We just returned from the American Medical Association (AMA) House of Delegates (HOD) gathering. Once again, it proved to be extensive, revealing, and eventful. ASCO’s Dr. Barbara McAneny was reelected to the AMA Board of Trustees, where she will now serve as the Chair. Dr. Chris Nunnink and I serve as ASCO’s delegates. We also welcomed the addition of Dr. Thomas Marsland to the House as an alternate delegate.
As usual, a number of issues were discussed. The general concerns that seem to garner the most attention focused on the Maintenance of Certification (MOC) and the restructuring of how to monitor AMA general advocacy issues. In addition, funding for critical access hospitals, discussions about physicians given special licenses without having to complete a residency program (Missouri enables physicians to go into practice after medical school without further training to compensate for the lack of residency slots), scope of practice, screening for lung cancer, and ensuring the access and prompt care of United States veterans all took center stage.
The AMA heard very clearly the concerns voiced not only by ASCO members but also by several other societies in regards to the MOC. The AMA has taken a stance that while we cannot be against measuring competence, the MOC as it is proposed does not meet the needs of physicians. It is clear that more has to be learned about this program’s ramifications. Like ASCO, the AMA is very sensitive to the MOC, and this will unquestionably be revisited during the interim meeting in November.
The defeat of legislative efforts to permanently fix the Medicare Sustained Growth Rate (SGR) policy by Congress was understandably unnerving. This led to discussions that, although aired on the floor, were mostly carried out in either hallways or closed Board discussions. It seemed to me that this event has the possibility of creating a more tenacious and solidified societal stance. It was more than stunning that Congress would not pass the proposed SGR fix that appeared to have both bipartisan and bicameral approval. It clearly underscored the bipartisan antics that are so pervasive in our Congress. It is far from clear as to what more could have been done to assure this fix. There is little question that unwavering professional/political pressure will need to continue post-election. One voice, one solidified opinion from those representing this nation’s health care will have to remain and become stronger. This demonstrates even more reason to join the AMA and take part in the grass-root process.
Other issues discussed, which are closely tied to our specialty, included a resolution sponsored by ASCO that opposes any limitation to the ordering of genetic testing based solely on medical specialty and/or nonmedical care–based criteria. Further language was added to this ASCO sponsored resolution that eliminated (as standard of care) the requirement to utilize non-medical affiliated specialists counseling prior to ordering any genetic test. This change enables oncologists to order and counsel patients who need this testing when a certified genetic counselor is not available. Also contested was the concept that low-dose CT lung scanning in “high-risk” patients should be a “covered” benefit. Fortunately, the HOD adopted both of these issues.
I, like so many others, am concerned about the state of affairs affecting our medical world. As I have stated before and will continue to stress, our oncologic-based issues are neither unique nor precedent setting. We will, as a profession, have to remain aware and engaged along with all of our colleagues. There can be no better forum to accomplish that than to be a part of those professional societies whose members face the same problems. The concern and discussion goes on, and we have a lot to discuss.