AMA House of Delegates 2018 Annual Meeting Recap

On June 8–13, the AMA House of Delegates (HOD) came together in Chicago for its 2018 Annual Meeting. With the recent change in apportionment of geographic and specialty delegates now equal to each other, more than 600 members of the HOD were present, with several hundred staff and attendees from the AMA and other medical associations.

Resolutions 523 & 225
The ACR delegation submitted one resolution and co-sponsored a second. Both were based on ACR priorities set forth by respective committees and endorsed by the Board of Directors. Resolution 523, for which the ACR garnered an additional nine specialty society cosponsors, asked that the AMA support the pathway for demonstrating biosimilar interchangeability that was proposed in draft guidance by the FDA in 2017; the FDA requires studies that alternate between the reference product and proposed interchangeable biosimilar to ensure interchanging the drugs does not affect the efficacy or patient safety. Second, Resolution 523 proposed the AMA ask the FDA to finalize this guidance to allow manufacturers to move forward with these studies and, hopefully, hasten more products to market and lower costs. The result: Our resolution was passed with a single-word amendment and is now AMA policy.

The ACR’s delegation co-sponsored Resolution 225, which was written by the American Society of Clinical Oncology (ASCO), regarding the impact of pharmacy benefit managers (PBMs) on patients. This resolution asked the AMA to gather more data to assess PBM tactics and impact on timely access to medications, outcomes and the patient–physician relationship. The result: This resolution was passed with amendments by the HOD with other data-gathering tactics, rather than a membership survey, and an additional resolution asking the AMA to request data from PBMs regarding their top 25 medication precertification requests and the percent approved after physician challenge.

Other Key Issues
Because a record number of reports and resolutions were considered at this meeting, our delegation used a grid to identify the issues that most affect our specialty and patients in order to focus our efforts. These are commented upon before the meeting by various ACR committees for their input. Following are some of the important issues commented on or tracked by our delegation:

• Regarding a resolution dealing with controversy over the efficacy of hyaluronic injections, the HOD reaffirmed policy that allows physicians to vary from practice guidelines based on the needs of individual patients, and states that payment decisions should not be based on these guidelines.
• A substitute resolution directed the AMA support efforts to reduce laboratory benefit managers’ policies that delay patient care, reduce access or increase costs, and preclude conflicts of interest from payers.
• A comprehensive report dealing with Maintenance of Certification (MOC) from the Council on Medical Education was approved. Pertinent to current ACR activities in this area, it asks the AMA to continue to work with boards that have not yet moved to a process improving or replacing the high stakes exam, and to engage with the ABMS Continuing Board Certification Vision for the Future Commission. I again attended a forum sponsored by the Pennsylvania Medical Society that highlighted data from a recent voluntary survey of more than 7,000 U.S. physicians from all states and specialties. This showed significant continuing concern over the efficacy of MOC, its costs, its impact on burnout and the physician workforce.
• A separate resolution asking that the Part 4 QI activities for MOC required by several of the boards, but currently on hold by American Board of Internal Medicine (ABIM) be abolished was referred for further study.
• Regarding the workforce, a resolution passed asking that the AMA continue to push for expansion of graduate medical education slots to match the increasing number of medical school graduates; this would hopefully lead to more fellowship slots in rheumatology.

Topics of Debate
A considerable amount of debate surrounded topics at the intersection of the medical community and our society. These included the serious public health issue of firearm violence in our country and the ways this could be affected; a report from the Council on Ethical and Judicial Affairs regarding physician aid in dying that was returned to the council for further study; and the effects of corporate investors, including private equity firms, on the healthcare marketplace. There has been significant impact on several specialties in recent years, including dermatology, radiation oncology and ophthalmology.

Physician Health
One theme that ran across multiple aspects of the meeting, including the opinions of those standing for election to the Board of Trustees or various councils, was concern over physician health and burnout. Although the AMA is active in many areas that affect this, such as around electronic medical records, prior authorization and other red tape issues, it was agreed that more needs to be done.

Gary Bryant, MD, FACR, is chair of the ACR’s delegation to the AMA House of Delegates.