Members of the ACR’s delegation to the House of Delegates (HOD) of the American Medical Association (AMA) are gearing up for the HOD Interim Meeting, slated for Nov. 14–18 in National Harbor, Md. The HOD, which includes more than 600 voting delegates and a corresponding number of alternate delegates from over 170 societies, meets twice a year to establish policy on health, medical, professional and governance matters. The ACR has been a member of this prestigious body since 1987.
Leading up to an annual meeting each June and an interim meeting each November, the delegates poll their colleagues and key ACR committees and consult with the ACR Board of Directors on the College’s top priorities. Then they develop and draft resolutions to bring forth for consideration by the larger HOD body.
Dr. Downey
Several members of the ACR’s delegation recently shared their reflections on the importance of this advocacy work and the issues that will be top of mind this fall.
Christina D. Downey, MD, current chair of the Government Affairs Committee, has been an ACR representative for the Young Physician Section of the HOD since 2019. Based on her own observations and discussions with colleagues, Dr. Downey expects that resolutions this fall will coalesce around three topic areas: protecting research funding and access to innovation; stemming dwindling physician reimbursement; and lessening regulatory burdens, such as prior authorizations and appeals.
Dr. Arriens
As a researcher focused on lupus, alternate delegate Cristina Arriens, MD, MSCS, clinical associate professor, Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Okla., is particularly concerned about funding for rare diseases. In general, the uncertainty regarding National Institutes of Health (NIH) grants and other government funding may impede the ability to plan for research projects into the future, she notes.
The Long Game
Gary Bryant, MD, chair of the ACR delegation and professor of medicine (retired), Division of Rheumatic and Autoimmune Diseases, University of Minnesota School of Medicine, Minneapolis, Minn., has been involved with the AMA HOD as an ACR representative since 2003, first as an alternate and then as the delegate starting in 2007. Since 2013, he’s been joined by co-delegate Eileen M. Moynihan, MD, FACP, FACRH. The ACR delegation also includes Luke Barré, MD, a Young Physician Representative, and Colin Edgerton, MD, who serves as an alternate delegate.
Dr. Bryant
Over the years, the ACR delegates have drafted several resolutions and seen some victories along the way that resulted in policy change at the national level. Many of the resolutions advanced by the ACR delegation have sought to address significant issues rheumatologists face that impact patient care and access, such as utilization management tactics like prior authorization, step therapy and other burdensome payer practices.
Just recently, the ACR team authored a resolution to raise the NIH’s indirect 15% cost cap on research grant funding, which was recommended for adoption at the HOD. In 2024, the ACR delegation led an initiative to support Medicaid payment parity for pediatric subspecialists, which was passed by the HOD.
However, “there are real challenges now as far as evidence-based medicine and public health are concerned,” Dr. Bryant notes. In June, the HOD issued emergency resolutions addressing the disbanding of the Centers for Disease Control & Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) and the necessity of separating evidence-based medicine from politics.
The process of crafting messaging to policy makers is “a long-term game,” notes Dr. Downey. “This is not an overnight-success sort of situation. Sometimes our efforts pay off and sometimes they result in a partial win. We need to be very tenacious with our advocacy efforts.”
Strength in Collaboration
“The AMA delegation is great because it’s the whole house of medicine,” Dr. Downey continues. “When we work with different medical specialties and we create coalitions, we find that other cognitive specialists face our issues.”
The ACR delegation has participated in forging multiple coalitions with other specialty societies, Dr. Bryant reports, efforts which have often produced a unified front and resulted in adoption of resolutions by the HOD. “The issues arising from the complexity of healthcare delivery and practice management in the United States dovetail with ensuring appropriate and timely care for our patients,” he says. Issues around medical education and research, too, are common across multiple specialties and produce natural alliances with others.
Dr. Moynihan
Dr. Moynihan points out, “We’ve often looked for partners so that our voice is louder, because if we can persuade the AMA House of Delegates to go along with what we see needs to be done, then they will help support us with financial and legal assistance.” She credits Dr. Bryant’s crucial efforts in forging relationships over the years with other groups. As a result, “coalitions come together a bit more easily since rheumatology has garnered more trust.”
Dr. Moynihan’s work with the AMA has included her election by the AMA’s Board of Trustees to serve as vice co-chair of the Relative Value Update Committee (RUC). Within the ACR, she also chaired the Committee on Rheumatologic Care (CORC) for three years and served on the Board of Directors.
Maintaining Critical Representation
The delegates’ message to their rheumatology colleagues is to ensure that they maintain their AMA membership, because delegate seats are awarded based upon the percentage of specialists who are AMA members.
ACR AMA delegation members. Back row, L to R: Dr. Bryant, Adam Cooper, VP Practice, Advocacy & Quality, Dr. Barré, Dr. Moynihan, Dr. Edgerton. Front row, L to R: Dr. Downey, Dr. Arriens
“The AMA is such an important aspect of advocacy. I would urge everyone, even if they have let their AMA membership lapse, to renew and join back in,” Dr. Arriens says.
Dr. Downey also advises engaging with state medical societies and elected representatives. She’s been involved in advocacy work for her entire career, from participation in the inaugural class of the Advocacy 101 program to her current role as chair of ACR’s Government Affairs Committee. “So much of what we do as physicians is out of our control,” she says. “If we’re in clinical practice, that means that we are abiding by rules and regulations that are set by people who are very unlikely to be physicians. So unless there are physicians who are sharing their perspectives and speaking up about the ways that all of the various rules and regulations impact physicians, someone’s going to be making those decisions for us. And that is less tolerable to me than at least trying to have a say.”
Dr. Arriens adds, “In those moments of frustration, whether it’s dealing with prior authorization or day-to-day clinical care, it’s nice for me to think about what the AMA needs to know about the issue and to be able to channel that energy into something positive.”
Gretchen Henkel is a health and medical journalist based in California.