News From the College

AMA House of Delegates addressed surgery issues


The annual meeting of the American Medical Association (AMA) House of Delegates (HOD) took place June 15-19 in Chicago, IL. More than 550 delegates as well as alternate delegates converged on the Windy City to consider and adopt policy for the AMA. Issues such as health care policy were discussed, educational sessions were presented, and elections took place.

Reports and resolutions

The HOD reviewed more than 160 resolutions and 65 reports, including the following centered on issues of relevance to surgeons:

Invasive procedures: As originally submitted to the HOD, this report from the AMA Board of Trustees called for revising the current AMA, definition of surgery and guidelines on invasive procedures for the treatment of chronic pain, including procedures using fluoroscopy. Efforts to bridge the definitions for surgery and procedures fell short. A revised report was adopted that retained the current AMA definition of surgery but focused only on invasive pain management procedures.

Recognition of obesity as a disease: The ACS and 10 other medical/specialty societies cosponsored this resolution, which called on the AMA to recognize obesity as a disease with multiple pathophysiological aspects requiring a range of interventions to advance treatment and prevention. Evidence presented demonstrated that obesity is a metabolic disease that occurs as a result of unhealthy behaviors related to food and beverage consumption; lack of sufficient physical activity; and work, school, and messaging environments. The resolution further noted that obesity leads to chronic diseases, such as hypertension, heart disease, diabetes, and arthritis. The ACS delegation emphasized that metabolic (bariatric) surgeons are on the front lines of treating severe obesity with life-improving and lifesaving results. The resolution passed with a 60 percent majority of the delegates.

Payment variations across outpatient sites of service: Cost transparency across sites of service was a major point of discussion, which received positive comments in reference committee testimony. In addition to adopting recommendations from the AMA Council on Medical Service to reaffirm some existing AMA policies related to Medicare payments across outpatient settings, the HOD adopted a recommendation that the AMA work with states to advocate for third party payors to:

• Assess equal or lower facility coinsurance for lower-cost sites of service (hospital outpatient department, ambulatory surgical center, or office-based facility);

• Publish and routinely update pertinent information related to patient cost-sharing; and

• Allow their plan’s participating physicians to perform outpatient procedures at an appropriate site of service as chosen by the physician and the patient.

AMA support for states in their development of legislation to support physician-led, team-based care: With a focus on physician-led, team-based care, this resolution was adopted and directed the AMA to assist state medical societies and specialty organizations with seeking passage of legislation that would define the valued role of mid-level and other health care professionals within a physician-led team that promotes optimal quality patient care and patient safety. The resolution also called on the AMA to actively oppose health care teams that are led by nonphysician health care practitioners.

An update on Maintenance of Certification (MOC), Osteopathic Continuous Certification (OCC), and Maintenance of Licensure (MOL): A major topic of discussion was MOC, OCC, and MOL requirements. Many resolutions introduced reflected concerns regarding the implementation, cost, and additional exam burdens on physicians that these requirements pose. These resolutions largely recommended that the Council on Medical Education continue to monitor the requirements and engage in ongoing dialogues with medical and licensing boards.

Government interference in the practice of medicine and the patient-physician relationship: The AMA HOD passed several resolutions that led to the adoption of a Statement of Principles concerning the roles of federal and state governments in health care and the patient-physician relationship. These principles include:

• Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors or disclosing information to patients, including proprietary information on exposure to potentially dangerous chemicals or biological agents that may affect their health or the health of their families, sexual partners, and other individuals with whom they have been in contact.

• All parties involved in the provision of health care, including government, are responsible for acknowledging and supporting the intimacy and importance of the patient-physician relationship and the ethical obligations of the physician to put the patient first.

• The fundamental ethical principles of beneficence, honesty, confidentiality, privacy, and advocacy are central to the delivery of evidence-based, individualized care and must be respected by all parties.

• Laws and regulations should not mandate the provision of care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, is either unnecessary or ill-suited for a particular patient at the time services are rendered.

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