American Medical Association House of Delegates Meets In-Person; ACR Successfully Advances New Policies

After two years of special virtual meetings, the American Medical Association (AMA) House of Delegates met in person for its Annual Meeting on June 10–15, 2022. Over 3,000 delegates, staff and guests attended the meeting in Chicago. Following two years of narrowly focused resolutions to adapt to the virtual setting, the in-person meeting allowed for debate of backlogged resolutions, including an ACR-led resolution on Medicare Administrative Contractors (MACs) policy processes (Resolution 254).

The opening session kicked off on Friday, June 10, with a reflection from AMA Executive Vice President and CEO James L. Madara, MD, on the AMA’s progress in its 175-year history and its response to the pandemic. Following a celebration of AMA’s history, AMA President Gerald E. Harmon, MD, unveiled a recovery plan for American physicians that includes improving prior authorization, supporting telehealth, reducing physician burnout and reforming Medicare reimbursement.

Working with Partners to Advance Rheumatology Issues

Following the opening session, reference committees heard testimony on various resolutions, including two resolutions co-led by the ACR: Resolution 223 on drug shortages of saline, lidocaine and iodinated contrast media and Resolution 519 on funding for the Advanced Research Projects Agency for Health (ARPA-H).

Led with colleagues at the American Academy of Dermatology, Resolution 223 called on the AMA to work with national specialties and other stakeholders to advocate that the Food & Drug Administration (FDA) take immediate action to alleviate the shortage of lidocaine, saline and iodinated contrast media.

Resolution 519, co-led with the Association for Clinical Oncology, called for the AMA to advocate that Congress and the Biden administration provide robust baseline funding increases for ARPA-H as well as to other research institutions and centers, including the National Institutes of Health.

Both resolutions were adopted by the full House of Delegates and are now implemented into policy of the AMA.

ACR Leads Resolution on MAC Policy Processes

In recent years, the ACR and other organizations in the rheumatology community, along with other specialty societies, have voiced deep concerns regarding the lack of transparent policies in the development of local coverage determinations (LCDs) and the inappropriate use of Local Coverage Articles (LCAs) to advance policy and impact access rather than simply to correct technical discrepancies or provide billing instructions. Considering these concerns, the ACR authored Resolution 254, titled Stakeholder Engagement in Medicare Administrative Contractor Policy Processes. The resolution was first introduced at the AMA’s virtual Interim Meeting in November 2021, and language was adopted during this June Annual Meeting to include the following actions:

• The AMA officially opposes MACs using LCAs that could have the effect of restricting coverage or access without providing data and evidentiary review or without issuing associated LCDs and following required stakeholder processes.
• The AMA will advocate and work with the Centers for Medicare & Medicaid Services (CMS) to improve the instructions to MACs regarding development of local coverage policies in such a manner as to prevent LCAs that could have the effect of restricting coverage or access from being adopted without the MAC providing public data, decision criteria and evidentiary review and allowing comment, or without an associated LCD and the required LCD stakeholder review and input process.
• The AMA will work with specialty and state medical societies and other interested stakeholders to identify LCAs that potentially restrict coverage or access and that were issued without the MACs providing opportunities for stakeholder input, public data, decision criteria and evidentiary review and will advocate that CMS require MACs to revise the policies by taking any such proposed changes through an appropriate stakeholder engagement, public data and evidentiary review.

The AMA House of Delegates meetings are significant policy-making endeavors intended to ensure AMA policy and the AMA advocacy agenda reflect the concerns of physician members, including rheumatologists. The ACR’s delegation to the AMA House of Delegates is instrumental to ensuring inclusion of the issues and concerns of rheumatologists and rheumatology professionals in broader conversations about the future of healthcare and the practice of medicine. The ACR thanks members of its delegation to the AMA House of Delegates, who voice the concerns and challenges of rheumatology professionals within the AMA: Gary Bryant, MD (delegate and delegation chair), Eileen Moynihan, MD (delegate), Cristina Arriens, MD (alternate delegate), Colin Edgerton, MD (alternate delegate), Luke Barre, MD (Young Physician Section representative), Christina Downey, MD (Young Physician Section representative), and Rami Diab, MD (Resident and Fellows Section representative).

Rheumatology’s voice and our seats at the AMA table are literally on the line during 2022, because the ACR’s five-year membership review is underway with the AMA House of Delegates. We ask all ACR members to pitch in now and join the AMA to ensure rheumatology can continue to be heard in these discussions and processes.