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Out-of-Network Care, MOC, Docs on Health Care Boards, Open Access Journals: Updates from the Annual AMA-HOD

The Pennsylvania Delegation played an integral role at the American Medical Association's annual House of Delegates (AMA-HOD) meeting in Chicago, held on June 10-14, 2017.

Following a Pennsylvania Medical Society (PAMED)-hosted forum on addressing Maintenance of Certification (MOC) at the state level, physicians from the Pa. delegation took part in health care policy-making decisions on issues like out of network care. Check out these highlights:

Out-of-Network Care

A resolution introduced by the American College of Emergency Physicians addressing issues directly related to unanticipated out-of-network care was approved by the AMA-HOD with the support of the Pennsylvania Delegation to the AMA. The new AMA policy asserts that:

  • Patients should not be financially penalized for receiving unanticipated care from an out-of-network provider.
  • Insurers should be transparent in their applicable policies.
  • Prior to scheduled procedures, insurers must provide enrollees with reasonable and timely access to in-network physicians.
  • A minimum coverage standard for unanticipated out-of-network services should be identified. 

There are also provisions related to emergency care. The AMA will be developing model state legislation for this issue.  


Maintenance of Certification

The business of the AMA-HOD continued to include the important issues surrounding MOC. A resolution introduced by the Florida Delegation with the strong support of the Pennsylvania Delegation reaffirmed the commitment to life-long learning and also took an important step toward having the AMA "undertake a study with the goal of establishing a program that will certify physicians as satisfying the requirements for continuation of their specialty certification by successful demonstration of lifelong learning utilizing high quality CME appropriate for that physician's medical practice …." 

Scott Shapiro, MD, Immediate Past President of PAMED, and Charles Cutler, MD, PAMED President, work closely with the growing number of physicians across the country who have raised issues relating to the work of the ABIM, opposed mandatory high stakes examinations for MOC, and supported appropriate and effective life-long learning.


Physician Participation on Health Care Organization Boards

A resolution sent to the AMA House of Delegates at the direction of PAMED's 2016 House of Delegates has been adopted at the national level. The resolution addressed the topic of increasing physician participation on health care organization boards and was initiated by the Dauphin County Medical Society last year. Jaan Sidorov, MD, now the CEO and President of PAMED's Care Centered Collaborative, sponsored the resolution at the PAMED level. 

The AMA reports that this resolution has the potential to help health care organizations improve patient outcomes and also address issues like physician burnout.

The issue was promoted by the Pennsylvania Delegation to the AMA, chaired by James Goodyear, MD.  After a reference committee hearing at the AMA level, "friendly" amendments were developed by the Reference Committee on Amendments to (the AMA) Constitution and Bylaws.  As approved by the AMA-HOD, the provisions of the resolution will become AMA policy.

The final provisions of the resolution read:

That our American Medical Association advocate for and promote the membership of physicians on

the boards of health care organizations including, but not limited to, acute care providers; insurance entities; medical device manufacturers; and health technology service organizations (New HOD Policy);

That our AMA provide physicians, the public, and health care organizations information on the positive impact of physician leadership. (Directive to Take Action)


High Costs of Publishing in Open Access Journals

PAMED member Virginia Hall, MD, an Ob-Gyn in Hershey, was successful in bringing her initiative on the high costs of publishing in open source journals before the AMA-HOD. Although Dr. Hall's resolution was not adopted, her colleagues in the HOD agreed to have the matter referred to the AMA Board of Trustees for further study – thus achieving her initial goal of bring attention to a growing issue.

Her resolution called upon the AMA to investigate the impact of the high costs of open source publication practices on the dissemination of research, especially by less well-funded and/or smaller entities, and to make recommendations to correct the imbalance of knowledge suppression that may occur because of financial limitations.

During debate before the reference committee, it was pointed out that the preferred phrase Open Access (OA) has replaced the terminology of "open source publication."

There was a wide-ranging discussion that covered the different business structures of Open Access journals and those that are scholarly society journals like JAMA® and the New England Journal of Medicine. Given the complexity of the economic underpinnings of the scientific research publication industry, it was agreed that further study would highlight the concern related to high cost but also provide clarity for the discussion.


To find more news about the 2017 AMA-HOD, visit the AMA online. And, get updates on PAMED's advocacy initiatives at www.pamedsoc.org/advocacy.


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