Report on the AMA Annual Meeting, June 2017 Chicago

Submitted by Robert Wailes, MD, AAPM AMA Delegate

The annual American Medical Association (AMA) House of Delegates (HOD) meeting convened June 9-14, 2017, in Chicago, IL. I represented the membership and interests of the American Academy of Pain Medicine at this meeting in my capacity as AAPM’s AMA Delegate along with our Alternate Delegate, Donna Bloodworth, MD. Scheduled opportunities to network with other delegates and advocate for Pain Medicine included the Pain and Palliative Medicine Specialty Section Council and meeting, the Neuroscience Caucus, and the Specialty and Services Society meeting. Invitations to attend the meetings of the Texas Delegation (Bloodworth), Pac West Caucus (Wailes), and the PM&R Section Council (Bloodworth) were also accepted.

AAPM Executive Director, Phil Saigh, and Program Manager, Mary Kay Ams, also organized, informed and coordinated AAPM’s participation at the meeting and were invaluable in achieving AAPM’s goals.

Before discussing the June meeting, I would like to suggest all members of the American Academy of Pain Medicine become members of the AMA. Your continued AMA membership is critically important for us to maintain our representation within the House of Delegates. Our role as physicians includes looking at the bigger picture regarding healthcare. It is all of our responsibility to support the advancement of healthcare utilizing “organized medicine” through our specialty, state, and national organizations. The AMA is by far the strongest voice for all physicians on a national basis. It is very important that we maintain our specialty representation within the AMA which requires our AAPM members to also be part of the AMA.

Your AAPM Delegation submitted one resolution to our AMA. It was passed without opposition by the AMA House of Delegates.

The resolution highlights the current challenges to pain management and proposes actions that will positively impact the future treatment of millions of patients suffering from pain. In keeping with the National Pain Strategy, which was released by the Department of Health and Human Services in March 2016, the AAPM resolution clearly documents the tremendous burden that pain – particularly chronic pain – places on the American public. According to a 2011 Institute of Medicine report, approximately 100 million Americans suffer from chronic pain.

The resolution also acknowledges the huge imbalance that exists regarding the attention paid by governmental and regulatory agencies toward the appropriate treatment of chronic pain versus the risks of opioid addiction. Therefore, the Future of Pain Care resolution calls on the AMA to convene a task force to discuss organized medicine’s response to the public health crisis of undertreated and mistreated pain. The task force would bring together the numerous specialties responsible for providing pain care, including primary care and medical and surgical specialties.

A charge of the proposed task force would be to explore and make recommendations for augmenting medical education in order to inform healthcare providers on how to help patients suffering from pain through the use of comprehensive evidence-based pain treatment options (including non-opioid medications for treating pain, alternative treatment modalities and the importance of behavioral health support, physical therapy, etc., along with proper prescribing of opioids among others). For example, ample evidence-based research shows the success of multidisciplinary pain management programs, which typically do not rely heavily on opioids, in treating chronic pain. Furthermore, many mental health techniques for the treatment of pain, such as cognitive behavioral training, meditation, relaxation techniques, biofeedback, self-hypnosis among others, have been shown to be successful in decreasing pain symptoms and reducing the need for opioids.

The task force hopes to address new concepts, such as that of the Anesthesiology Perioperative Surgical Home, which has demonstrated reduction in the burden of post-operative pain and/or acute pain thus resulting in less chronic pain and less need for opioids. Building on these successes, the task force will also discuss strategies that prevent or mitigate acute pain, educate physicians about these strategies and suggest research to study these strategies prevent the development of chronic pain. We hope to start working with the AMA to initiate this task force soon.

Other House actions of specific interest to AAPM members include:

Council on Medical Services Report 4 -- Survey of Addiction Treatment Centers’ Availability: This report was the result of a previous AAPM resolution looking to demonstrate the poor availability of addiction treatment centers for many of our members throughout the entire country. The Council decided that it would be too costly to do a national survey and instead suggested AMA members utilize different types of treatment locators that may be available in their community. The main source of national data is SAMHSA’s “behavioral health treatment services locator” (findtreatment.samhsa.gov). It is updated by addiction treatment provider responses to a national survey on substance abuse treatment services and national mental health services survey. The Council did make a recommendation that this locator service provide information regarding the type of insurance providers accept. The Council also made a recommendation to encourage physicians who are authorized to provide medication-assisted treatment (MAT) to be listed publicly in SAMHSA’s treatment locators. It was noted by SAMHSA’s leaders at the meeting that members of their organization only represent 20% of all addiction specialists and very few of them want to be listed publicly because their panel is already full. This demonstrates that it will be an ongoing problem finding good access to addiction services in many of our communities.

Resolution 506 -- Expanding Access to Buprenorphine for the Treatment of Opioid Use Disorder: This was amended by the reference committee to include a clause that would remove the mandate for extra certification for this use of the medication. Currently, many of us in the pain field use it off label for pain management but if used for detox then we need to get specific certification. Despite widespread agreement to remove the mandate, it was sent to the Board of Trustees to review and report back at the next meeting.

A significant amount of time was dedicated to the AMA positioning itself and reestablishing policy regarding the future of healthcare policy with the new administration and Congress. There is a great deal of uncertainty regarding expectations for future changes in our healthcare system. There was a generalized consensus that funding for the Medicaid program should not be impossible. The HOD opposed per-capita caps that would weaken this state’s ability to respond to enrollment changes, greater care needs, or breakthrough treatments.

The AMA Wire has excellent coverage of the meeting with the highlights being presented on June 15, 2017. Highlights appear below for your review.

Top 10 stories from the AMA Annual Meeting

June 15, 2017

Hundreds of physicians, medical students, residents, and fellows gathered at the 2017 AMA Annual Meeting in Chicago to consider a wide array of proposals designed to help fulfill the Association's core mission of promoting medicine and improving public health. These are the top stories from the meeting. Read full coverage at AMA Wire®.

Physicians recognize new psychoactive substances as a health threat
Legal synthetic drugs such as Spice are quickly emerging and difficult to track. The AMA wants new strategies and education on these new drugs of abuse.

Amid high-stakes changes, physicians can light the way
On gun violence, health reform, mega-mergers, practice burdens and more, the AMA is taking a leadership role, says outgoing AMA President Andrew W. Gurman.

Physicians get an inside view of health reform debate at crossroads
Experts on the reform discussion in Washington and value-based medicine offer their insights on the health system’s uncertain future.

New policies target mental health stigma in physicians, students
Delegates address how medical licensing boards handle physicians who have sought behavioral health treatment.

Pain care and opioid-use disorder are the focus of new efforts
While reversing the opioid epidemic remains a vital focus, AMA delegates seek strategies, education to help the millions who live with chronic pain.

New AMA president: Physicians must lead to reshape medicine
Board-certified family physician David O. Barbe, MD, MHA, says the time is right for physician-style leadership that puts patients and professionalism first.

Physicians offer fixes to improve veterans’ access to care
The AMA will continue collaboration with the VA, calls for new funding for the Veterans Choice Program.

AMA takes several actions supporting transgender patients
LGBT-friendly, nondiscriminatory policies land backing from the AMA House of Delegates.

Refugees, detained immigrants deserve access to quality care
Delegates seek better care for detained immigrants. The AMA also votes to keep information in patient records out of immigration officials’ hands.

AMA’s vigor, vision spread across all areas of medicine
The AMA offers critical resources and policies, guides lifelong physician growth and helps improve the nation’s health, says AMA CEO James L. Madara, MD.

Physicians encouraged to take a seat at the table on health care boards
Doctors’ education, expertise and experience warrant greater participation on the boards of health care organizations, says new AMA policy.

Background information about and orientation to the AMA House of Delegates and its meetings:
The HOD is composed of 535 delegates (and slightly fewer alternate delegates) who represent all physician (attending and resident) and medical student members of our AMA. About 60 percent of the delegates represent state associations and about 40 percent represent specialty societies.

Our AMA creates national medical policy through the debate of and adoption of Council reports and of resolutions brought forth by Delegations. The following Councils report at the Annual Meeting: Board of Trustees; Constitution and Bylaws; Ethical and Judicial Affairs; Medical Education; Medical Service; and Science and Public Health.

The President of our AMA is David O. Barbe, MD, MHA, and the President-Elect is Barbara McAneny, MD. Susann R. Bailey, MD, and Bruce A. Scott, MD, remain our AMA’s Speaker and Vice-Speaker, respectively.

If you have any ideas for future resolutions or any suggestions for business at the AMA please contact the AAPM office (This email address is being protected from spambots. You need JavaScript enabled to view it.) or your AAPM delegate or alternate delegate directly:
Bob Wailes (This email address is being protected from spambots. You need JavaScript enabled to view it.)
Donna Bloodworth (This email address is being protected from spambots. You need JavaScript enabled to view it.)

Respectfully submitted,
Robert Wailes, MD, AAPM AMA Delegate

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