AMA adopts several derm-related resolutions

cyndi_yag_howard.jpgBy Cyndi Yag-Howard, MD
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 Interim Meeting of the House of Delegates (HOD) November 10-14 in Honolulu, HI. During the meeting, the Dermatology Section Council (DSC) met, deliberated, and contributed to the policy discussions and voted on numerous critical health policy and AMA governance matters, many of which pertain to dermatology.

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Beginning next year, a new plan will be implemented to equalize the number of AMA delegates from the states and specialty societies. As a result, if individual AAD members do not increase their membership in the AMA by December 31, 2017, the AAD is at risk of losing 25% of our delegation and voice at the HOD. Join or renew your membership now.

Dermatology Section Council resolutions

This year the DSC authored three resolutions and co-authored one resolution. All of these resolutions were adopted or referred for study 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.

  Boris_Lushniak.jpg
At the AMA's November HOD meeting, Boris D. Lushniak, MD, MPH, former acting surgeon general of the United States, was awarded the American Medical Association’s Distinguished Service Award. The award was granted by the AMA Board of Trustees and endorsed by the AMA House of Delegates, and honors an AMA member for their “meritorious service in the science and art of medicine.”

Dr. Lushniak is board-certified in dermatology and preventative medicine, and is currently the dean of the School of Public Health at the University of Maryland, College Park. He served as acting surgeon general from July 2013 to December 2014, and served as deputy surgeon general from 2010 to 2013 and from 2014 to 2015. He was also the assistant commissioner for counterterrorism policy for the U.S. Food and Drug Administration from 2004 to 2010. Dr. Lushniak received his medical degree from Northwestern University and his MPH from Harvard University.

The DSC resolutions were as follows:

  • Modifier 25: The DSC advocated for the AMA to update its policy on modifier 25 as an increasing number of insurers look to implement policies that inappropriately reduce reimbursement for modifier 25. Increased uptake in this policy would lead to reimbursement below the cost of physician expense, patients incurring higher out of pocket costs due to follow-up visit, and longer wait times to see a specialist. Specifically, this resolution called on the AMA to aggressively and immediately advocate through any legal means possible, including direct payer negotiations, regulations, legislation, or litigation, to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.
  • Price transparency: The resolution calls on the AMA to 1) work with states and state medical societies to reduce health insurance contract provisions or gag clauses that restrict disclosure of pricing information to patients (2) work with states and state medical societies to ensure that health insurance contracts do not prohibit the application of discounts to uninsured or under-insured patients if such discounts are compliant with federal anti-kickback statutes and 3) support access to real-time prescription drug pricing and cost transparency at the point of prescribing. This resolution addresses an issue with some private health insurance contracts where clauses can restrict disclosure of a reasonably priced charge master for self-pay or uninsured patients. This lack of transparency prevents hospital-based and other employed physicians' ability to develop rational prices and appropriately discount for services and can potentially foster a sense of distrust between the patient and physician. The HOD reaffirmed Policies D-155.987, H-155.958, and H-380.994 (regarding price transparency) and referred the clause requesting for the AMA to support access to real-time prescription drug pricing and cost transparency at the point of prescribing. The DSC will provide an update in 2018 on the status of the AMA’s work on increasing transparency at the point of prescribing.
  • Out of network care: The resolution requests that the AMA support requiring that health insurers that terminate in-network providers: a) Notify providers of pending termination at least 90 days prior to removal from network b) Give to providers a copy of the health insurer’s letter notifying patients of the provider’s change in network status at least 60 days prior to distribution, and c) Allow the provider 30 days to respond to and contest if necessary the letter prior to its distribution. The policy addresses the issue of when plans update networks, but mistakenly terminate physicians and the physician’s patient receive false notices. This resolution builds upon earlier efforts and urges the AMA to amend its adopted network adequacy policy to ensure this notification is provided to both physicians and patients.
  • Oppose physician assistant independent practice: This resolution calls on the AMA to adopt policy to oppose legislation or regulation that allows physician assistant independent practice. Due to the substantial differences in training between PAs and physicians, the HOD passed this new policy. Dermatology has a long history of advocating on scope of practice issues affecting the house of medicine. We remain active at the state level supporting legislation that promotes the physician-led health care team.

DSC members have plans in place to introduce additional resolutions next spring at the AMA Annual Meeting.

Additional resolutions of interest to dermatology

MOC exam fees
The DSC supported a resolution calling on the AMA to update its policy to state: The MOC process should be reflective of and consistent with the cost of development and administration of the MOC components, ensure a fair fee structure and not present a barrier to patient care. Additionally, the AMA continue to work with the national medical specialty societies to advocate for the physicians of America to receive value in the services they purchase for Maintenance of Certification from their specialty boards. Value in MOC should include cost effectiveness with full financial transparency, respect for physicians’ time and their patient care commitments, alignment of MOC requirements with other regulator and payer requirements, and adherence to an evidence basis for both MOC content and processes. The DSC testified in support of working to assure the MOC process is less burdensome for physicians.

Drug shortages
The DSC supported a report of the Council on Science and Public Health calling on the AMA to amend its drug shortage policy to include the following statement: AMA urges that during the evaluation of potential mergers and acquisitions involving pharmaceutical manufacturers, the Federal Trade Commission (FTC) consult with the Food and Drug Administration (FDA) to determine whether such an activity has the potential to worsen drug shortages. Drug Shortages are increasingly becoming a major issue for physicians and their patients. Dermatologists and many other specialties currently face a national shortage of lidocaine with epinephrine.

Opposing the Advanced Practice Registered Nurses (APRN) Compact
The DSC testified in support of a resolution that called on the AMA to convene an in-person meeting of relevant physician stakeholders to initiate creation of a consistent national strategy (consensus principles of agreement/solutions, model legislation, national and state public relations campaigns) purposed to: (1) effectively oppose the continual, nationwide efforts to grant independent practice (e.g., APRN Consensus Model, APRN Compact) to non-physician practitioners; (2) effectively educate the public, legislators, regulators, and healthcare administrators; and (3) effectively oppose state and national level legislative efforts aimed at inappropriate scope of practice expansion of non-physician healthcare practitioners; with report back at the 2018 Annual Meeting. The resolution also updated AMA Policy H-35.988 to read that AMA, in the public interest, opposes enactment of legislation to authorize the independent practice of medicine by any individual who has not completed the state’s requirements for licensure to engage in the practice of medicine and surgery in all of its branches. Our AMA opposes enactment of the Advanced Practice Registered Nurse (APRN) Multistate Compact, due to the potential of the APRN Compact to supersede state laws that require APRNs to practice under physician supervision, collaboration or oversight.

Drug pricing/transparency
The DSC testified regarding its concern for the sudden dramatic price increases of older drugs which were once affordable. Additionally, the DSC highlighted the need to advocate for transparency in how PBMs play a role in establishing drug prices for patients. The final resolution, after being amended by the reference committee, stated that our AMA 1) oppose provisions in pharmacies’ contracts with pharmacy benefit managers that prohibit pharmacists from disclosing that a patient’s co-pay is higher than the drug’s cash price 2)continue its efforts with the National Association of Insurance Commissioners addressing the development and management of pharmacy benefits 3) develop model state legislation on the development and management of pharmacy benefits 4)advocate for policies that prohibit price gouging on prescription medications when there are no justifiable factors or data to support the price increase 5) continue implementation of its TruthinRx grassroots campaign to expand drug pricing transparency among pharmaceutical manufacturers, pharmaceutical benefit managers and health plans, and to communicate the impact of each of these segments on drug prices and access to affordable treatments and 6) report back to the HOD at the 2018 Interim Meeting on the progress and impact of the TruthinRx grassroots campaign.

Excluding Part B drugs from MIPs scoring
The DSC spoke in favor of the AMA continuing to work with impacted specialties to actively lobby the federal government to exclude Medicare Part B drug reimbursement from the Merit-Based Incentive Payment System (MIPS) payment adjustment as part of the Quality Payment Program (QPP). Due to the unpredictable nature of drug prices, it would be unreasonable to penalize the physician for something which they do not have control over today. The DSC expressed its support for the exclusion of Part B drugs from the MIPs scoring for payment adjustment of participating physicians.

Other issues of pertinence to dermatology

Representation in the House of Medicine
Beginning next year, a new plan will be implemented to equalize the number of AMA delegates from the states and specialty societies. As a result, if individuals AAD members do not increase their membership in the AMA by December 31, 2017, the AAD is at risk of losing 25% of our delegation and voice at the HOD. If you are not an AMA member, please join now.

Dermatologist receives AMA’s top honor
Boris Lushniak, MD, MPH, former U.S. Surgeon General, received the American Medical Association’s Distinguished Service Award. This award honors a member of the AMA for meritorious service in the science and art of medicine. Dr. Lushniak’s most impressive service, to date, includes his time in Africa treating patients and leading the only US Government hospital treating Ebola patients there. He was out in the field, involved in the care of patients and healthcare workers infected with Ebola in Africa. Additionally, Dr. Lushniak was commended for his service as the U.S. Surgeon General where he made significant public health contributions including raising the issue of skin cancer by publishing the Surgeon General’s Call to Action to Prevent Skin Cancer.

Your Dermatology Section Council

Dermatology is well represented in the AMA HOD by the DSC, which includes dermatologists representing the American Academy of Dermatology Association (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, provide testimony when appropriate and vote collaboratively to increase the specialty’s influence.

Members of the DSC:

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
Klint Peebles, MD, AAD YPS Delegate (Young Physician Section)
Nathaniel Miletta, MD, AAD YPS Delegate (Young Physician 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
Daniel Bennett, MD, SID Delegate
Erica Dommasch, MD, SID Alt. Delegate
Michel McDonald, MD, ACMS Delegate
Divya Srivastava, MD, ACMS Alt. Delegate
Nita Kohli, MD, ACMS YPS Delegate
Keena Que, MD, ACMS RFS Delegate
Melissa Piliang, MD, ASDP Delegate
Karl Napekoski, MD, ASDP Alt. Delegate
Brett Coldiron, MD, State Society Alt. Delegate(OH)
Billie Jackson, MD, State Society Delegate (GA)
Hazle Konerding, MD, State Society Delegate (VA)
Lawrence Cheung, MD , State Society Delegate (CA)
Leah McCormack, MD, State Society Delegate (NY)
Cindy Smith, MD, State Society Alt. Delegate (MN)
Todd Schlesinger, MD, State Society Alt. Delegate (SC)
Eric Millican, MD, State Society Delegate-YPS (UT)
Josephine Nguyen, MD, Navy Delegate
Ricardo Mejia, MD, Alt. Delegate Intl. Society of Hair Restoration Surg.
Christopher Shea, MD, Assoc. of Professors of Derm. Delegate
Jack Resneck, MD, AMA Board of Trustees
Georgia Tuttle, MD, AMA Board of Trustees