Opioids to Transgender: AMA Agenda Promises Heated Debate

http://www.medpagetoday.com/MeetingCoverage/AMA/58434?xid=nl_mpt_DHE_2016-06-11&eun=g578717d0r

CHICAGO — The American Medical Association will open its annual House of Delegates meeting here Saturday and its agenda highlights many of the same issues that have been grabbing national headlines — transgender rights, Medicare, the Zika virus, and safe treatment of pain.

Those issues come before the House in a series of reports and resolutions, all of which must be discussed, debated, and finally voted upon before they become AMA policy.

The planned “Part B experiment” by Medicare may be this year’s hottest-button issue and the oncology community continues to be way out in front leading the opposition to the plan that would change — read reduce — the way Medicare handles drug payments under Part B. This proposal has been burning up the halls of Congress and expect it to have the same effect here.

Not surprisingly the AMA has a full plate of resolutions asking it to use its political muscle to get Congress to free up funds for Zika prevention and treatment, so it is likely that the AMA will soon be instructing its lobbyists to take up that fight — but first its House of Delegates must vote to approve that instruction.

There are also a slew of resolutions aimed at guaranteeing access to medical care for lesbian, gay and transgender individuals including one that asks the AMA to support “public and private health insurance coverage for treatment of gender dysphoria as recommended by the patient’s physician.”

The use of opioids and the treatment of pain will also be a focus here as the delegates consider proposals that suggest eliminating the use of pain as “the fifth vital sign” along with resolutions asking the AMA to push the CDC to soften its position on the use of opioids for chronic pain to permit wider prescribing for nursing home patients.

The AMA is once again considering ways to adjust the size of its big tent — how to keep its often unwieldy House of Delegates to a reasonable size and still guarantee its “one doc, one vote” representational stance.

For years the AMA restricted specialty societies to a single delegate regardless of the size of the society, but at the same time states were allotted votes (delegates) based on the number of AMA members from that state.

Beginning in the 1990s the AMA initiated several rule changes with the goal of offering specialty societies votes based on a scheme in which AMA members could designate a specialty as his or her designated “specialty ballot” in the House. That plan improved specialty representation, but, according to the AMA Board of Trustees, the designated ballot system has not achieved the goal of true representation. One reason it hasn’t worked is that many physicians belong to two or more specialty organizations.

As a result, the AMA’s board is again asking the House to revamp the rules for specialty representation but this time it is using a set formula that allots one delegate per 1,000 AMA members belonging to a specialty society and then it reduces that number by 25%, a fudge factor to account for multiple memberships.

If the House adopts this latest resizing, it will boost the number of specialty delegates from 220 to 225 in 2017. Most specialties won’t experience a big difference, but the American Academy of Family Physicians, which seats 18 delegates and is the largest specialty delegation in the House, would lose five delegates. By contrast, the American College of Physicians would increase its vote clout from 13 to 17, and the American College of Surgeons would jump from six to 10.

Filed under: General Problems