Society Active at the AMA’s 2019 House of Delegates: Report

Last week, first-time Society delegates Wayne Saltsman, MD, PhD, CMD, and Walter Lin, MD, MBA, attended the American Medical Association (AMA) House of Delegates meeting in Chicago, IL. The Society tracked and reviewed hundreds of resolutions submitted by state and specialty societies dealing with a variety of top policy issues. While the Society did not submit any resolutions for this year’s meeting, there were many that we monitored closely.

The American Association Geriatric Physiatry (AAGP) introduced resolution 708, “Access to Psychiatric Treatment in Long-Term Care.” The original resolution read:

RESOLVED, That our American Medical Association ask the Centers for Medicare and Medicaid Services (CMS) to acknowledge that psychotropic medications can be an appropriate long-term care treatment for patients with chronic mental illness (Directive to Take Action); and be it further

RESOLVED, That our AMA ask CMS to discontinue the use of psychotropic medication as a factor contributing to the Nursing Home Compare rankings, unless the data utilized is limited to medically inappropriate administration of these medications (Directive to Take Action); and be it further

RESOLVED, That our AMA ask the CMS to acknowledge that antipsychotic medication can be an appropriate treatment for dementia-related psychosis if non-pharmacologic approaches have failed (Directive to Take Action); and be it further

RESOLVED, That our AMA ask CMS to refrain from issuing citations or imposing financial penalties for the medically necessary and appropriate use of antipsychotic medication for the treatment of dementia-related psychosis. (Directive to Take Action)

Testimony on Resolution 708, including from the Society delegation, was unanimously supportive with a number of delegates raising concerns of skilled nursing facilities (SNFs) denying patients on antipsychotics to facilities for fear of being penalized and negative impact on Nursing Home Compare.

A member of the Council on Medical Service called for an amendment to adopt the second Resolved and reaffirm Policy D-120.951 (Appropriate Use of Antipsychotic Medications in Nursing Home Patients) in lieu of the other Resolve clauses. In its testimony, the Council noted that Policy D-120.951, which passed the AMA in 2012, not only addresses the first, third, and fourth Resolve clauses but also is nearly identical language. However, the Council supported adoption of the second Resolve and recognized that the AMA’s lack of policy on the use of antipsychotic medication is a factor in Nursing Home Compare rankings. Testimony noted that current CMS policies on the use of antipsychotic medications may cause patient harm and urged AMA action on this issue.

Resolution 708 was adopted as amended (to only include the second Resolved) and Policy D-120.951 reaffirmed.

Society Delegates Drs. Walter Lin and Wayne Saltsman with AAGP delegate colleagues.

The Society also paid close attention to reports that the House is considering Advanced Practice Models (APMs) that called for changes to risk adjustment methodology. The report, written in response to a resolution the Society supported previously, received positive testimony focusing on the need for sociodemographic adjustments. The Society is supportive of this report and noted additional considerations for risk adjustment models such as frailty. This has been a top priority for the Society, which has discussed these changes with CMS.

Lastly, the AMA adopted a new report on use of Centers for Disease Control and Prevention (CDC) guidelines for opioid use. The report noted that many patients who require opioids may not be getting adequate access due to ongoing concerns with the opioid epidemic. The Society has expressed similar concerns and issued its own statements last December about the use of opioids in PALTC.

The AMA addressed many other topics at the meeting. For a full report please visit https://www.ama-assn.org/house-delegates.