Report from the AMA Interim Meeting
November 2018, National Harbor, MD
Submitted by Robert Wailes, MD, AAPM AMA Delegate
The AMA House of Delegates (HOD) met November 10-13 in National Harbor, MD, to discuss many challenging issues and draft new policies intended to shape the practice of medicine in the United States. Topics as diverse as gun control and physician aid in dying were among the numerous issues debated.
Misapplication of CDC Guideline
Donna Bloodworth (AAPM's alternate delegate) and I (AAPM's delegate) represented pain medicine and supported and co-sponsored an American Society of Addiction Medication-initiated resolution regarding issues around the use of strict guidelines for prescribing, based on the CDC Guideline. We were happy to work within the house of medicine to craft the following resolution that was ultimately passed by the HOD.
RESOLVED, that our American Medical Association (AMA) applaud the Centers for Disease Control and Prevention (CDC) for its efforts to prevent the incidence of new cases of opioid misuse, addiction, and overdose deaths (Directive to Take Action)
RESOLVED, that our AMA actively continue to communicate and engage with the nation's largest pharmacy chains, pharmacy benefit managers, National Association of Insurance Commissioners, Federation of State Medical Boards, and National Association of Boards of Pharmacy in opposition to communications being sent to physicians that include a blanket proscription against filing prescriptions for opioids that exceed numerical thresholds without taking into account the diagnosis and previous response to treatment for a patient and any clinical nuances that would support such prescribing as falling within standards of good quality patient care. (Report back at A-19) (Directive to Take Action), and be it further
RESOLVED, that Policies H-120.924, D-95.987, D-160.981, H 265.998, and H-220.951 be reaffirmed (Reaffirm Existing HOD Policy), and be it further
RESOLVED, that our AMA affirms that some patients with acute or chronic pain can benefit from taking opioid pain medications at doses greater than generally recommended in the CDC Guideline for Prescribing Opioids for Chronic Pain and that such care may be medically necessary and appropriate, and be it further
RESOLVED, that our AMA advocate against misapplication of the CDC Guideline for Prescribing Opioids by pharmacists, health insurers, pharmacy benefit managers, legislatures, and governmental and private regulatory bodies in ways that prevent or limit patients' medical access to opioid analgesia, and be it further
RESOLVED, that our AMA advocate that no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guideline for Prescribing Opioids.This is somewhat complex, but each part of the resolution was very important to some, if not all of our members. This also applies to all other prescribing physicians as well.
Future of Pain Care
In 2017, AAPM sponsored a resolution calling on the AMA to create a task force focused on the future of pain care. The AMA Pain Care Task Force has met twice to set priorities that it will address, including clinical practice environment challenges (such as misapplication of the CDC Guideline and reimbursement for multidisciplinary pain care), clinician education and training in pain care, and stigma around pain care.
Physician Free Speech
Another prior AAPM resolution went to the Board of Trustees for a report that was presented at this meeting. This resolution was supportive of physician's rights to express their medical opinions. The context for this resolution regards the numerous lawsuits that have been filed against opioid producing pharmaceutical companies and physicians (who have provided medical education in the past regarding the use of opioids). Many of these physician speakers and key opinion leaders have now been brought into lawsuits based on the material they presented and the medical opinions they expressed. Each of us should feel free to help educate others regarding issues where we have specific training and expertise. Even with disclaimers physicians are being drawn into lawsuits if their material matches up with what the opioid producing drug companies were promoting at the same time. The AMA has an excellent Litigation Center, which supports physicians in cases that may set precedence for other physicians across the country. They are looking closely at supporting our Academy and the many physicians within the field of pain medicine that have been named in many of these lawsuits. In collaboration with the AMA Litigation Center we provided a resolution that was ultimately amended and passed at this recent interim meeting. The final resolution that passed was very simple and reads:
That our American Medical Association support a physician's First Amendment right to express opinions relating to medical issues.
We are happy with the outcome of this resolution since it clearly states that physicians have a right to express their medical opinions, which are appropriately covered by the first amendment of our constitution. This has the potential to help with some upcoming litigation issues.
Other House actions of specific interest to AAPM members include:
CEJA Report #2 regarding the "Study of Aid in Dying as End-of-life Option" and "the need to distinguish 'Physician Assistant Suicide' and 'Aid in Dying.'" This is a very complex issue with people on both sides of the fence promoting excellent arguments. Some states already have physician aid in dying legislation. After much debate, the report will go back to the Council on Ethics and Judicial Affairs (CEJA) for further deliberation and study.
There was also a lot of work regarding the AMA promoting the streamlining of the prior authorization process. They also dealt with the CMS proposal to consolidate evaluation and management services, suggesting further study in lieu of the changes that have already been delayed.
Finally, I would like to thank all of you AAPM members who also belong to the AMA. Your commitment to both organizations is critical to the development of Pain Medicine. I am particularly pleased to report that, in the 5-year census the AMA has instituted for all specialty societies, AAPM has once again maintained its standing in the AMA House of Delegates. Effectively, this gives the Academy a voice at the table of national organized medicine, which in turn allows AAPM to advocate from a much stronger position. So if you've not already done so, remember to initiate or renew your membership in the AMA, designating AAPM as your medical specialty society.
Robert Wailes, MD, AAPM Delegate to the AMA