Inside the AMA Annual Meeting

Reports on the 2016 Annual Meeting of the AMA House of Delegates

The 2016 Annual Meeting of the AMA House of Delegates in Chicago concluded recently with a relentless flurry of action. The meeting began with news of the tragic Orlando shooting, which stimulated an emergency resolution on gun control legislation and research, which passed nearly unanimously. Other notable events during the five days of meetings included the passing of the gavel from fellow Emergency Physician and President Steven Stack and a presentation on Medicare payment reform by CMS administrator Andy Slavick, during which he made a plea for physician input. Emergency medicine was again well represented by the ACEP Section Council and by numerous emergency physician delegates and alternate delegates scattered throughout various state and other delegations, including the YPS and the RFS.

Among the 64 reports by the Board of Trustees and the various Councils, there are several that have direct or indirect relevance to practicing emergency physicians, including the following:

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• Principles for Measuring and Rewarding Physician Performance: This report highlighted many of the pros and cons of this somewhat controversial issue, especially in the evolving era of big data.
• The AMA Modernized Code of Medical Ethics: This report, which has been in the process of revision for several years, was finally passed. Since this code applies to all practicing physicians it would behoove all emergency physicians to be at least familiar with this extensive and comprehensive document.
• Powdered Alcohol (Palcohol): The AMA recommends banning it, for many good reasons, including that Palcohol could easily result in many overdoses, especially children and adolescents, despite the claims to the contrary by the manufacturer.
• Preventing Violent Acts Against Health Care Providers: This report comprises a comprehensive review of violence in the health care setting, which affects all emergency departments. A related resolution on Weapons in the Hospital advocates for a total ban of weapons in healthcare facilities.
• Restrictive Covenants in Physician Contracts: This report addresses an issue very germane to emergency physicians and contains valuable information advocating against restrictive covenants.
• Update on MOC and Osteopathic Continuous Certification: This report includes a thorough review of this evolving landscape of significant interest to all physicians. The Council on Medical Education continues to work closely with the ABMS and the Board Community on improving and refining the Certification Process.

The 184 resolutions considered ran the gamut from ultra specific to the very generic. Popular topics included the manifold issues surrounding the Zika virus and the evolving potential pandemic, drinking water safety (a la Flint, MI), smoking and tobacco products. The whole topic of opioids garnered a lot of attention, including pain control and patient satisfaction and PMP utilization and guidelines and rehab, as well as EHRs and their effect on physician burnout and safety. Interestingly, a resolution advocating collective bargaining for physicians was defeated, but I am sure that this one will return. Of particular interest to emergency physicians includes the following resolutions:

• Pain Control and Patient Satisfaction: Recommendations include eliminating or modifying patient satisfaction questions on pain control because of the obvious relationship to the administration and prescription of narcotics. Related resolutions advocated removing pain scores from quality metrics entirely and eliminating pain as the fifth vital sign. I can’t think of a single emergency physician who would disagree with these resolutions.
• Survey on Addiction Treatment Centers Availability: This resolution would provide much needed information and resources for many of our patients who are opioid dependent.
• Retail Clinics: A resolution recommended that this burgeoning industry – which has little regulation and oversight and many consequences to emergency departments – be studied closely.
• Intimacy and Sexual Behavior in Residential Aged-Care Facilities: A resolution brings long overdue attention to this somewhat neglected issue. There is nothing worse than having to do a sexual assault evaluation on an elderly person who has no memory.
• Sexual Assault on College Campuses: An especially timely resolution on this burgeoning social issue, whose victims end up in the ED.
• Pre-exposure Prophylaxis (PreP) for HIV: This resolution advocates educating the medical community about this increasingly common practice, including the EM community. Are you aware of this phenomenon?
• MOC Resolutions: Several MOC resolutions addressed the MOC parts and processes, resulting in a recommendation that the high stakes exam be eliminated and advocated for CME as an alternative. A related resolution advocated for the elimination of Board Certification as a criterion for medical staff membership or hospital credentialing or insurance panels.

All in all, it was a most interesting meeting. From these few examples cited above, the link between the AMA and emergency physicians should be obvious. Many of these reports and resolutions will affect us directly or indirectly. Therefore, it is vitally important that we be involved in the process of forming them. Although our colleague Dr. Stack enters his last year on the board as Immediate Past President, there are many fine young emergency physicians who are in the process of ascending the leadership ladder in the AMA and should be well positioned to serve emergency medicine well into the future. The AMA needs the voice of emergency medicine; please consider joining.