounding: AMA to engage in efforts to convince United States Pharmacopeia (USP) to retain the current special rules for procedures in the medical office that could include but not be limited to allergen extract compounding in the medical office setting and, if necessary, engage with the U.S. Food and Drug Administration (FDA) and work with the U.S. Congress to ensure that small volume physician office-based compounding is preserved. AMA to undertake to forming a coalition with affected physician specialty organizations such as allergy, dermatology, immunology, otolaryngology, oncology, ophthalmology, and neurology, and rheumatology to jointly engage with USP, FDA and the U.S. Congress on the issue of physician office-based compounding preparations and the proposed changes to USP Chapter 797. AMA to reaffirm that the regulation of compounding in the physician office for the physician’s patients be under the purview of state medical boards and not state pharmacy boards. AMA to support the current 2008 USP Chapter 797 sterile compounding rules as they apply to allergen extracts, including specifically requirements related to the beyond use dates of compounded allergen extract stock. (New HOD Policy)
  • Fixing the VA Physician Shortage with Physicians: AMA to work with the Veterans Administration (VA) to minimize the administrative barriers that discourage or prevent non-VA physicians without compensation (WOC) from volunteering their time to care for our nation’s veterans.

Additional resolutions of interest to dermatology

Telemedicine
The DSC supported a resolution calling for model state legislation on telemedicine. The section council worked to offer an amendment to keep the policy aligned with dermatology’s position on telemedicine and to ensure that the proper safeguards are in place for patient privacy. The resolution called for:​

  • AMA to develop model legislation and/or regulations encouraging telemedicine services or vendors to coordinate care with the patient’s medical home and/or existing treating physicians, which includes at a minimum identifying the patient’s existing medical home and treating physicians and providing to the treating physician a copy of the medical record, with the patient’s consent.
  • The model legislation and/or regulations to also require the vendor to abide by laws addressing the privacy and security of patients’ medical information.
  • AMA to include in that model state legislation the following concepts based on AMA policy: 1) A valid patient-physician relationship must be established before the provision of telemedicine services; 2) Physicians and other health practitioners delivering telemedicine services must be licensed in the state where the patient receives services, or be providing these services as otherwise authorized by that state’s medical board; and 3) The standards and scope of telemedicine services should be consistent with related in-person services.

Modernized Code of Medical Ethics
The Council on Ethical and Judicial Affairs presented its updated report of the AMA Modernized Code of Medical Ethics. After several years of work to update the code the HOD accepted the revised version. The updated code will soon be available at this link: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page?

Prescription Drug Formulary
The DSC supported a resolution addressing the transparency of prescription drug formularies. Access to real time data at the point of prescribing is important for both physicians and patients when deciding the best course of treatment. The DSC offered a friendly amendment to the original resolution to ensure the posted formularies are up-to-date and accurate. The following language was accepted by the HOD:

  • AMA promote the value of online access to up-to-date and accurate prescription drug formulary plans from all insurance providers nationwide.
  • AMA support state medical societies in advocating for state legislation to ensure online access to up-to-date and accurate prescription drug formularies for all insurance plans.
  • AMA reaffirm Policy H-125.979, which states that our AMA will work with pharmacy benefit managers, health insurers, and pharmacists to enable physicians to receive accurate, real-time formulary data at the point of prescribing.

Clerical Errors
The DSC actively supported a resolution addressing the CMS process for reviewing clerical errors which may lead to a physician’s billing privileges being suspended. Minor clerical errors can cause long payment backlogs and are sometimes treated as fraud. The DSC felt this issue must be addressed by CMS to ensure a streamlined process is in place to deal with clerical errors and prevent any delays in patients receiving necessary care. The HOD adopted the following resolution regarding this issue:

  • AMA urge the Centers for Medicare & Medicaid Services (CMS) to create an expedited process to review minor clerical errors on enrollment applications that result in CMS deactivating the physician’s billing privileges.
  • AMA urge CMS to remove a physician from a potential fraud and abuse review if there is proof that the error is only related to a clerical mistake.
  • AMA urge CMS to create a process that not only reactivates a physician’s billing privileges but also retroactively applies the effective date to the initial date when the minor clerical error occurred and applies no penalty to payments due for care provided to Medicare beneficiaries during this time frame.

Dry Needling
The DSC actively supported a resolution regarding the use of dry needling. The DSC agreed that the AMA should advocate against inappropriate scope of practice expansions. DSC members testified that it is necessary for the AMA to have policy on this issue as this is a patient safety issue. The final adopted resolution included the following language:

  • AMA to recognize dry needling as an invasive procedure, and maintain that dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.

Other issues of importance to dermatology

New Dermatology Organization Representation in the HOD

The DSC actively supported the American Society of Dermatopathology (ASDP) being granted representation in the AMA House of Delegates. The report to add ASDP was adopted by the HOD. Melissa Piliang, MD, will serve as the ASDP delegate and Karl Napekoski, MD, will serve as the ASDP alternate delegate, thus increasing the size of dermatology’s presence and influence within the HOD.

CMS Acting Administrator Addressing HOD

Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), addressed the HOD and discussed MACRA. He called upon physicians to work with him and CMS as the new Medicare payment system is designed. He stated that, “We don’t profess to have all the answers…We continue to look for comments … on how to simplify further, how to align the performance categories, how to make sure we’re not encouraging compliance but rather rewarding care.”

Candidate Interviews

The DSC approved an updated version of its standard operating procedures to allow for the section council to interview candidates running for positions in the HOD. The DSC conducted interviews for 16 candidates running for the following positions: President-elect, Board of Trustees, Council on Science and Public Health, and Council on Medical Service.

Dermatology Hosting Welcome Reception

The DSC hosted a welcome reception in recognition of several of the state society’s collaboration with the Dermatology Section Council over the years. HOD delegates from the following states were in attendance: New Hampshire, Florida, Ohio, Virginia, Arizona, New York, Mississippi, California, Texas, and Tennessee.

Your Dermatology Section Council

Dermatology is well represented in the AMA HOD by the DSC, which includes dermatologists representing the AADA, the Society for Investigative Dermatology (SID), the American Society for Dermatologic Surgery Association (ASDSA), the American College of Mohs Surgery (ACMS), American Society of Dermatopathology (ASDP), and dermatologists who represent their state medical societies and the armed services. The DSC is the collective voice of dermatology; members deliberate regarding the issues before the HOD, determine a position, collaborate with other organizations to garner support for our positions, attempt to mitigate opposition prior to debate on the floor of the HOD, and provide testimony when appropriate and vote collaboratively to increase the specialty’s influence.

Members are as follows:​
Cyndi Yag-Howard, MD, AAD Delegate, Chair
Hillary Johnson-Jahangir, MD, PhD, AAD Delegate, Vice Chair
Andrew Lazar, MD, AAD Delegate, Immediate Past Chair
Marta Van Beek, MD, AAD Delegate
Sabra Sullivan, MD, PhD, AAD Alt. Delegate
Adam Rubin, MD, AAD Alt. Delegate
Lindsay Ackerman, MD, AAD Alt. Delegate
Seemal Desai, MD, AAD Alt. Delegate
Erica Dommasch, MD, AAD YPS Delegate (Young Physician Section)
Nathaniel Miletta, MD, AAD YPS Delegate (Young Physician Section)
Mariam Totonchy, MD, AAD RFS Delegate (Resident Fellow Section)
Sara Hogan, MD, M.H.S, AAD RFS Delegate (Resident Fellow Section)
Hao Feng, M.D., M.H.S, AAD RFS Delegate (Resident Fellow Section)
Jessica Krant, MD, ASDSA Delegate
Chad Prather, MD, ASDSA Alt. Delegate
Anthony Rossi, MD, ASDSA YPS Delegate
William Waller, MD, ASDSA YPS Alt. Delegate
Nita Kohli, MD, ASDSA RFS Delegate
Daniel Bennett, MD, SID Delegate
Paul Bergstresser, MD,SID Alt. Delegate