ACS delegation influences AMA policy at HOD meeting
The American Medical Association (AMA) annual House of Delegates (HOD) meeting took place June 10–14, in Chicago, IL. The agenda included 62 reports from the AMA board and councils and 186 resolutions from state medical associations, specialty societies, and AMA sections.
The uncertain mood of the HOD was shaped by congressional activity on the Affordable Care Act and a competitive election for AMA president-elect. At the start of the meeting’s final day, the HOD paused to remember the lives lost and changed one year earlier at the Pulse nightclub in Orlando, FL. The HOD also noted the value of American College of Surgeons (ACS) Stop the Bleed® training in response to the shooting June 14 at the Republican congressional baseball team practice in Alexandria, VA.
In the AMA House of Delegates, which is composed of 545 members, the College was represented by its six-member delegation.
The meeting has eight reference committees that focus on the following issues: bylaws and medical ethics, health care system, legislation, medical education, public health, medical science and technology, governance, and medical practice. John H. Armstrong, MD, FACS, co-author of this article, chaired Reference Committee A, which reviewed items pertaining to the health care system. This article provides an overview of several issues of relevance to ACS members.
Medical education
The priority issue for the ACS at this meeting was protecting the profession’s autonomy in defining the standards of lifelong learning through Maintenance of Certification (MOC). Five items related to MOC and Continuing Medical Education (CME) resulted in considerable debate. Internists and medical specialists were particularly frustrated by their experiences with their certifying boards. While acknowledging opportunities to improve MOC, the College delegation took the lead in collaborating with other specialty and state societies to argue against referring MOC to the state legislatures and in creating a new solely CME-based certification system.
• Council on Medical Education Report 2, Update on Maintenance of Certification and Osteopathic Continuous Certification, provided an overview of board-specific MOC innovations that increase relevance and reduce cost. The report was amended to have the AMA advocate that physicians who participate in programs related to quality improvement and/or patient safety should receive credit for MOC Part IV.
• Resolution 302, Comprehensive Review of CME Process, directed the AMA, in collaboration with the Accreditation Council for Continuing Medical Education, to conduct a comprehensive review of the CME process on a national level, with the goal of decreasing costs and simplifying the process of providing CME.
• Resolution 316, Action Steps Regarding Maintenance of Certification, sponsored by the largest state delegations in the HOD (Arizona, California, Florida, Georgia, New York, Pennsylvania, and Texas), sought to extend AMA model state legislation against MOC by barring hospitals, health care insurers, and state licensing boards from linking nonparticipation in the American Board of Medical Specialties (ABMS) MOC process to exclusion from credentialing. Further, it sought to create AMA policy that would replace MOC with high-quality CME under the purview of a physician’s specialty society solely as the demonstration of lifelong learning in hospital, insurance, and licensing credentialing. The HOD conversation shifted from restricting how hospitals, licensing boards, and insurers can use MOC, to redefining MOC.
To address this challenge to professional autonomy while emphasizing the need for responsiveness to concerns across boards, the ACS Delegation applied a strategy that involved prepared talking points; caucus presentations by ACS Executive Director David B. Hoyt, MD, FACS, and Dr. Armstrong; reference committee testimony from Dr. Hoyt and Vice-Chair of the ACS Board of Regents Leigh A. Neumayer, MD, FACS, and ACS Regent James Denneny, MD, FACS, executive director, American Academy of Otolaryngology-Head and Neck Surgery; as well as hallway conversations and HOD floor discussion. As a result, the AMA affirmed that lifelong learning is a fundamental obligation of the profession and recognizes that, for a physician, it is best achieved through ongoing participation in a program of high-quality CME appropriate to the physician’s medical practice as determined by the relevant specialty society. The concept of the AMA lobbying hospital associations, health care insurers, and state licensing boards to not use the ABMS-sponsored MOC process with lifelong interval high stakes testing for credentialing, in addition to the idea of the AMA partnering with state medical associations and specialty societies to undertake a study to establish a separate program of certification by 2020, were referred for further consideration. The ACS will continue to emphasize that a core element of professionalism is self-regulation of lifelong learning through standard-setting.
• Resolution 318, Oppose Direct-to-Consumer Advertising of the ABMS MOC Product, asked the AMA to oppose direct-to-consumer marketing of the ABMS MOC product in print media, social media, apps, and websites that specifically target patients and their families, including but not limited to the promotion of false or misleading claims linking MOC participation with improved patient health outcomes and experiences where limited evidence exists. This item was referred for further study.
• Resolution 319, Public Access to Initial Board Certification Status of Time-Limited ABMS Diplomates, was adopted. The AMA now advocates that the initial certification status of time-limited diplomates be listed and publicly available on all ABMS and ABMS member board websites and physician certification databases and that the names and initial certification status of time-limited diplomates remain on ABMS and ABMS member board websites or physician certification databases, even if the diplomate opts out of MOC participation.
