The American Medical Association (AMA) Interim House of Delegates (HOD) meeting took place November 12–15, 2016, in Orlando, FL. A total of 530 state medical society and specialty society delegates, including the six members of the American College of Surgeons’ (ACS) delegation, debated the policy implications of 32 reports and 101 resolutions. Occurring within a week of the national elections, a central focus of the meeting was the uncertainty about the future of the Affordable Care Act (ACA). On the other hand, the Stop the Bleed® program received an enthusiastic reception.
ACS delegation sponsors Stop the Bleed skills course
AMA meetings provide an opportunity for the ACS delegates to share College initiatives with physician leaders from a breadth of geographic locations, specialties, and career stages. In this spirit, ACS delegates, all of whom are Stop the Bleed instructors, along with Leonard J. Weireter, MD, FACS, Vice-Chair, ACS Committee on Trauma, presented the skills course to 125 practicing physicians, residents, and medical student delegates. Through four half-hour sessions, participants refreshed their hands-on skills in bleeding control and became advocates for bringing the course back to their communities. Course success was recognized before the entire HOD.
Surgical Caucus focuses on mass casualty readiness
The Surgical Caucus sponsored a one-hour educational session, The Hartford Consensus: Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events. Dr. Weireter shared an overview of the Hartford Consensus recommendations for effective response to active shooter and mass casualty events and highlighted the value of the Stop the Bleed course in improving survival of casualties from these events.
Orlando trauma surgeon Michael Cheatham, MD, FACS, gave a synopsis of the Orlando Regional Medical Center response to the Pulse nightclub shooting in June 2016. In addition to conducting relevant readiness drills, he emphasized the importance of including casualty family assistance and post-event hospital staff counseling in mass casualty plans.
At this meeting, the AMA endorsed recommendations from a 2015 call to action by eight health professional organizations and the American Bar Association to reduce the public health consequences of firearm-related injury.
U.S. elections put health care system in spotlight
Five resolutions covering a spectrum of opinions about AMA engagement in ACA reform were discussed. The five proposals were consolidated into one adopted resolution, which calls for the AMA, in collaboration with state and specialty medical societies, to actively discuss the future of health care reform with the new presidential administration and Congress. AMA executive vice-president James Madera, MD, sent a letter to congressional leaders on January 3 emphasizing the AMA’s interest in proposals that “make coverage more affordable, provide greater choice, and increase the number of those insured.”
The ACS delegation focused on the ACS Health Care Reform General Principles, which promote a systems-based approach to health care quality and safety, patient access to surgical care, reduction of health care costs, and medical liability reform.
Maintenance of Certification
General disaffection with Maintenance of Certification (MOC) requirements persists in multiple specialties, with particular concerns related to its use in credentialing and privileging decisions. The HOD adopted a policy that directs the AMA to increase efforts to ensure that MOC does not become a requirement for insurance panel participation, state medical licensure, and medical staff membership (initial and ongoing).
Medical student and resident training
Delegates agreed with a need for formal leadership training during medical school. The AMA now advocates for the creation of leadership programs that emphasize experiential learning of skills necessary to lead inter-professional teams. Delegates also recognized the importance of having training program policies that support residents who are breastfeeding. As a result, the AMA will now work with appropriate professional regulatory organizations to put policies for protected times and locations for breastfeeding into program requirements.
Surgeon management of patients with perioperative pain
A resolution intended to reduce perioperative opioid consumption was introduced, calling for hospitals to adopt practices for perioperative pain management, which include services dedicated to acute pain management. This proposal generated a great deal of concern among surgical and anesthesiology delegates. The HOD appreciated that surgeons are trained to manage the perioperative pain of their patients and may consult for additional services as needed. Thus, existing AMA efforts to promote appropriate clinical use of opioid analgesics were reaffirmed in lieu of the resolution.
The next meeting of the AMA HOD is scheduled for June 10–14 in Chicago. This meeting will be the first since the inauguration of President Donald Trump, and the ACS delegates anticipate that national health care policy will again dominate the discussion. ACS members with suggestions for potential resolutions should forward them to Jon Sutton at email@example.com.
ACS Delegation at the AMA HOD
• John H. Armstrong, MD, FACS (Delegation Chair), acute care surgery, Ocala, FL
• Brian J. Gavitt, MD, MPH (also Young Physicians Section delegate), general surgery, Cincinnati, OH
• Jacob Moalem, MD, FACS (also Young Physicians Section delegate), general surgery, Rochester, NY
• Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents
• Naveen F. Sangji, MD, general surgery resident, Boston, MA
• Patricia L. Turner, MD, FACS, general surgery, Chicago, IL; Director, ACS Division of Member Services; Chair, AMA Council on Medical Education
Dr. Armstrong is a member of the American College of Surgeons (ACS) Health Policy and Advocacy Group, and Past-Chair, ACS Professional Association political action committee (ACSPA-SurgeonsPAC).
Mr. Sutton is Manager, State Affairs, ACS Division of Advocacy and Health Policy, Washington, DC.