November 15, 2017

HONOLULU – The American Medical Association (AMA), the premier national physician organization in the country, voted to adopt new policies on emerging health care topics during the voting session of its Interim Meeting.

The AMA’s House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, medical students and residents representing every state and medical field. Delegates work in a democratic process to create a national physician consensus on emerging issues in public health, science, ethics, business and government to continually provide safer, higher quality and more efficient care for patients and communities.

The policies adopted by the House of Delegates include:

ICE Agents In Medical Facilities
Weeks after Immigration and Customs Enforcement (ICE) agents in Texas took into custody a 10-year-old girl with cerebral palsy shortly after she was discharged from a hospital where she just had surgery,

the American Medical Association voted to oppose the presence of ICE enforcement at health care facilities. ICE policy states that enforcement actions, including interviews, searches, apprehensions, or arrests, should not occur at sensitive locations, including healthcare facilities and medical treatment centers.
“Our patients should not fear that entering a hospital will result in arrests or deportation. In medical facilities, patients and families should be focused on recovery and their health, not the ramifications of their immigration status,” said Andrew W. Gurman, MD, Immediate Past President of the AMA.
Support for Communication and Resolution Program

The AMA expressed its support for communication and resolution programs as an option to settle disputes before litigation. Many studies show these types of programs are effective way to learn from medical errors and near misses, enhance patient safety and improve the liability system.

“A structured communication and resolution program can help identify necessary patient safety improvements while also improving communication with patients without a resulting increase in litigation. The programs help foster a culture of safety and transparency in a blame-free environment rather than the confrontational litigation route,” said Carl A. Sirio, MD, a member of the AMA Board of Trustees.

Treating Opioid Use Disorder in Correctional Facilities

As part of its ongoing effort to end the nation’s opioid epidemic, the AMA adopted new policy today affirming that, while in correctional facilities, patients with opioid use disorder should have access to evidence-based treatment, including initiation and continuation of medication assisted treatment, as well as counseling. In addition, when people are released from prison, they should have access to providers so they can access treatment plans for opioid use disorder, including education, medication for addiction treatment and medication for preventing overdose deaths.

“Patients with opioid use disorder should not have their treatment interrupted once they enter prison. Access to evidence-based care is crucial to treatment, no matter what the setting,” said Patrice A. Harris, M.D., chair of the AMA Opioid Task Force and immediate past chair of the Board of Trustees.

Confronting Health Insurer Business Practices That Can Delay Patient Treatment

Health insurers bear responsibility when they systematically impose bottom-line business practices over accepted medical guidelines that result is an unfair devaluation or denial of legitimate physician services.

In the latest example, Anthem Blue Cross recently notified physicians in several states that effective on January 1, 2018 it would change company policy and reduce reimbursement for valid evaluation and management (E/M) services provided to patients. The change would routinely and automatically deny E/M services and procedures that are reported the health insurer under specific circumstances that require a designated code known as modifier-25.

In simpler terms, modifier -25 is reported on a medical claim when a physician evaluates, manages, and treats a patient for separate and distinct health care problems during the same visit. That work takes additional physician time and resources and should be reimbursed.  However, health insurers frequently ignore modifier –25 and reimburse for just one service – typically the service with the lowest cost.

“The AMA will work aggressively to prevent implementation of unfair health insurer rules  that are detrimental to physicians who are trying to practice medicine according to the needs of their patients.” said AMA President David O. Barbe, M.D., M.H.A. “Health insurers that deny E/M services associated with procedures performed on the same day are needlessly forcing patients into multiple visits and delaying the provision of necessary care.”

In response, physicians at the AMA Interim Meeting adopted policy to “aggressively and immediately advocate through any legal means possible, including direct payer negotiations, regulations, legislation, or litigation, to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.”

Backing Paid Leave for Organ Donors

To ease the financial burden on organ donors, the AMA approved new policy to encourage paid leave for those making organ donations. Studies have shown that direct costs to living organ donors are greater than one month’s wage for 76 percent of donors, and many donors do not have sufficient medical leave and/or vacation time to accommodate their recovery.

“Living organ donors make a tremendous, brave sacrifice and often require more recovery time than employers provide. Our hope is that employers will take this selflessness into account and formulate policies that allow men and women to be living organ donors without taking a financial hit for doing so,” said S. Bobby Mukkamala, M.D., a member of the AMA Board of Trustees.

Emergency Medicaid Funding and Assistance for Puerto Rico

With the Caribbean battered by Hurricane Irma and still dealing with its repercussions, the AMA will urge the federal government to help Puerto Rico and the U.S. Virgin Islands’ recovery by adequately funding their Medicaid program.

“Increased federal funding for Puerto Rico and the U.S. Virgin Islands’ Medicaid programs would provide support for the medical and public health needs of their residents and would help provide needed care and restore access to health care services,” said Russell W.H. Kridel, MD, a member of the AMA Board of Trustees.

Need for Cervical Cancer Screening in Female-to-Male Transgender Patients

Although routine cervical screening has been shown to greatly reduce the incidence of new cervical cancers, as well as death from the disease, sexual and gender minority individuals may be less likely to undergo regular cancer and sexually transmitted infection screenings based on anatomy, despite their comparable or elevated risk for these conditions. To improve screening and health outcomes among sex and gender minority patients, the AMA House of Delegates approved policy to better educate physicians about the need for regular cancer screening and sexually transmitted infection screening among this population.

“Sexual and gender minority patients may be unaware of the risks they face and the screening that could lower their risk of cervical cancer,” said Ryan Ribeira, M.D., MPH. “Equipping our physicians with the knowledge and tools necessary to fight this disease and treat this vulnerable population will reduce the incidence of cervical cancer and sexually transmitted infections and save lives.”

Reducing Health Issues Associated with Births

With at least one in seven women experiencing anxiety or depression during pregnancy or in the first year after childbirth and 65,000 U.S. women having serious health complications from pregnancy-related causes, the American Medical Association adopted new policies to encourage a routine protocol that would include depression screening in pregnant and postpartum women. The AMA also will advocate for state and federal legislation that would establish Maternal Mortality Review Committees to analyze the circumstances surrounding deaths that occur during pregnancy or within the first year after childbirth.

“As attention is turned toward the newborn, the health and wellbeing of the mother can, unfortunately, take a back seat, even as preventable physical and mental issues pose dangers. We need to recognize that dangers of post-partum depression and recognize that pregnancy-related deaths have been increasing,” said Albert J. Osbahr III, MD, a member of the AMA Board of Trustees.


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