The American Medical Association (AMA) House of Delegates (HOD) met virtually Nov. 13–17 for its 2020 Interim Meeting. Over 600 members of the House of Delegates participated, along with AMA staff and guests. Despite the now-familiar challenges associated with replicating a live meeting on a virtual platform, the HOD was able to debate and take action on significant issues that face the House of Medicine.
The opening session of the House of Delegates included awards and addresses by AMA leadership, including the president and executive vice president. The definitive highlight this year was the awarding of the Medical Executive Lifetime Achievement Award to ACR’s own former executive vice president, Mark Andrejeski.
AMA President Susan Bailey, MD, an allergist from Texas, noted AMA successes and engagement in 2020 despite the challenges of the COVID-19 pandemic, focusing on the strength and resolve of physicians caring for patients, as well as the activities of the AMA to support this care and strengthen our public health infrastructure. She highlighted the significant informative resources created for physicians by the AMA in 2020 dealing with COVID-19 issues, and the advocacy around sustaining financial support for physician practices via the CARES Act and procuring personal protective equipment.
James Madara, MD, AMA executive vice president, discussed other ways the AMA has supported physicians during the pandemic and how COVID-19 is a painful validation of the organization’s long-term strategic vision for healthcare.
Advancing Rheumatology Issues
The ACR’s priorities at the meeting included AMA policies on home infusion and copay accumulators.
An ACR-authored and led resolution that substantially added to AMA policy on copay accumulators was successfully adopted by the House of Delegates. Resolution 212 called for the AMA to support federal and state legislation or regulation that would ban copay accumulator policies, including in federally regulated ERISA plans. This is now part of AMA policy and its advocacy agenda. The ACR resolution had the support of six other specialty societies, as well as the state medical associations of New Jersey and Georgia. The resolution was particularly timely to help ensure patients can afford to stay on their medications during the COVID-19 public health emergency. Within a week, one of the large national insurers announced a delay in implementation of their copay accumulators policy.
ACR and the American Society of Clinical Oncology (ASCO) co-authored Resolution 508 to update AMA policies on home infusion that take into account the concerns of both the oncologic community and other specialties that prescribe home infusion. The modifications will:
- Remove the AMA’s endorsement of home infusion for chemotherapy;
- Add that the decision to use home infusion should be the result of shared decision making by the physician and patient;
- Add that flexibilities for home infusions of biologics or chemotherapy during the COVID-19 public health emergency should only be considered when the benefits outweigh the potential risks;
- Shift AMA support for home infusion to focus mostly on antibiotics;
- Oppose any insurer requirement of home administration of drugs if the physician deems it not appropriate, or if precautions cannot be met to protect the patient and caregivers; and
- State that insurers should not withhold payment or prior authorization for settings outside of the home.
The ACR delegation specifically supported a resolution introduced by ASCO asking the AMA to advocate against the implementation of mandatory demonstration projects testing a “Most Favored Nation” policy during the COVID-19 public health emergency. This was passed by the HOD. We believe this was a key advocacy step, in addition to significant ACR grassroots activity, leading to a late December decision by the District Court of Maryland to delay the planned Jan. 1, 2021, implementation of this flawed model for reimbursement of Part B drugs under Medicare.
We also commented in the reference committees or supported resolutions reviewed within the ACR committee structure. These included important and timely issues, such as continuation of expanded telemedicine opportunities and reimbursement, other efforts to both assist and protect physicians dealing with the pandemic, H1B and J1 visa issues affecting physician shortages and escalating pharmaceutical prices.
The ACR delegation discussed many other issues and resolutions with other societies and within the various caucuses that we are part of, including Pain and Palliative Medicine, Cancer, American College of Physicians and Mobility. We provided input and perspective from a rheumatology viewpoint based on ACR priorities and policies as put forward by the Board of Directors and/or with input from ACR committees.
Every ACR/ARP Member Has a Role
On behalf of the ACR AMA delegation, I want to thank all ACR/ARP members for your efforts on behalf of the ACR and the patients we all serve and for your continuing support of our involvement with the AMA.
Eileen Moynihan, MD, serves with me as a HOD delegate for rheumatology. Colin Edgerton, MD, and Cristina Arriens, MD, serve as alternate delegates. We were fortunate to recruit two new Young Physicians Section delegates, Christina Downey, MD, and Luke Barre, MD, who truly had a baptism by fire in their first AMA meeting. In addition, Rheumatology Fellow Rami Diab, MD, joined us while participating in the Resident and Fellow Section deliberations. We were of course admirably assisted by the ACR staff team led by Adam Cooper and Rachel Myslinski. My thanks to all of my colleagues for their service.
Because the ACR had over 1,000 AMA members at our five-year review in 2017, we retained our seat in the HOD and participation in other vital AMA-convened activities, such as the RVS Update Committee (RUC) and Current Procedural Terminology (CPT) Advisory Committee. However, we cannot rest on our laurels: Our AMA membership is tabulated each year, and we must maintain membership close to our current level to retain our second delegate.
I am happy to report that we again exceeded 1,000 AMA members and have retained our second delegate for 2021. Our next five-year review will come in 2022. I encourage you to renew your AMA membership now if you have not already done so for 2021 and to recommend this to your colleagues.
Gary Bryant, MD, MACR, is a rheumatologist in Minnesota and the ACR’s lead delegate to the American Medical Association.
