Hail to the Chief

Highlights from the AMA House of Delegates annual meeting

The just concluded Annual Meeting of the AMA House of Delegates will go down as one of the most memorable for emergency physicians, if only because Steven Stack, MD, was inaugurated as the first emergency physician president of the AMA in more than 160 years. In his inaugural speech, he spoke eloquently about being an emergency physician, but you didn’t need to be an EP to feel his emotion and passion. His speech is available in text and video on the AMA website; and I highly recommend it to you.

With the broken and much maligned SGR finally executed and buried by Congress this Spring after many annual attempts, the AMA House of Delegates needed some new meat to chew on. One of the likely candidates for this emotional blood-letting was the Maintenance of Certification Programs created by the ABMS and its 24 member boards. The vast majority of the venom was aimed at the ABIM, which has more diplomates than any other board. There were no fewer than 4 Board of Trustee Reports about MOC, primarily through the Council on Medical Education, several of which gave a very thorough and unbiased assessment of the ABMS and MOC. Additionally, there were no fewer than 8 MOC resolutions, ranging from dissolution of MOC to drastically modifying Part 3 to making suggestions on how to improve MOC. In the end it became obvious that most of the emotional anger was directed at the ABIM. In reality, many of the criticisms of the ABIM and some of the other ABMS member boards have already been addressed by the ABEM, such as freezing fees for the past 4 years, establishing an aggressive feedback mechanism for diplomates following every MOC activity, having a board and committees comprised only of actively practicing physicians, and establishing a personal page for each diplomate on the ABEM website for enhanced communication and understanding of requirements.

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There were also several resolutions and council or BOT reports of significant interest to emergency physicians, including but not limited to the following:

• Abolition of the Medicare 3-day Rule. This affects EPs every time that we admit a patient to anything other than full Inpatient status, which then does not count toward the 3-day requirement for subsequent coverage of placement into a skilled or long-term care facility. This places us and our patients at a disadvantage.
• Study the Impact of the ACA Medicaid Expansion. We all know that the ACA was supposed to provide more healthcare options for those who previously had no insurance and therefore unburden EDs of sometimes overwhelming utilization. Anyone who works in EDs today knows that this just is not the reality that we live. Such a study will go a long way toward finding better solutions.
• BOT Report on the Development and Promotion of Single National Prescription Drug Monitoring Program. We are all in varying stages of being encumbered by and required to utilize user-unfriendly PMPs in our states and regions. This report is comprehensive and lobbies for ease of access and use, seamless integration into the workflow, and uniform standards of use. Wouldn’t that be wonderful?
• BOT Report on Liability Related to Referrals from Free Clinics recommends extension of medical liability immunity under the Federal Tort Claims Act to all physicians who provide charity care wherever they practice. This would certainly include emergency physicians in emergency departments.
• Tackling EHR Challenges. Several resolutions addressed EHRs and recommended vendor responsibility to address ongoing and significant problems of lost productivity and unpredictable downtime and lack of interoperability of systems. We are plagued daily by these problems in our own practices and they badly need solutions.
• Model State Legislation Eliminating Restrictive Covenants in Physician Contracts was referred to the board. Restrictive covenants remain a relatively common problem in contracts with emergency physicians and need to be eliminated.
• Autonomy in Utilization of CME funds by Employed Physicians applies directly to emergency physicians employed by larger entities and provided with CME funds, the use of which are sometimes dictated by the employer. Individual physicians should have complete control over how these funds are utilized.
• The Council on Medical Education report on Competency and the Aging Physician. Clearly, as our EP community ages so will their competencies change. From a workforce and a quality of care standpoint, we need to be aware of these changes and plan accordingly.
• Report on Concussion and Youth Sports generated lots of debate. Clearly today there is a much greater sensitivity regarding closed head injuries in contact sports and their sequelae and their treatment, and emergency medicine is very much a part of that debate. How much prevention is enough? And at what price?
• A Resolution Banning Powdered Alcohol Distribution and Sale was referred. This is a new product that may be coming to your ED soon. Clearly an ounce of prevention applies here.
• The twin issues of Chronic Pain Management and Drugs of Abuse and their Overdose Complications were addressed by two excellent Council and BOT Reports and several Resolutions. Since EPs see these entities on a daily basis, we are very much a part of the solution to this increasing and deadly problem.
• Preventing Violent Acts Against Health Care Providers came in response to the recent tragic murder of a cardiologist by a patient, but it highlighted the very high risk that EPs live with every day. It advocated study of mechanisms to prevent the violence and ways to improve the safety and security of providers.

All in all, it was an outstanding meeting. From the above examples of some of the issues considered and debated, you should be able to discern the link between emergency medicine and the American Medical Association. Many of these reports and resolutions will affect us directly or indirectly. It is vitally important that we be involved in the process. And, besides, we now have a President of the AMA in Steve Stack who lives our lives and knows our issues and who will be an outstanding ambassador for emergency physicians and the patients we serve. There’s never been a better time to get involved.