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Report from the November 2019 AMA Interim Meeting

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

The Interim Meeting of the American Medical Association (AMA) House of Delegates (HOD) convened November 16, 2019 in San Diego. 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.

Before discussing the November meeting, we would like to suggest all eligible 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 Interim Meeting dealt with many challenging issues and new policies were created. Numerous issues were relevant to our specialty. There were resolutions and reports related to the opioid issues, addiction medicine, cannabis, prior authorizations among others. Please see below for more details and a link to the major topics covered at the AMA.

Our delegation spearheaded a move to create a new AMA Cannabis Task Force "to evaluate and disseminate relevant scientific evidence to health care providers and the public." This was supported by our Pain and Palliative Medicine Specialty Section Council, which one of our primary homes in the AMA House of Delegates. We are all challenged by the lack of clear evidence regarding cannabis (including CBD). In fact, there are some studies that have valid findings that may be useful. We hope this task force will be a good resource for many types of data regarding cannabis products so in turn we can provide better education for our patients.

Previously we proposed and created the AMA Pain Care Task Force. This group is still meeting to hopefully put together a report to advance policy that will support all our efforts to have better patient access to quality pain medicine services. We hope to see a report some time in the next year.

Some highlights of adopted new policies include the following excerpts from AMA coverage.

Doctors back innovative local efforts to battle opioid epidemic
While recognizing that opioid-epidemic reversal strategies that may work in one community may not be transferable elsewhere, successful local programs can still provide lessons and inform the development of treatment and prevention efforts in other communities, according to an AMA Board of Trustees report whose recommendations delegates have adopted. The report highlights strategies in Huntington, West Virginia, and Clark County, Indiana, and examines whether other communities could use them as examples for their own efforts.

AMA to boost education on methadone maintenance therapy
The AMA supports the evidence-based use of methadone in the treatment of opioid-use disorder (OUD), and model state legislation drafted by the AMA calls for all payers to make all forms of medication-assisted treatment (MAT) available without prior authorization and placed on a formulary's lowest cost-sharing tier.

The AMA board "strongly supports additional educational efforts to, at the very least, reduce the stigma" of methadone maintenance therapy (MMT). Delegates have directed the AMA Opioid Task Force to "increase its evidence-based educational resources focused on MMT and publicize those resources to the Federation of Medicine."

New Pathway for Addiction Medicine Board Certification
Delegates at the 2019 AMA Interim Meeting adopted policy to recognize the ABPM (American Board of Preventative Medicine) for "developing and providing pathways for all qualified physicians to obtain certification approved by the American Board of Medical Specialties in the new ABPM subspecialty of Addiction Medicine, in order to improve access to care for patients with substance use disorder."

Stop sales of e-cigarettes that lack FDA approval
The House of Delegates has adopted policy to "urgently advocate for regulatory, legislative or legal action at the federal or state levels to ban the sale and distribution of all e-cigarette and vaping products, with the exception of those which may be approved by the FDA for tobacco-cessation purposes and made available by prescription only."

Boost transit for improved access to care
Barriers exist for patients to access affordable public transportation. Additionally, shifting from personal car use to public transportation can lead to a six fold drop in greenhouse gas emissions, according to a resolution introduced by the Michigan delegation. Implementing a new transit system can help increase physical activity and decrease body mass index among new users, while also improving access to health care for underserved populations and geographical areas.

Make healthful food options available at all health care facilities
AMA policy has already encouraged healthy, plant-based food options in hospitals. Such diets have been shown to improve health in everyone, not just patients in hospitals. These options also have the potential to be cheaper than other alternatives, according to a resolution introduced by the AMA Medical Student Section.

Given the need for healthy, plant-based options at all medical care facilities, delegates amended existing policy to:

  • Encourage healthful food options be available, at reasonable prices and easily accessible, on the premises of health care facilities.
  • Call on all health care facilities to improve the health of patients, staff and visitors by: providing a variety of healthy food, including plant-based meals and meals that are low in saturated and trans-fat, sodium and added sugars; eliminating processed meats from menus; and providing and promoting healthy beverages.
  • Call for health care facility cafeterias and inpatient meal menus to publish nutrition information.

More training needed on health care finance 
It's well documented that the United States spends more on health care than any other nation. Citing research indicating that educational interventions on health care finance during residency training may have a positive impact on future health care spending in the future—and in light of a lack of explicit language that encourages coverage of this topic in residency—delegates amended existing policy on the topic.

According to the amended policy, the AMA will:

  • Ask medical schools and residencies to encourage that basic content related to the structure and financing of the current health care system, including the organization of health care delivery, modes of practice, practice settings, cost effective use of diagnostic and treatment services, practice management, risk management, and utilization review or quality assurance, is included in the curriculum.
  • Ask medical schools and residencies to ensure that content related to the environment and economics of medical practice in fee-for-service, managed care and other financing systems is presented at educationally appropriate times during undergraduate and graduate medical education.
  • Encourage the Liaison Committee on Medical Education to ensure that survey teams pay close attention during the accreditation process to the degree to which "socioeconomic" subjects are covered in the medical curriculum.
List transgender patient's preferred name in EHR

Delegates moved to bolster the AMA's existing policy on promoting inclusive gender, sex and sexual orientation options on medical documentation. The current policy supports the voluntary inclusion of a patient's biological sex, current gender identity, sexual orientation and preferred gender pronoun, and delegates modified AMA policy to also support inclusion of "preferred name and clinically relevant, sex-specific anatomy" in medical documentation.

For more information, view highlights from the 2019 AMA Interim 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:

  • Bob Wailes, MD (This email address is being protected from spambots. You need JavaScript enabled to view it.)
  • Donna Bloodworth, MD (This email address is being protected from spambots. You need JavaScript enabled to view it.)
Respectfully submitted,

​Bob Wailes, MD
AAPM Delegate to the AMA​

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