On the Radar: 2019 AMA House of Delegates Report

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Opioid treatment, burnout and hospital consolidation among key topics.

The 2019 Annual Meeting of the AMA House of Delegates convened recently in Chicago, starting off with a bang with a demonstration by a group against the American Medical Association’s position on “Medicare for All.”


Other notable events during the meetings, held June 8-12, included a presentation on Medicare administrative reform by current CMS administrator Seema Verna. 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.

Among the 65 reports by the Board of Trustees and the various Councils, most of which contain extensive research and information, there are several that have direct or indirect relevance to practicing Emergency Physicians. Here are some of the highlights:

  • Opioid Treatment Programs Reporting to PMPs. This medication reporting mandate would include methadone, not currently required. Currently emergency physicians may be unaware that a patient is on methadone or other medication assisted treatment unless the patient so states, which can impact directly on treatment plans.
  • Developing Sustainable Solutions for Discharge of Chronically Homeless Patients. There is growing support that chronically homeless patients should not be “just discharged” from medical facilities, which although admirable in its intent, could present a logistical nightmare for emergency departments. So far, no regulatory mandates.
  • Employed Physician Bill of Rights and Basic Practice Professional Standards would apply to the many emergency physicians who are currently employees. Every employed emergency physician should be aware of his or her rights.
  • Physician Burnout and Wellness Challenges; Physician and Physician Assistant Safety Net; Identification and Reduction of Physician Demoralization. This report recognizes the severe effects of burnout in our professional colleagues and advocates for steps in addressing these very significant issues, before they end in tragedy.
  • Hospital Consolidation. This increasingly prevalent practice potentially threatens the independence of practicing physicians everywhere, especially in the emergency department. We should be very concerned about this phenomenon.
  • Update on MOC and Osteopathic Continuous Certification 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 178 resolutions considered ran the gamut from the ultra specific and nearly irrelevant to Emergency Medicine to the very generic and germane.


Popular topics included the manifold issues surrounding gun violence and safety; smoking and tobacco products; pharmaceutical pricing and availability; physician suicide and burnout. The whole topic of opioids continued to generate much attention, including narcotic and non-narcotic pain control and guidelines; patient satisfaction, PMP utilization, and rehab and medication assisted treatment programs.

Of particular interest to emergency physicians included the following resolutions:

  • Opposition to Involuntary Civil Commitment for Substance Use Disorder. We have a vested interest in this issue, since this is one of the tools commonly used for our repeatedly intoxicated patients. The negative feelings by our non-emergency colleagues is particularly strong, however.
  • Eliminating the CMS Observation Status. This issue has been so problematic for our Medicare patients who literally cannot afford to be placed in this status. This would not eliminate observation services reimbursement, but rather would eliminate the CMS Observation Status.
  • Mitigating the Negative Effects of High Deductible Health Plans. These plans disincentivize patients to get routine health care and medications, resulting in their accessing Emergency Departments for complications of their conditions.
  • EHR-Integrated PMP Rapid Access would incorporate this access into the EHR, which would make accessing this required information seamless and convenient.
  • Availability of Naloxone Boxes and Implementing Naloxone Training in the BLS Certification Program would increase the availability and use of naloxone in opioid overdoses, thus potentially saving lives. Hard to argue that one.
  • Access to Psychiatric Treatment in Long-Term Care. A significant problem frequently encountered in the emergency department is an elderly patient in a long-term care facility referred to the emergency department for psychiatric evaluation, usually a behavioral problem, which ties up beds and personnel.

All in all, it was a most interesting meeting. From these few examples cited above, the link between the AMA and the emergency physician community should be obvious. Many of these reports and resolutions will affect us directly or indirectly. Therefore, it is vitally important that we all be involved in this process.

Although 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 still needs a louder voice from Emergency Medicine. Please consider joining.



Dr. Carius is an alternate delegate to the AMA from Connecticut. He is also a past president of ACEP, and an executive editor for Emergency Physicians Monthly.

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