The annual American Medical Association (AMA) House of Delegates (HOD) meeting is another of the countless in-person meetings to be canceled in the wake of COVID-19. In lieu of the five-day June meeting, the AMA has scheduled a two-hour business call this summer and may expand the interim meeting in November to allow for policymaking discussions.
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“Just like the rest of society, [the AMA is experiencing] some delay in moving forward, but it doesn’t put a stop to the considerable efforts,” says Gary Bryant, MD, MACR, who has been a delegate for ACR since 2007 and before that served as an alternate delegate from 2003–2006. “Just as ACR has continued to advocate for our issues, the AMA does as well.”
The ACR’s delegates stand ready to promote the College’s priorities, which include ongoing efforts to create rules around step therapy, prior authorization, reimbursement and pharmacy benefit manager (PBM) transparency. Newer topics include workforce issues and telehealth.
House of Delegates
The ACR has had a presence at the AMA HOD meeting since 1987, just one year after the ACR split from the Arthritis Foundation to form a discrete society. This presence is important because of the AMA’s influence in Washington, D.C.
“AMA membership allows the ACR to leverage the size, respect and advocacy resources of the AMA for rheumatologists,” says Colin Edgerton, MD, FACP, RhMSUS, chair of the ACR’s Committee on Rheumatologic Care (CORC) and alternate delegate to the AMA HOD. “In essence, the AMA is an amplifier or loudspeaker for the ACR and, consequently, for rheumatologists.”
In its early years, the ACR had just one delegate in the HOD; it now has two, based on the number of ACR members who are also AMA members. To help ensure the ACR keeps its seats and the associated benefits, ACR members need to join the AMA or renew their membership, says Eileen Moynihan, MD, MACR, ACR delegate. By joining the AMA, ACR members help ensure that rheumatology practice issues are represented in national policymaking efforts.
The ACR delegation’s intended agenda for the AMA HOD June meeting included several ongoing ACR priorities, such as prior authorization and PBM transparency, although changes to the landscape since the COVID-19 pandemic have raised newer issues as well.
“This is one of those inflection points in America, and [the country and medicine are] never going to be the same as [they were],” Dr. Bryant says. “In medicine, the biggest disruption will be the expansion of telehealth.”
The expansion of telehealth during the pandemic has highlighted some challenges, such as reimbursement rates and integration with electronic medical records. Although these issues need to be discussed and resolved, it is likely that telehealth use will never return to pre-COVID-19 levels.
“Telehealth may help us with our workforce issues,” Dr. Moynihan says, adding that this is another topic of interest for advocacy efforts. The decreasing number of practicing rheumatologists is becoming a growing concern, especially as the number of patients increases. Not only are U.S. physicians retiring in greater numbers, but foreign physicians have a harder time obtaining visas to train or practice in the U.S. as a result of revised U.S. immigration policies.
“Those [workforce issues] have been discussed at the House of Delegates,” Dr. Bryant says.
All topics brought to the AMA HOD reflect current ACR advocacy priorities as approved by the board of directors and build on the efforts of the various committees, such as the CORC, the Government Affairs Committee and the Committee on Education. The ACR delegation’s recent efforts have successfully advanced key rheumatology issues, including PBM transparency, step therapy and prior authorization, which have become part of AMA policy and its advocacy agenda.
Kimberly Retzlaff is a freelance medical journalist based in Denver.