This year’s Annual AMA meeting was held at the Hyatt Regency Chicago from Saturday, June 15 through Wednesday, June 19. As usual, the Hand Surgery Caucus met on Saturday afternoon following opening ceremonies of the House of Delegates to discuss matters of interest to the hand, orthopaedic and plastic surgery communities. The purpose of the deliberations is to build consensus and then work with our respective state and specialty delegations to leverage our influence on the floor of the House.
Among items discussed at the Hand Caucus were:
- Voting for the President Elect and other selected AMA offices: The caucus was divided in its preference for President-elect (Joe Annis, M.D. an anesthesiologist from Texas was favored for his people and communication skills, but Robert Wah, M.D., an obstetrician-gynecologist from D.C., was favored for his administrative abilities and legislative experience. Dr. Wah ended up winning the general election by 18 votes. The Caucus had no controversy in supporting the successful re-election bid of Andy Gurman, M.D., a member of the Hand Caucus, for House Speaker, and Susan Baily, M.D., from Fort Worth Texas, as Vice Speaker. The Caucus also supported the successful re-election bid of David Barbe, M.D. to the AMA Board of Directors (and to his pre-ordained position as the new BOD Chairman).
- The status of the AMA Interim meeting: The Hand Caucus had previously come out in favor of either eliminating the interim meeting or turning it into a much smaller-scale advocacy-only meeting to be held in Washington DC. This year the AMA BOD recommended eliminating the meeting completely, and the Hand Caucus agreed. After a very spirited debate on the floor of the House, the delegates voted to continue the interim meeting in its current format.
- The status of Maintenance of Certification as well as the recertification process, itself. Many delegations at the AMA have been infuriated at what they feel is an unregulated and overly proscriptive process for maintenance of certification and recertification. This year a slew of resolutions were submitted, calling on the AMA to oppose or at least curtail the current onslaught of rules and mandates. The Hand Caucus shares the concerns of these delegations but feels that it is fruitless to oppose them too vigorously because they are supported by the legislature, industry and the public-at-large. In addition, if done properly using evidence-based methodology, a judiciously executed MOC process is likely to benefit the quality of health care delivered as well as assuring the public that the profession is regulating itself. In conclusion, the Caucus supported resolutions calling for judicious implementation with careful oversight of the process but not appearing opposed to the concept. After lengthy and spirited debate on the floor of the House, the final wording of the AMA resolution was very strongly opposed to the entire process as it is now being implemented.
As in past years, members of the Hand Caucus represent hand surgeons from various states and societies and wield far greater influence at the meeting than our small numbers would indicate. This year, our members (not all of whom could attend the caucus) participated on several reference committees and held several key committee and section leadership positions. We are very pleased that one of our members, Dr. Andy Gurman, is the House Speaker and also a key member of the AMA BOD.
Other issues of interest to hand surgeons along with actions taken at the HOD:
- Maintaining Public safety and Trust in Medicine: Basically, this issue has to do with truth in advertising by physicians. The vote of the HOD was essentially to support previous AMA policy that states that the AMA encourages and assists all physicians and medical societies to monitor and report to the appropriate state and federal agencies any health care advertising for which there is a reasonable, good-faith basis for believing that said advertising is false and/or deceptive.
- Performance of surgical procedures by non-physicians: This issue most directly refers to the performance of pain management procedures. The vote of the HOD reflects that, while invasive pain management procedures require physician-level training, certain technical aspects of invasive pain management procedures may be delegated to appropriately trained, licensed or certified, credentialed non-physicians under direct and/or personal supervision of a physician who possesses appropriate training and privileges in the performance of the procedure being supervised. All in compliance with local, state, and federal regulations.
- Virtual Reference Committees (VRS’s) in the HOD: The debate in the house was over the value of the pilot VRCs and whether the practice of a preliminary reference committee report based on VRC testimony was of value. Again, following a spirited debate, it was decided that the preliminary report should only summarize the comments made by the AMA membership, but the report should not be used as a template for the final reference committee reports as they were in several instances this year.
- Radiation exposure registry: This resolution encouraged the AMA to establish registries with appropriate medical societies to study radiation exposure to patients in various treatment settings. The vote on the floor was to support effective policies already in place to accomplish this.
- Value Based Insurance Design. (VBID): The AMA Council on Medical Services report 02 recommended the use of value-based insurance design (VBID) to increase cost-sharing among patients and increase the use of value-heavy health care. The AAOS section council noted that a recent example of assessing the value of THA and TKA in Oregon’s VBID program assigned higher co-pays to the procedures because of their lower perceived value and that this conflicts with findings from the AAOS’s own study on the Social and Economic Value of Orthopaedic Surgery. The ortho group therefore recommended that VBID programs should only be used in pilots with close monitoring of outcome until their ability to improve value is established in real-world practice for specific clinical conditions. On the floor of the HOD, the following addendum to the CME report was passed: Practicing physicians must be actively involved in the development of VBID programs. VBID program design related to specific medical/surgical conditions must involve appropriate specialists.
- Several other resolutions were passed or reaffirmed in support of better medical practice and patient access to care including independent physician contracting with Medicare patients for various services, replacement of the flawed SGR reimbursement formula, repeal of the ACA’s IPAB payment review process, etc. The full slate of resolutions, reports and HOD action can be found on the AMA website.
Once again, the members of your Hand Surgery delegations thank the governance of the ASSH and AAHS for permitting us to represent our specialty and its interests at the AMA HOD. We continue to strongly endorse the work of the AMA in representing the physicians of all specialties on a national level. This year was a milestone for the AMA because it noted for the first time in many years a growth in membership numbers in all categories. We feel that it is only through the strength in numbers that our voices will be heard above the throng of opinions being distributed in congress and throughout the many regulatory agencies.
In addition, we feel strongly that the new AMA strategic focus on 1) improving access to healthcare for all Americans, 2) changing and modernizing the way we educate the medical profession, and 3) advocating for physicians and their patients across the nation, will surely resonate with most doctors and the American public. To this end we recommend that the ASSH and the AAHS continue to actively encourage maximum AMA participation by all of our members.
David M. Lichtman, MD
Peter C. Amadio, MD
J. Stewart Haskin
ASSH Alternate Delegate
Nicholas B. Vedder, MD
AAHS Alternate Delegate
Desirae M. McKee, MD
ASSH Young Member Delegate