AMA House of Delegates adopts several dermatology-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 Annual Meeting of the House of Delegates (HOD) June 10-14 in Chicago. 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, DSC authored two resolutions, co-authored one resolution, and revised a Board of Trustees (BOT) report created in response to a resolution authored by the DSC at the previous AMA meeting. All of these resolutions and the BOT report revision 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:

  • Regulation of Physician Assistants: This resolution called the AMA to advocate in support of maintaining the authority of medical licensing and regulatory boards to regulate the practice of medicine through oversight of physicians, physician assistants, and related medical personnel. Additionally, the resolution asks the AMA to oppose legislative efforts to establish autonomous regulatory boards meant to license, regulate, and discipline physician assistants outside of the existing state medical licensing and regulatory bodies’ authority and purview.
  • United States Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategies (REMS): This resolution calls on the AMA to work with the FDA to develop a gender-neutral patient categorization model in REMS programs, focusing exclusively on childbearing potential rather than gender identity. This resolution addresses the inability of transgender individuals to register in REMS programs in a manner commensurate with their gender identity while also accurately stating their childbearing potential, thus creating a barrier to care with perpetuation of cultural insensitivity, in many cases resulting in deferral of otherwise indicated treatment.
  • Out of Network Care: The resolution requests that the AMA develop model state legislation addressing coverage of and payment for unanticipated out-of-network care and adopt the following principles:
    1. Patients must not be financially penalized for receiving unanticipated care from an out-of-network provider.
    2. Insurers must meet appropriate network adequacy standards that include adequate patient access to care, including access to hospital-based physician specialties. State regulators should enforce such standards through active regulation of health insurance company plans.
    3. Insurers must be transparent and proactive in informing enrollees about all deductibles, copayments, and other out-of-pocket costs that enrollees may incur.
    4. Prior to scheduled procedures, insurers must provide enrollees with reasonable and timely access to in-network physicians.
    5. Patients who are seeking emergency care should be protected under the "prudent layperson" legal standard as established in state and federal law, without regard to prior authorization or retrospective denial for services after emergency care is rendered.
    6. Out-of-network payments must not be based on a contrived percentage of the Medicare rate or rates determined by the insurance company.
    7. A minimum coverage standard for unanticipated out-of-network services should be identified. The minimum coverage standard should pay out-of-network providers at the usual and customary out-of-network charges for services, with the definition of usual and customary being based upon a percentile of all out-of-network charges for the particular health care service performed by a provider in the same or similar specialty and provided in the same geographical area as reported by a benchmarking database. Such a benchmarking database must be independently recognized and verifiable, completely transparent, independent of the control of either payers or providers and maintained by a non-profit organization. The non-profit organization shall not be affiliated with an insurer, a municipal cooperative health benefit plan or health management organization.
    8. Mediation should be permitted in those instances where the physician's unique background or skills (i.e., the Gould Criteria) are not accounted for within a minimum coverage standard.
  • Patient-Physician Text Messaging Guidelines: In response to a resolution authored by the DSC at the previous AMA meeting, the AMA Board of Trustees updated its policy on electronic mail and text messaging. The updated policy reads as the following:
    • Policy H-478.997, “Guidelines for Patient-Physician Electronic Mail and Text Messaging"
    • New communication technologies must never replace the crucial interpersonal contacts that are the very basis of the patient-physician relationship. Rather, electronic mail and other forms of Internet communication should be used to enhance such contacts. Furthermore, before using electronic mail or other electronic communication tools, physicians should consider Health Information Portability and Accountability Act (HIPAA) and other privacy requirements, as well as related AMA policy on privacy and confidentiality, including Policies H-315.978 and H-29 315.989. Patient-physician electronic mail is defined as computer-based communication between physicians and patients within a professional relationship, in which the physician has taken on an explicit measure of responsibility for the patient's care. These guidelines do not address communication between physicians and consumers in which no ongoing professional relationship exists, as in an online discussion group or a public support forum.
    • The policies and procedures for email be applied to text and electronic messaging using a secure communication platform, where appropriate. (Note: full policy available online)
    • Lastly, the AMA enacted new policy on texting that reads as such: That our American Medical Association work with the Office of Civil Rights to develop guidance on text messaging to facilitate the appropriate and safe use of this technology when communicating patient information.

DSC members have plans in place to introduce additional resolutions this fall at the AMA Interim Meeting.

Additional resolutions of interest to dermatology

Remove Practice Expense and Malpractice Expense from Publicly Reported Payments
The DSC supported a resolution calling on the AMA to petition the Centers for Medicare & Medicaid Services and the Office of Health & Human Services to remove practice expense and malpractice expense from reimbursements reported to the public. When reporting the data CMS removes some practice expense data such as some office-administered drugs but does not remove all practice and malpractice expense. By failing to remove these expenses it creates a misrepresentation of a physician’s income.

Certified Interpreter and Translation Services
The DSC supported a resolution calling on the AMA to work to relieve the burden of the costs associated with translation services implemented under Section 1557 of the Affordable Care Act.

It also requests for the AMA to advocate for legislative and/or regulatory changes to require that payers including Medicare programs and Medicaid managed care plans cover interpreter services and directly pay interpreters for such services, with a progress report at the 2017 interim meeting of the AMA house of delegates.

Risk Adjustment Provisions in MACRA
The DSC testified in support of a resolution that called on the AMA, in the interest of patients and physicians, encourage the Centers for Medicare and Medicaid Services and Congress to revise the Merit-Based Incentive Payment System to a simplified quality and payment system with significant input from practicing physicians, that focuses on easing regulatory burden on physicians, allowing physicians to focus on quality patient care. The resolution also requested that the AMA advocate for appropriate scoring adjustments for physicians treating high-risk beneficiaries in the MACRA program and urge CMS to continue studying whether MACRA creates a disincentive for physicians to provide care to sicker Medicare patients. The DSC testified that we need to ensure we have appropriate risk adjustments especially when treating patients with chronic conditions. Physicians should not be penalized for treating sicker patients.

Drug Pricing/Transparency
The DSC testified regarding its concern for the sudden dramatic price increases of older drugs which were once affordable. The final resolution, after being amended by the reference committee, stated the following: That our American Medical Association support drug price transparency legislation that requires pharmaceutical manufacturers to provide public notice before increasing the price of any drug (generic, brand, or specialty) by 10 percent or more each year or per course of treatment and provide justification for the price increase.

Free Speech Applies to Scientific Knowledge
The DSC supported a resolution calling on the AMA to advocate that scientific knowledge, data, and research will continue to be protected and freely disseminated in accordance with the U.S. First Amendment. The DSC testified that it is crucial that we maintain this first amendment right as science continues to advance.

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 the AAD does not maintain its membership from dermatology by December 31, 2017, it is at risk of losing 25 percent of our delegation and voice at the HOD. If you are not an AMA member, please join now

Candidate Interviews and Welcome Reception
The DSC hosted candidates running for positions within the AMA at the 2017 Annual meeting. The DSC conducted interviews for 17 candidates running for the following positions: President-elect, Board of Trustees, Council on Science and Public Health, Council on Medical Education and Council on Medical Service. A welcome reception with other specialty societies was held to recognize these stakeholders’ continued collaborative efforts with the DSC within the House of Medicine.

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
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 Delegate
Daniel Bennett, MD, SID Delegate
Paul Bergstresser, MD, SID Alt. Delegate
Michel McDonald, MD, ACMS Delegate
Divya Srivastava, MD, ACMS Alt. Delegate
Nita Kohli, MD, ACMS YPS Delegate
Kenna Que, MD, ACMS RFS Delegate
Melissa Piliang, MD, ASDP Delegate
Karl Napekoski, MD, ASDP Alt. Delegate
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)
Jon ("Klint") Peebles, MD, State Society Delegate-RFS (WI)
Eric Millican, MD, State Society Delegate-RFS (UT)
Josephine Nguyen, MD, Navy Delegate
Christopher Shea, MD, Assoc. of Professors of Derm. Delegate
Jack Resneck, MD, AMA Board of Trustees
Georgia Tuttle, MD, AMA Board of Trustees