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Report from the June 2019 AMA Annual Meeting

The following report was submitted by Robert Wailes, MD, AAPM AMA Delegate

The Annual Meeting of the American Medical Association (AMA) House of Delegates (HOD) convened from June 8-12, in Chicago, Illinois. 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 M. Bloodworth, MD. Phil Saigh, our AAPM Executive Director, was there to support our efforts as well.

Before discussing the June meeting, I would like to suggest all physician members of the American Academy of Pain Medicine become members of the AMA and designate AAPM as your specialty organization. The role of physicians includes looking at the bigger picture regarding healthcare. It is all our responsibility to support the advancement of healthcare utilizing the resources of "organized medicine" through our specialty, state, and national organizations. The AMA is by far the strongest voice of all physicians on a national basis. It is very important that we maintain our specialty representation within the AMA. There is a specific requirement that a certain percentage of our membership also be members of the AMA in order for us to maintain our AAPM delegation.

The Annual Meeting dealt with many challenging issues and new policies were created. Topics as diverse as prior authorizations and physician aid in dying, as well as many others, kept the meeting very busy. We also had elections for several major positions, including President-Elect. Numerous issues were relevant to our specialty. Some highlights include the following excerpts from AMA coverage on the internet link referenced below.

The AMA House of Delegates (HOD) adopted new policy to:

Advocate for state legislatures and other policymakers, health insurance companies and pharmaceutical benefit management companies to remove barriers, including prior authorization, to nonopioid pain care.

Support amendments to opioid-restriction policies to allow for exceptions that enable physicians, when medically necessary in the physician's judgment, to exceed statutory, regulatory or other thresholds for post-operative care and other medical procedures or conditions.

Oppose health insurance company and pharmacy benefit management company utilization-management policies, including prior authorization, that restrict access to post-operative pain care, including opioid analgesics, if those policies are not based upon sound clinical evidence, data and emerging research.

Support balanced opioid-sparing policies that are not based on hard thresholds, but on patient individuality, and help ensure safe prescribing practices, minimize workflow disruption, and ensure patients have access to their medications in a timely manner, without additional, cumbersome documentation requirements.

Oppose the use of "high prescriber" lists used by national pharmacy chains, pharmacy benefit management companies or health insurance companies when those lists do not provide due process and are used to blacklist physicians from writing prescriptions for controlled substances and preventing patients from having the prescription filled at their pharmacy of choice.

A separate resolution notes there is a "pain treatment gap" because pharmacy benefit plans will not cover medications that could serve as alternatives to opioids for treatment of pain.

In adopting the resolution's recommendation, the HOD directed the AMA to "petition the Centers for Medicare & Medicaid Services to allow reimbursement for off-label use of medications like gabapentin or lidocaine patches at the lowest co-payment tier for the indication of pain so that patients can be effectively treated for pain and decrease the number of opioid prescriptions written."

To address this gap, delegates directed the AMA to:

Advocate for increased access and coverage of non-opioid treatment modalities including pharmaceutical pain care options, interventional pain management procedures, restorative therapies, behavioral therapies, physical and occupational therapy, and other evidence-based therapies recommended by the patient's physician.

Advocate for nonopioid treatment modalities being placed on the lowest cost-sharing tier for the indication of pain so that patients have increased access to evidence-based pain care as recommended by the Health and Human Services Interagency Pain Care Task Force.

Encourage the manufacturers of pharmaceutical pain care options to seek U.S. Food and Drug Administration approval for additional indications related to non-opioid pain-management therapy.

The AMA was also directed to incorporate into its advocacy that clinical practice guidelines specific to cancer treatment, palliative care, and end of life care be used in lieu of the CDC's Guideline for Prescribing Opioids for Chronic Pain as per the CDC's clarifying recommendation.

The AMA passed a resolution supporting better integration of Prescription Drug Monitoring Programs directly with EHRs to promote rapid and easy access.

The AMA House of Delegates adopted new policy to "support the legal access to and use of naloxone in all public spaces regardless of whether the individual holds a prescription."

Delegates also amended existing policy that asks the AMA to "support the widespread implementation of easily accessible naloxone rescue stations (public availability of naloxone through wall-mounted display/storage units that also include instructions) throughout the country following distribution and legislative edicts similar to those" for AEDs.

Noting that language associated with substance-use disorders shapes attitudes among health professional towards patients with addiction, delegates adopted new policy for the AMA to:

Use clinically accurate, non-stigmatizing terminology (substance-use disorder, substance misuse, recovery, negative/positive urine screen) in all future resolutions, reports and educational materials regarding substance use and addiction.

Discourage the use of stigmatizing terms including substance abuse, alcoholism, clean and dirty.

The AMA also will "create educational materials on the importance of appropriate use of clinically accurate, non-stigmatizing terminology and encourage use among all physicians and U.S. health care facilities."

There was a lot of discussion and work addressing the high level of physician burnout and suicide. This will be addressed in many ways and can be reviewed on the AMA website.

There were also educational sessions including "What does the science say about opioid management?"

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 from the Council on Ethics and Judicial Affairs (CEJA) was approved by the HOD. The report concluded that Physician Assisted Suicide is unethical.

For more information, review highlights from the 2019 AMA Annual Meeting.

The HOD is composed of approximately 640 delegates (and slightly fewer alternate delegates) who represent all physician 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. 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:

Respectfully submitted,

Bob Wailes, MD
AAPM Delegate to the AMA

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