AMA Interim Meeting 2016 Report from the Society’s Delegate, Dr. Tangalos

The American Medical Association (AMA) interim meeting is devoted to advocacy. It remains a much-abbreviated meeting from the annual event held every June in Chicago. The Society had no resolutions to present at the recent interim meeting, held in Orlando, FL, but a number of issues were of interest.

The Reference Committee on Medical Service had the most packed agenda and drew the most attention. It also had a number of resolutions for which the Society has existing policy. One that garnered additional discussion before the full House was on health care while incarcerated. State Medicaid benefits are uniformly suspended during incarceration and often are not reinstated in a timely fashion when a prison or jail term ends. Health care lapses thus occur. The AMA will now support partnerships and information sharing between correctional systems, community health systems, and state insurance programs to provide access to a continuum of health care services for those who are incarcerated.

The AMA has taken up the issue of concurrent care for both hospice and palliative care. Though not at all settled, the discussion was about earlier entry into palliative care with more smooth transitions to hospice care. There was also an excellent report on making hospital discharge summaries and communication to the receiving health care provider more meaningful.

The Society also has an interest in the Annual Wellness Visit and how patients are attributed to a practice. There is a growing trend for retail practices to perform this service with no intention to follow the patient or create a plan of care. This was never the intension of the legislation and the AMA will continue to advocate that the Annual Wellness Visit is a building block to the primary care experience.

Another policy recommendation of particular interest to Society members came from Kentucky, requiring pharmacies to document discontinuing medications just as they document a prescription fill. You and I may sign an order for a drug discontinuation but because of a $0.45 cost to fill and another $0.45 cost to discontinue a drug at the pharmacy, this software function is not often used. It is why we end up confronted with prescription refills long after discontinuation leading to abuse and misadventure.

Emergency Trauma Units are also experiencing Centers for Medicare & Medicaid Services (CMS) mandates that we in post-acute and long-term care have long experienced. The current issue involves the mandate to treat sepsis with Ringer’s lactate and the mandate to measure serum lactate rather than pro-calcitonin.

Very little was addressed at this meeting regarding the Merit-Based Incentive Payment System (MIPS) and the Medicare Access and Chip Reauthorization Act of 2015 (MACRA). What did come up as new business was to advocate the exemption of small private practices from these rules as they are being forced out of existence by these requirements. Finally, the Council on Ethical and Judicial Affairs further addressed the Society’s interest in collaborative care in a new report with eight policy implications. The upshot being support of all the principles we already endorse. The only debate on the subject was on the definition of “ethical” leadership and a further call that a physician-led collaborative model needs even more clarity.

-Eric G. Tangalos, MD, FACP, AGSF, CME