2024 AMA HOD Meeting Summary

2024 AMA HOD Meeting Summary

Travis Harker, MD, MPH, NH AMA Delegate
Alan Hartford, MD, NH AMA Alternate Delegate
Maria Boylan, DO, NHMS President 

The AMA House of Delegates (HoD), made up of representatives from more than fifty state and territory societies and from over 120 national medical specialty societies, gathered in Chicago June 7-12 for the AMA’s 2024 Annual Meeting. The HoD meets twice yearly to establish policies on health, medical, professional, and governance matters, and they also establish the principles that guide the AMA’s business activities.

Following days of discussion and debate spanning hundreds of resolutions, top AMA action items emerged, including:

1. Legislative reform of the Medicare payment system – AMA’s #1 priority;

2. Battle against scope creep threatening patient safety;

3. Advocacy for a strong future for telehealth;

4. Model to address Medicare’s broken “buy and bill” drug reimbursement method;

5. Legislation for coverage of care ordered by out-of-network doctors;

6. Head start on loan forgiveness for Indian Health Service physicians;

7. Support for shift of USMLE Step 3 to pass-fail to address residents’ well-being;

8. Reform of Medicare Advantage payment policies;

9. Careful attention to the use of doctors’ personal info in the burnout fight;

10. Assurance that medical staff have key say on health AI tools;

11. Health plan accountability for prior authorization delays and denials.

Details regarding these items, along with many other important health care issues addressed at the Annual Meeting, may be found at this link: https://www.ama-assn.org/house-delegates/annual-meeting/highlights-2024-ama-annual-meeting.

Specifically, your New Hampshire delegation successfully championed two important resolutions:

1. “Preservation of the Primary Care Relationship,” authored by Travis Harker, MD, MPH

With the support of the New England delegation, this resolution created new AMA policy designed to help protect the relationship between patients and their primary care physicians. The national phenomenon of consolidation in healthcare has led to the practice by some large systems of limiting patient access to certain specialists to only those primary care physicians employed by that system. In addition, they have encouraged patients to abandon their existing PCPs and establish new relationships with the employed PCPs to then access specialty care. The New Hampshire delegation led the effort to create AMA policy opposing this practice and has asked for clarification by the AMA Council on Ethical and Judicial Affairs whether this practice erodes the doctor-patient relationship and may create an ethical concern. 

The policy states:

Resolved, Our AMA opposes health systems requiring patients to switch to primary care physicians within a health system in order to access specialty care; and be it further

Resolved, Our AMA deems the coercion of patients to change primary care providers for specialty access as contrary to ethical healthcare practices and detrimental to patient welfare; and be it further

Resolved, Our AMA advocates for policies that promote patient choice, ensure continuity of care, and uphold the sanctity of the patient-physician relationship, irrespective of healthcare system pressures or economic incentives; and be it further

Resolved, Our AMA study the scope and impact of this practice of systems limiting access to specialty care to patients who see their employed primary care physicians, PAs and NPs to the exclusion of outside primary care practitioners.

With this policy change we can advocate for improved access to care for patients, oppose large systems from excluding patients in our communities, and preserve the primary care relationship which is so vital to our patients’ health. 

2. “Supporting the Inclusion of Information about Lung Cancer Screening within Cigarette Packages”

CT-based screening reduces lung cancer mortality, but screening rates are low among those at highest risk, especially among underserved racial, ethnic, and socioeconomic populations. As a result, over the past several months, multiple medical associations have discussed whether cigarette packaging might serve as a vehicle for disseminating information about lung cancer screening.

At the American College of Radiology (ACR)’s Annual Meeting in April, a group of radiation oncologists enthusiastically introduced this idea, including the idea that QR codes might be an effective mechanism. While this idea was percolating amongst the radiologists at the national level, researchers and clinicians at MGH had independently developed a similar proposal. This proposal was introduced this past May through the Massachusetts Medical Society, and then strongly endorsed by the entire New England Delegation (including the NHMS, as well as radiology and oncology representatives within NED).

The resolution then moved onto the AMA’s national debate stage. With its broad-based roots of support, the issue was extensively discussed, amended, and then endorsed by a wide range of organizations – including (for example) the AMA’s Women Physicians Section, the American Society for Clinical Oncology and multiple other oncologic societies, the ACR and numerous other radiological societies, and a large raft of state medical societies extending from California to New England. Nevertheless, the larger HoD bridled the resolution due to concerns about possible unintended negative consequences – such as the potential reemergence of tobacco company litigation. As a result, the HoD referred the resolution to the AMA’s Board of Trustees “for decision,” meaning that the Board may perform a deeper dive into the issue and craft a thoughtful response in the coming months.

In such situations, your New Hampshire delegation is teamed with other societies to monitor progress on the topic – one that we believe potentially may constitute a useful public health intervention for educating the at-risk public about screening, cancer, and available resources, and thereby one that may save many lives.

NHMS President Boylan attends the AMA’s 179th Inaugural Dinner and Ceremony

It was a privilege and honor to attend the AMA’s 179th President’s Inaugural Dinner, standing alongside physician leaders and other state society presidents from across the country. I am extremely proud to have represented New Hampshire at this annual meeting, and had the opportunity to highlight the incredible work of the Society and its members advocating on behalf of our profession, our patients, and the betterment of public health in New England. When meeting with many of our colleagues, from fellow state society presidents and, particularly, our New England Delegation, it was confirmed that many of the issues we face in New Hampshire are not unlike those of our neighbors. From concerted prior authorization reform efforts, addressing health care workforce challenges, and increased non-physician led scope creep legislation, we all are fighting similar battles, battles that the AMA is fighting on a national level as well. 

I want to share a moment that moved me during this summer’s meeting, which was during former AMA President Jesse Ehrenfeld’s outgoing address:

 “[We have a] responsibility to speak out against barriers that our patients and fellow physicians face. The responsibility to stand up for science and the high ethical standards of our profession. The responsibility to give voice to the everyday challenges that physicians are experiencing. Helping lead to a better healthcare system that is more inclusive, more sustainable, and better supports the needs of physicians so that we can take the best possible care of our patients.”

President Ehrenfeld’s speech reinforced the challenges that physician leaders face when balancing their commitments in the exam room, maintaining an active presence in their state and specialty societies, all while showing up as a spouse/partner, parent, loved one, community member, etc. In addition to serving as the NHMS President, I am also a mom of two young children, a full-time family practice physician, and a leader within my own hospital system. With that, I understand firsthand how vital it is to prioritize your health and wellness as a physician leader as you would your patients. 

While I am a physician leader representing a smaller state, the significance of our state’s health care needs and legislative battles should not be diminished. This year’s HoD was a reminder that while it can sometimes feel like physicians are fighting a battle all on our own - from reimbursement rates, tackling physician burnout, to protecting patients’ rights to receive appropriate, evidence-based care, free from government intrusion - the battles we face, collectively, are best fought together, from the Granite State to the Golden State.