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Report from the Section Council on Emergency Medicine: Highlights of the AMA Interim Meeting, Nov 2015, Atlanta, GA

515 of 540 Delegates sat for debate on the Monday opening of the House of Delegates (HOD). We were fresh off a Capitol Club luncheon starring a PBS anchor and Fox News reporter about the current state of Presidential Campaigning. Fascinating but impossible to predict seems the result as all known rules don’t seem to apply.

We typically have a 30-minute opening session of the HOD on Sunday morning. Instead, 90 minutes later the House recessed to reference committees after a lengthy exercise in parliamentary procedure referable to a new rule on “A motion to table” which is not debatable. The AMA recently changed its parliamentary resource from Sturgis to the American Institute of Parliamentarians Standard Code of Parliamentary Procedure. With the addition of this rule, it was used to prevent debate on a subject that the HOD did not seem to want to spend time discussing, namely issues related to Planned Parenthood. Arguments ensued about denial of opportunity for a minority to be heard. The House voted about 350 to 109 to table. Part of this plurality was due to the issue and part probably due to angst against the physician who brought the issue, having brought similar issues to the HOD repetitively in the past.

A special reference committee on the Modernized Code of Medical Ethics heard testimony on the latest Council on Ethical and Judicial Affairs (CEJA) effort to modernize the code.  The code was again referred back for further work based on numerous objections. An example is the Code does not allow a physician to participate in assisted suicide. However many states have laws that allow physicians to do so. California law apparently stipulates that the state law will trump the AMA Code of Ethics. But many states do not have this protection.

Unanimous testimony was offered in support of the medical student resolution to remove disincentives and study the use of incentives to increase the national organ donor pool. Misery and disability due to lack of organs is evidenced every day in our practices. The HOD voted first to support a study on use of incentives, including valuable consideration, second to eliminate disincentives and third to remove legal barriers to research investigating the use of incentives.

The HOD voted to support seeking over the counter approval from the FDA for Naloxone and to study ways to expand the access and use of naloxone to prevent opioid-related overdose deaths.

There were resolutions that touched on balance billing and network adequacy as it relates to emergency services. One was reaffirmed as previous AMA policy endorsing fair payment for emergency care. Another was adopted directing the AMA to advocate that health plans be required to document to regulators that they meet requisite standards of network adequacy, including for hospital-based physician specialties at in-network facilities and supporting that insurers pay out-of-network physicians fairly and equitably for emergency and out-of-network bills in a hospital.

There were again multiple resolutions regarding MOC which were referred to the Board for ongoing action reflecting the productive dialogue between ABMS and the AMA/Council on Medical Education. GME was again highlighted as an urgent need for action to expand GME positions to better match the expansion of medical school graduates.

Medical students proposed multiple resolutions regarding the need to address wellness throughout the medical education/practice environment.

As usual, several educational sessions were also held at the AMA. The AMA website summarizes several of those sessions, including:

 

Highlights of the opening session were two. First was a presentation by President Steve Stack to Cal Chaney, an executive recognition award for his outstanding contributions to the AMA and ACEP during his many years as staff of the Section Council on Emergency Medicine.  Second was of course an outstanding address by our AMA President, Steve Stack, a speech interrupted numerous times by thunderous applause.  The Board of Trustees members are uniformly complimentary and appreciative of Steve’s service on the Board and his performance as President.  We are justly proud of him and having an emergency physician as President of the AMA. You can see a synopsis of his speech and hear it at the following link:

http://www.ama-assn.org/ama/ama-wire/post/moments-matter-physicians-must-back-ama-president

ACEP and EMRA were also proud to host a reception for medical students attending the Interim Meeting to mingle and discuss careers in emergency medicine with the medical students. In addition to ACEP’s five delegates and five alternate delegates, the EM footprint in the HOD continues to grow and flourish. 21 emergency physicians serve as HOD delegates or alternate delegates for their state societies. Several others serve in key positions on various councils and sections.  Among those emergency physicians, other interested physicians, medical students and ACEP staff attending one or both of the Section Council on Emergency Medicine meetings were:

Nancy J. Auer, MD, FACEP

Mark Bair, MD

Michael D. Bishop, MD, FACEP

Brooks F. Bock, MD, FACEP

Michael L. Carius, MD, FACEP

Ted Christopher, MD

John Corker, MD

Shamie Das, MD, MPH, MBA

Taylor DesRosiers

Erick Eiting, MD

Stephen K. Epstein, MD, MPP, FACEP

Hilary Fairbrother, MD, MPH

Catherine Ferguson, MD

Gary Figge, MD

Diana Fite, MD, FACEP

Wayne Hardwick, MD

Marilyn Heine, MD, FACEP

David Hexter, MD, FACEP

Rebecca Hierholzer MD

Amy Ho, MD

Tiffany Jackson, MD

Jay Kaplan, MD, FACEP

Gary Katz, MD

Seth M. Kelly

Josh Lesko

Marc Mendelsohn, MD

John C. Moorhead, MD, MS, FACEP

Joshua B. Moskovitz, MD, MPH, FACEP

Richard Nelson, MD

Reid Orth, MD, PhD, MPH

Rebecca B Parker, MD, FACEP

Craig Price, CAE

Alexander M. Rosenau, DO, CPE, FACEP

Matthew Rudy, MD

Sarah Selby, DO

Michael J. Sexton, MD, FACEP

Steven Stack, MD, FACEP

Richard L. Stennes, MD, MBA, FACEP

Ellana Stinson, MD

Arlo Weltge, MD

Gordon Wheeler

Jennifer Wiler, MD, MBA, FACEP

Dean Wilkerson, JD, MBA, CAE

Joseph P. Wood, MD, JD, FACEP, FAAEM

Carlos Zapata, MD

 

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A Review of Obama’s Speech to the AMA

The AMA Section Council on Emergency Medicine

The AMA Section Council on Emergency Medicine

ACEP President Nick Jouriles shares his thoughts on President Obama’s speech to the AMA House of Delegates yesterday

President Obama was warmly received by the physicians at the AMA Annual Meeting earlier today. Like many in the crowd, I went with mixed feelings. Our current system is not sustainable, we all know that. But would he actually speak specifically to some- even one – of the critical issues in emergency medicine today? What are his plans, how will our issues be addressed, and where do we go from here?

For starters, the President told us that he is not trying to create a state run plan. “When you hear the naysayers claim that I’m trying to bring about government-run health care, know this–they are not telling the truth,” Mr. Obama emphasized.

But his plan does have a public component and includes: an emphasis on preventative care, widespread use of electronic health records, and changes in the health insurance industry including a new “exchange” where individuals and businesses can purchase a health plan. That “exchange” includes a government option.

Like many in the audience I was wondering about President Obama’s emphasis on wasteful spending in health care. He does not lay the blame at the foot of physicians, but the constant drumbeat coming from his administration on this issue is unsettling. Can inefficiencies be wrung from the system? Can we streamline some of our processes? Can things be done differently? Yes, yes and yes. But to the tune of hundreds of billions of dollars? I don’t see it. Most emergency physicians don’t see it, and neither will most Americans.

But then, he brought up an issue we can all agree on. I am encouraged that he is open to changes in the medical liability system. That was a position I had not expected from this Administration, and although he does not take a strong position, it is a start. President Obama said, “[W]hile I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.”

Like I said, a start.

We will also have to look long and hard at proposals affecting the physician payment system. In addressing the issue, Mr. Obama said, “We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease.”

How that plays out for emergency medicine will be key, but given our 25 year history with EMTALA, where many hospitals receive extra funds for indigent care while we do not , his emphasis on this is not a good sign.

Finally, it was disappointing not to hear emergency medicine mentioned specifically. We saw how our emergency departments were affected with the “worried well” of H1N1. And the New York Times published my letter to the editor addressing that point. But the White House has hit the mute button for now- or until the next epidemic or natural disaster occurs- regarding the crisis in emergency medicine.

It was a good speech and a good start. It was great to be in the audience. Now it’s time for Congress to get down to business and find solutions that we can all believe in. And time for the nation’s emergency physicians to stand up and make our voice heard. Our patients need us.

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An ACEP Report from the AMA Annual Meeting

Nick Jouriles, MD, FACEP

Nick Jouriles, MD, FACEP

ACEP President Nick Jouriles, MD, FACEP, is at the AMA Annual Meeting in Chicago and sends this report:

First, let me congratulate Jennifer Wiler, MD, MBA, the former EMRA Speaker was just elected Chair of the AMA Women Physicians Congress. Great job, Dr. Wiler, and a well deserved honor.

In addition to the work being done by Dr. Wiler, members of ACEP’s AMA Section Council continue their outstanding representation of emergency medicine at the AMA House of Delegates meeting, where final voting on a number of resolutions important to emergency medicine will occur later in the week. Congratulations to Section Council Chair John Moorhead, MD, FACEP our other Section Council Members and staff liaison Cal Chaney for their efforts.

AMA President Dr. Nancy Neilson has been very impressive. During her speech at Saturday’s Opening Session, Dr. Nielsen compared the moment at hand for America’s physicians—the nationwide debate about health care reform—to one of the greatest in the country’s history, D-Day. “We now have the best, and maybe last, chance in a generation to build [a] bridge,” Dr. Nielsen said. “This is our profession’s D-Day.”

The speech got a standing ovation from the crowd. How appropriate that Dr. Neilson compared our task to D-Day. Our nation’s Commander-in-Chief, President Barack Obama, will be speaking the House of Delegates on Monday morning and asking America’s physicians to support his plans for health care reform. ACEP member response to the speech will be posted later that day.

After his presentation, President Obama will meet privately with the AMA Board of Trustees, which includes three ACEP members. We are living in interesting times and I’m hopeful for emergency medicine.

Here are some specifics on resolutions being considered at the meeting that are of interest to emergency medicine:

CMS Report 3-A-09: Emergency Department Boarding and Crowding, and Resolution 719: Decreasing Emergency Department Overcrowding, received unanimous support from witnesses at the reference committee.

Two ACEP leaders, Linda Lawrence, MD, FACEP and Stephen Epstein, MD, FACEP were among those who testified. Dr. Epstein urged the reference committee to accept an amendment calling for House of Delegates support for enactment of the Access to Emergency Medical Services Act and for its inclusion in federal health care reform proposal.

Next Steps: The Reference Committee will issue its report/recommendations tomorrow with House of Delegates action to follow. House of Delegate adoption of the resolution (especially if amended per Dr. Epstein’s suggestion) would constitute official AMA endorsement of the Access Act. Stay tuned

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