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2018 Interim Meeting American Medical Association House of Delegates

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2018 Interim Meeting American Medical Association House of Delegates October 22, 2018 Memo to: Delegates, Alternate Delegates Executive Directors State Medical Associations, National Medical Specialty Societies, Professional Interest Medical Associations, Other Societies, Sections and Special Groups Subject: 2018 Interim Meeting Handbook Addendum We are pleased to provide the following items received in addition to those included in the advance Delegate’s Handbook. Reports • CEJA Opinion 03 - Mergers of Secular and Religiously Affiliated Health Care Institutions – CORRECTED (Info. Report) • CEJA Report 01 - Competence, Self-Assessment and Self-Awareness (Amendments to C&B) • CEJA Report 02 - Study Aid-in-Dying as End-of-Life Option / The Need to Distinguish "Physician-Assisted Suicide" and "Aid-in-Dying" (Amendments to C&B) • CEJA Report 03 - Amendment to E-2.2.1, "Pediatric Decision Making" (Amendments to C&B) • CEJA Report 04 - CEJA Role in Implementing H-140.837, "Anti-Harassment Policy" (Amendments to C&B) • CEJA Report 05 - Physicians' Freedom of Speech (Amendments to C&B) • CME Report 05 - Reconciliation of AMA Policy on Medical Student Debt (C) • CMS Report 03 - Sustain Patient-Centered Medical Home Practices (J) • CSAPH Report 01 Improving Screening and Treatment Guidelines for Domestic Violence Against Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and Other Individuals (K) • CSAPH Report 02 - FDA Expedited Review Programs and Processes (K) • Report of the House of Delegates Committee on Compensation of the Officers • Joint Report CMS-CSAPH 01 - Aligning Clinical and Financial Incentives for High-Value Care (J) Resolutions Recommended for Consideration • 002 - Protecting the Integrity of Public Health Data Collection • 003 - Mental Health Issues and Use of Psychotropic Drugs for Undocumented Immigrant Children • 215 - Extending the Medical Home to Meet Families Wherever They Go • 216 - Medicare Part B Competitive Acquisition Program (CAP) • 217 - Opposition to Medicare Part B to Part D Changes • 218 - Alternatives to Tort for Medical Liability • 219 - Promotion and Education of Breastfeeding • 220 - Supporting Mental Health Training Programs for Corrections Officers and Crisis Intervention Teams for Law Enforcement • 221 - Regulatory Relief from Burdensome CMS "HPI" EHR Requirements • 222 - Patient Privacy Invasion by the Submission of Fully Identified Quality Measure Data to CMS • 223 - Permanent Reauthorization of the State Children's Health Insurance Program • 224 - Fairness in the Centers for Medicare and Medicaid Services Authorized Quality Improvement Organization's (QIO) Medical Care Review Process • 225 - Surprise Out of Network Bills • 226 - Support for Interoperability of Clinical Data • 227 - CMS Proposal to Consolidate Evaluation and Management Services • 603 - Support of AAIP's Desired Qualifications for Indian Health Service Director • 806 - Telemedicine Models and Access to Care in Post-Acute and Long-Term Care • 807 - Emergency Department Copayments for Medicaid Beneficiaries • 808 - The Improper Use of Beers or Similar Criteria and Third-Party Payer Compliance Activities (H-185.940) • 809 - Medicaid Clinical Trials Coverage • 810 - Medicare Advantage Step Therapy • 811 - Infertility Benefits for Active-Duty Military Personnel • 812 - ICD Code for Patient Harm from Payer Interference • 813 - Direct Primary Care Health Savings Account Clarification • 814 - Prior Authorization Relief in Medicare Advantage Plans • 815 - Uncompensated Physician Labor • 816 - Medicare Advantage Plan Inadequacies • 817 - Increase Reimbursement for Psychiatric Services • 818 - Drug Pricing Transparency • 819 - Medicare Reimbursement Formula for Oncologists Administering Drugs • 820 - Ensuring Quality Health Care for Our Veterans • 821 - Direct Primary Care and Concierge Medicine Based Practices • 915 - Mandatory Reporting • 916 - Ban on Tobacco Flavoring Agents with Respiratory Toxicity • 917 - Protect and Maintain the Clean Air Act • 918 - Allergen Labeling on Food Packaging • 919 - Opioid Mitigation • 920 - Continued Support for Federal Vaccination Funding • 921 - Food Environments and Challenges Accessing Healthy Food • 958 - National Health Service Corps Eligibility • 959 - Physician and Medical Student Mental Health and Suicide • 960 - Inadequate Residency Slots • 961 - Protect Physician-Led Medical Education • 962 - Improve Physician Health Programs Resolutions Not for Consideration • 602 - AMA Policy Statement with Editorials Finally, your Speakers wish to inform you that the charts listing actions taken in follow-up to resolutions and report recommendations from the 2017 Interim and 2018 Annual Meetings will be posted on the Interim Meeting website (www.ama-assn.org/interim-meeting). Sincerely, Susan R. Bailey, MD Bruce A. Scott, MD Speaker, House of Delegates Vice Speaker, House of Delegates CORRECTED REPORT OF THE COUNCIL ON ETHICAL AND JUDICIAL AFFAIRS* CEJA Opinion 3-I-18 Subject: Mergers of Secular and Religiously Affiliated Health Care Institutions Presented by: James E. Sabin, MD, Chair 1 INTRODUCTION 2 3 At the 2018 Annual Meeting, the American Medical Association (AMA) House of Delegates 4 adopted the recommendations of Council on Ethical and Judicial Affairs Report 2-A-18, “Mergers 5 of Secular and Religiously Affiliated Health Care Institutions.” The Council issues this Opinion, 6 which will appear in the next version of AMA PolicyFinder and the next print edition of the Code 7 of Medical Ethics. 8 9 E-11.2.6 – Mergers of Secular and Religiously Affiliated Health Care Institutions 10 11 The merger of secular health care institutions and those affiliated with a faith tradition can 12 benefit patients and communities by sustaining the ability to provide a continuum of care 13 locally in the face of financial and other pressures. Yet consolidation among health care 14 institutions with diverging value commitments and missions may also result in limiting what 15 services are available. Consolidation can be a source of tension for the physicians and other 16 health care professionals who are employed by or affiliated with the consolidated health care 17 entity. 18 19 Protecting the community that the institution serves as well as the integrity of the institution, 20 the physicians and other professionals who practice in association with it, is an essential, but 21 challenging responsibility. 22 23 Physician-leaders within institutions that have or are contemplating a merger of secular and 24 faith-based institutions should: 25 26 (a) Seek input from stakeholders to inform decisions to help ensure that after a consolidation 27 the same breadth of services and care previously offered will continue to be available to the 28 community. 29 30 (b) Be transparent about the values and mission that will guide the consolidated entity and 31 proactively communicate to stakeholders, including prospective patients, physicians, staff, 32 and civic leaders, how this will affect patient care and access to services. * Opinions of the Council on Ethical and Judicial Affairs will be placed on the Consent Calendar for informational reports, but may be withdrawn from the Consent Calendar on motion of any member of the House of Delegates and referred to a Reference Committee. The members of the House may discuss an Opinion fully in Reference Committee and on the floor of the House. After concluding its discussion, the House shall file the Opinion. The House may adopt a resolution requesting the Council on Ethical and Judicial Affairs to reconsider or withdraw the Opinion. © 2018 American Medical Association. All rights reserved. CEJA Op. 3-I-18 -- page 2 of 2 1 (c) Negotiate contractual issues of governance, management, financing, and personnel that 2 will respect the diversity of values within the community and at minimum that the same 3 breadth of services and care remain available to the community. 4 5 (d) Recognize that physicians’ primary obligation is to their patients. Physician-leaders in 6 consolidated health systems should provide avenues for meaningful appeal and advocacy 7 to enable associated physicians to respond to the unique needs of individual patients. 8 9 (e) Establish mechanisms to monitor the effect of new institutional arrangements on patient 10 care and well-being and the opportunity of participating clinicians to uphold professional 11 norms, both to identify and address adverse consequences and to identify and disseminate 12 positive outcomes. 13 14 Individual physicians associated with secular and faith-based institutions that have or propose 15 to consolidate should: 16 17 (f) Work to hold leaders accountable to meeting conditions for professionalism within the 18 institution. 19 20 (g) Advocate for solutions when there is ongoing disagreement about services or arrangements 21 for care. (VII, VIII, IX) REPORT 1 OF THE COUNCIL ON ETHICAL AND JUDICIAL AFFAIRS (1-I-18) Competence, Self-Assessment and Self-Awareness (Reference Committee on Amendments to Constitution and Bylaws) EXECUTIVE SUMMARY The expectation that physicians will provide competent care is central to medicine. It undergirds professional autonomy and the privilege of self-regulation granted to medicine by society. The ethical responsibility of competence encompasses more than knowledge and skill. It requires physicians to understand that as a practical matter in the care of actual patients, competence is fluid and dependent on context. Importantly, the ethical responsibility of competence requires that physicians at all stages of their professional lives be able to recognize when they are and when
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