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Medicare for All, Opioid Crisis Up for Discussion at AMA Meeting

CHICAGO — Medicare for All, physician-assisted suicide, and the opioid crisis are just a few of the items on the table for discussion at this year’s annual meeting of the American Medical Association (AMA) House of Delegates, which begins on Saturday.

The AMA will also weigh in on whether to modify or repeal the “Sunshine Act” — a healthcare law designed to provide more transparency around physicians’ financial relationships with teaching hospitals and drug manufacturers — whether to study the benefits and risks of marijuana use, and whether to eliminate non-medical exemptions for immunizations.

Medicare for All

One item expected to stir passions at the meeting is the debate around single-payer healthcare proposals such as Medicare for All. The AMA has historically opposed a single-payer system. AMA President Barbara McAneny, MD, confirmed that stance in an October 2018 interview with MedPage Today.

A new report from the AMA’s Council on Medical Service, “Covering the Uninsured Under the AMA Proposal for Reform,” also reaffirms that stance, calling for improvements in the Affordable Care Act — increasing subsidies, and expanding eligibility and the size of cost-sharing reductions — rather than “threatening the stability of coverage for those individuals who are generally satisfied with their coverage.”

There will be resolutions calling on the AMA to support federal laws that would not eliminate the private health insurance market and to collect data comparing Medicare reimbursement to the cost of delivering services.

Meanwhile, a protest organized by Physicians for a National Health Program (PNHP) and other single-payer proponents is slated to take place Saturday afternoon shortly before the meeting begins. Physicians, nurses, medical students, and other activists are demanding that the AMA drop its opposition to Medicare for All and quit the Partnership for America’s Health Care Future — an anti-single payer lobbying group.

Fighting the Opioid Epidemic

The House of Delegates also will be looking at ways it can help stem the opioid crisis. The AMA’S Opioid Task Force just released its 2019 Progress Report, which notes a boost in the number of physicians waivered to prescribe medication-assisted treatment (MAT) and applauds more than a dozen states for taking action to help remove prior authorization barriers for MAT.

On the House floor, delegates are expected to discuss a resolution calling for drug manufacturers to be “held financially responsible” for healthcare-related and economic costs of their “unethical and deceptive misbranding, marketing, and advocacy” of opioid products.

What’s the best way to handle privacy and confidentiality issues involving patients with a history of substance use disorder? AMA delegates will consider resolutions on that topic as well, including one seeking to align various federal laws so they protect patient privacy while still allowing physicians to learn about a patient’s substance abuse history so that they can provide the right treatment and avoid putting patients in danger of relapsing. (See MedPage Today’s prior coverage of the privacy vs appropriate care debate.) Another opioid resolution calls on the AMA to reaffirm prior policy regarding the inappropriate use of CDC opioid guidelines.

Mental Health and Sexual Harassment

Mental health is expected to be another hot-button issue at the meeting, particularly the problems of physician burnout, depression, and suicide.

The House will release a report on medical student, resident, and physician suicide which includes a recommendation to study the “manner of death” for a subset of physicians in the association’s Deceased Physicians Masterfile. The AMA also wants to monitor efforts by the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education, to collect data on medical student, resident, and fellow suicides to discern patterns that may predict these deaths.

The House also is expected to take up the issue of bullying within medicine. The delegates’ Young Physicians Section has submitted a resolution urging the study of both bullying’s prevalence and its impact on targets, and development of guidelines aimed at preventing “professional bullying” with a report back at the 2020 meeting.

One additional resolution aims to promote development of peer support groups that address the “second victim” or “secondary traumatization” phenomenon, in which a clinician is involved in “an unanticipated patient event, a medical error, and/or a patient-related injury ” and is traumatized by it, and to work with other groups on a survey that quantifies the effects of stress and burnout.

Sexual harassment — a subject which caused controversy at last year’s meeting — is expected to come up again this year. At the AMA’s 2018 interim meeting last November, the organization’s leadership faced criticism that it had not responded appropriately to at least one claim of harassment said to have taken place at a previous AMA conference.

The group’s House of Delegates passed an emergency resolution calling for an independent investigation into the AMA’s approach to assessing and adjudicating claims of harassment and calling for the organization to establish new processes if consultants deem it necessary.

In a blog post published this past April, McAneny and AMA Board of Trustees Chair Jack Resneck Jr., MD, reported findings from the inquiry by outside consultants, which included recommending “simpler ways to report alleged violations, processes to more promptly investigate and resolve claims, changes to ensure investigation independence and avoid conflicts of interests, and greater flexibility in procedures and processes.”

In addition to the report, briefing documents for the meeting include a resolution describing “Expectations for Behavior at House of Delegates Meetings” and a resolution calling for the development of best practices to level the playing field in medical research and “remov[ing] any gender bias from the review and adjudication of grant applications and submissions for publication in peer-reviewed journals” including removing names and gender identity information from the submission or application.

A third resolution calls for the AMA to consider becoming a partner of the TIME’S UP movement to eliminate sexual harassment in the workplace.

The House also will consider the problem of high-cost prescription drugs, including a resolution calling on the AMA to petition the Centers for Medicare & Medicaid Services to allow reimbursement for brand-name medications in the lowest copayment tier in the event of a generic medication recall.

The House of Delegates meeting runs through Wednesday.


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