The American Medical Association (AMA) annual House of Delegates (HOD) meeting took place June 10–14, in Chicago, IL. The agenda included 62 reports from the AMA board and councils and 186 resolutions from state medical associations, specialty societies, and AMA sections.
The uncertain mood of the HOD was shaped by congressional activity on the Affordable Care Act and a competitive election for AMA president-elect. At the start of the meeting’s final day, the HOD paused to remember the lives lost and changed one year earlier at the Pulse nightclub in Orlando, FL. The HOD also noted the value of American College of Surgeons (ACS) Stop the Bleed® training in response to the shooting June 14 at the Republican congressional baseball team practice in Alexandria, VA.
In the AMA House of Delegates, which is composed of 545 members, the College was represented by its six-member delegation.
The meeting has eight reference committees that focus on the following issues: bylaws and medical ethics, health care system, legislation, medical education, public health, medical science and technology, governance, and medical practice. John H. Armstrong, MD, FACS, co-author of this article, chaired Reference Committee A, which reviewed items pertaining to the health care system. This article provides an overview of several issues of relevance to ACS members.
The priority issue for the ACS at this meeting was protecting the profession’s autonomy in defining the standards of lifelong learning through Maintenance of Certification (MOC). Five items related to MOC and Continuing Medical Education (CME) resulted in considerable debate. Internists and medical specialists were particularly frustrated by their experiences with their certifying boards. While acknowledging opportunities to improve MOC, the College delegation took the lead in collaborating with other specialty and state societies to argue against referring MOC to the state legislatures and in creating a new solely CME-based certification system.
• Council on Medical Education Report 2, Update on Maintenance of Certification and Osteopathic Continuous Certification, provided an overview of board-specific MOC innovations that increase relevance and reduce cost. The report was amended to have the AMA advocate that physicians who participate in programs related to quality improvement and/or patient safety should receive credit for MOC Part IV.
• Resolution 302, Comprehensive Review of CME Process, directed the AMA, in collaboration with the Accreditation Council for Continuing Medical Education, to conduct a comprehensive review of the CME process on a national level, with the goal of decreasing costs and simplifying the process of providing CME.
• Resolution 316, Action Steps Regarding Maintenance of Certification, sponsored by the largest state delegations in the HOD (Arizona, California, Florida, Georgia, New York, Pennsylvania, and Texas), sought to extend AMA model state legislation against MOC by barring hospitals, health care insurers, and state licensing boards from linking nonparticipation in the American Board of Medical Specialties (ABMS) MOC process to exclusion from credentialing. Further, it sought to create AMA policy that would replace MOC with high-quality CME under the purview of a physician’s specialty society solely as the demonstration of lifelong learning in hospital, insurance, and licensing credentialing. The HOD conversation shifted from restricting how hospitals, licensing boards, and insurers can use MOC, to redefining MOC.
To address this challenge to professional autonomy while emphasizing the need for responsiveness to concerns across boards, the ACS Delegation applied a strategy that involved prepared talking points; caucus presentations by ACS Executive Director David B. Hoyt, MD, FACS, and Dr. Armstrong; reference committee testimony from Dr. Hoyt and Vice-Chair of the ACS Board of Regents Leigh A. Neumayer, MD, FACS, and ACS Regent James Denneny, MD, FACS, executive director, American Academy of Otolaryngology-Head and Neck Surgery; as well as hallway conversations and HOD floor discussion. As a result, the AMA affirmed that lifelong learning is a fundamental obligation of the profession and recognizes that, for a physician, it is best achieved through ongoing participation in a program of high-quality CME appropriate to the physician’s medical practice as determined by the relevant specialty society. The concept of the AMA lobbying hospital associations, health care insurers, and state licensing boards to not use the ABMS-sponsored MOC process with lifelong interval high stakes testing for credentialing, in addition to the idea of the AMA partnering with state medical associations and specialty societies to undertake a study to establish a separate program of certification by 2020, were referred for further consideration. The ACS will continue to emphasize that a core element of professionalism is self-regulation of lifelong learning through standard-setting.
• Resolution 318, Oppose Direct-to-Consumer Advertising of the ABMS MOC Product, asked the AMA to oppose direct-to-consumer marketing of the ABMS MOC product in print media, social media, apps, and websites that specifically target patients and their families, including but not limited to the promotion of false or misleading claims linking MOC participation with improved patient health outcomes and experiences where limited evidence exists. This item was referred for further study.
• Resolution 319, Public Access to Initial Board Certification Status of Time-Limited ABMS Diplomates, was adopted. The AMA now advocates that the initial certification status of time-limited diplomates be listed and publicly available on all ABMS and ABMS member board websites and physician certification databases and that the names and initial certification status of time-limited diplomates remain on ABMS and ABMS member board websites or physician certification databases, even if the diplomate opts out of MOC participation.
• Council on Medical Service Report 6, Expansion of U.S. Veterans’ Health Care Choices, was adopted with an amendment offered by the ACS delegation. The AMA will encourage the Veterans Health Administration (VHA) to engage with VHA physicians to explore and develop solutions to improve the health care choices of veterans. The AMA also will continue to support efforts to improve the Veterans Choice Program (VCP) and make it permanent, advocate for new funding to support expansion of the VCP, and encourage the acceleration of interoperability of electronic personal and health records and the exchange of medical records between VHA and non-VHA physicians.
• Substitute Resolution 115, Out-of-Network Care, combined four resolutions on the subject of greatest interest in the Reference Committee A hearing—surprise (unanticipated) billing for out-of-network care. It was adopted with eight AMA principles regarding unanticipated out-of-network care and AMA development of model state legislation addressing the coverage of and payment for unexpected unanticipated out-of-network care.
• Resolution 419, Improving Physicians’ Ability to Discuss Firearm Safety, was adopted with minor amendments. As a result, the AMA is working with appropriate stakeholders to develop state-specific guidance for physicians on how to counsel patients to reduce their risk for firearm-related injury or death by suicide, including guidance on when and how to ask sensitive questions about firearm ownership, access, and use; and clarification on the circumstances under which physicians are permitted or may be required to disclose the content of such conversations to family members, law enforcement, or other third parties.
• Substitute Resolution 706, Concurrent and Overlapping Surgery, was adopted. The AMA will work with interested national medical specialty societies on issues related to concurrent and overlapping surgery.
The June meeting is when AMA officers, trustees, and councilors are elected. Barbara McAneny, MD, an oncologist from New Mexico, was elected AMA president-elect. Three ACS-endorsed candidates were successful in their bids to serve on the Council on Medical Education. Liana Puscas, MD, MHS, FACS, associate professor of surgery, Duke University School of Medicine, Durham, NC, and Luke Selby, MD, a general surgery resident, University of Colorado School of Medicine, Denver, were reelected; Krystal Tomei, MD, assistant professor of neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, was elected.
The Surgical Caucus hosted a well-attended educational session, Cultivating and Protecting Your Digital Presence: Do’s and Don’ts of Social Media. Speakers included Deanna Attai, MD, FACS, a breast surgeon and assistant clinical professor of surgery, David Geffen School of Medicine, University of California, Los Angeles, and Ravi Goel, MD, an ophthalmologist in private practice in Cherry Hill, NJ, and delegate from the American Academy of Ophthalmology. Both presentations emphasized that surgeons need to manage their online reputation in practice reviews and other web content. Drs. Attai and Goel provided constructive ideas for personal and professional branding through social media, as well as practical ways for surgeons to build and protect their social media reputation. Both presentations are available on the Surgical Caucus web page at facs.org/advocacy/ama-house-of-delegates/surgical-caucus.
The ACS delegation successfully put forth the College’s priorities at the June AMA HOD meeting. The delegation is now working with the ACS Division of Advocacy and Health Policy, the Health Policy and Advocacy Group, and other committees to develop next steps in shaping AMA policy consistent with College principles.
The next AMA meeting is the Interim Meeting in Honolulu, HI, November 11–14. The College’s delegation welcomes input from Fellows regarding issues of importance to surgeons. Comments and questions should be directed to.
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, general surgery, Rochester, NY
Leigh A. Neumayer, MD, FACS, general surgery, Tucson, AZ; Vice-Chair, ACS Board of Regents
Naveen F. Sangji, MD, (also Resident and Fellow Section delegate), 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 affiliate associate professor of surgery, University of South Florida Morsani College of Medicine, and former Florida Surgeon General and Secretary of Health (2012–2016). He 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.