Update from the AMA House of Delegates

By David A. Provenzano, MD    Jun 20, 2019

Attending my first American Medical Association (AMA) House of Delegates meeting was a truly enjoyable experience. As the ASRA representative, I was able to watch the House of Delegates and its caucuses and sections discuss more than 30 pain care-related resolutions. 

During the opening ceremonies, we heard from AMA President-Elect and AMA Opioid Taskforce Chair Patrice A. Harris, MD: “We need help from policymakers to ensure that more people have access to [pain] treatment. Physicians are responding to the [opioid] epidemic and we are seeing results, but we cannot enforce parity laws or eliminate administrative barriers without the help of state and federal authorities, and that’s what is limiting treatment now.”

That set the stage for quite a bit of work to related to ASRA’s work in acute and chronic pain. 

Specifically, actions were taken to:

  • Advocate for state legislatures and other policymakers, health insurance companies, and pharmaceutical benefit management companies to remove barriers, including prior authorization, to nonopioid pain care including interventional pain procedures.
  • Support amendments to opioid-restriction policies to allow for exceptions that enable physicians, when medically necessary in the physician’s judgment, to exceed statutory, regulatory, or other thresholds for postoperative care and other medical procedures or conditions.
  • Oppose health insurance company and pharmacy benefit management company utilization-management policies, including prior authorization, that restrict access to appropriate postoperative pain care, including opioid analgesics, if those policies are not based on sound clinical evidence, data, and emerging research.
  • Support balanced opioid-sparing policies that are not based on hard thresholds but on patient individuality and help ensure safe prescribing practices, minimize workflow disruption, and ensure patients have access to their medications in a timely manner, without additional, cumbersome documentation requirements.
  • Oppose the use of “high prescriber” lists used by national pharmacy chains, pharmacy benefit management companies, or health insurance companies when those lists do not provide due process, are used to blacklist physicians from writing prescriptions for controlled substances, and prevent patients from having prescriptions filled at their pharmacies of choice.

Practice management issues were also a leading topic of conversation at the meeting. Specifically, Seema Verma, Centers for Medicare & Medicaid Services (CMS) administrator, discussed three priorities of her agency:

  1. CMS Patients Over Paperwork initiative, an initiative to reduce “burden hours” of administrative paperwork
  2. Simplifying the new Medicare payment system created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
  3. Reforming payment for evaluation and management (E/M) services and interoperability of electronic health record (EHR) systems.

The House also took action on many practice management issues including:

  • Exploring emerging technologies to automate the prior authorization process for medical services and evaluate their efficiency and scalability
  • Advocating for more use and reimbursement of telemedicine visits
  • Continuing to address the institutional causes of physician demoralization and burnout, including gaps in physician leadership, documentation requirements, inefficient workflows, and regulatory oversight.

Members of the House discussed Practice Overhead Expense and Site-of-Service Differential at great length. Because of the complex nature of these items, the House directed the AMA Board of Trustees to consider all of the testimony provided and decide the next course of action. We should learn more later this summer about their actions.

We will also hear more about marijuana after more information is collected. AMA will be discussing marijuana research, terminology, and use in medical facilities at its fall meeting.

As can be seen above, the recent AMA House of Delegates meeting covered many important healthcare policies and practices critical to the field of pain management. ASRA will continue represent the needs of its members at future AMA meetings.

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