By Barbara L. McAneny, MD, MACP, FASCO; Ray D. Page, DO, PhD, FACOI, FASCO; Kristina L. Novick, MD, MS; and Steve Y. Lee, MD, FACP

In November 2023, ASCO’s delegation to the American Medical Association (AMA) House of Delegates (HOD) met in the Washington, DC, area to participate in the 2023 AMA HOD Interim Meeting. The AMA HOD meets twice a year, with the interim meeting focused on AMA’s advocacy and policies that will guide the organization for the upcoming year.

ASCO Member Roles in the AMA HOD

Authors Dr. Page, Dr. McAneny, Dr. Lee, and Dr. Novick, and Erin L. Schwab, MD, MPH, served as ASCO delegates to the meeting; David Savage, MD, PhD, Ashley L. Sumrall, MD, FASCO, FACP, and Jill Gilbert, MD, FACP, FASCO, served as alternate delegates.

The ASCO delegation continues to expand. At the meeting, medical oncology fellows Mark Chang, DO, and Dayna Isaacs, MD, MPH, were elected as Resident & Fellow Section delegates sponsored by ASCO. This engagement with trainee and early-career physicians helps ASCO extend its reach and increase opportunity for member engagement in advocacy and AMA HOD activities.

At each AMA HOD meeting, ASCO looks for opportunities to make meaningful progress towards addressing priority issues facing patients with cancer and health care providers. ASCO members are encouraged to get involved in these and other essential advocacy activities via the ACT Network. 

Cancer-Specific Impact and Resolutions

At each AMA HOD meeting, ASCO hosts the Cancer Care Caucus (CCC), a diverse group of specialties that meet to discuss resolutions that particularly impact cancer. The CCC is an engaging forum for discussion of issues vital to oncology. In addition, it provides a platform for adjacent specialties to bring issues to the attention of the cancer care community. ASCO engages in coalition building and collaborative work on resolutions, as well as considered endorsement of candidates for a variety of elected and appointed positions with the AMA. Collaborations with multiple specialty and state societies at the AMA HOD meetings help strengthen ASCO’s ability to advocate for its members and patients with cancer.

During this year’s CCC, ASCO successfully advocated for the second annual National Lung Cancer Screening Day, which was held on Saturday, November 11, 2023.  This was done in conjunction with National Lung Cancer Screening Awareness Month, and was co-led by the Radiology Section Council, the American College of Chest Physicians, and ASCO.

ASCO also crafted the following resolutions, which were all adopted and have become official AMA policy:

• Expansion of Remote Digital Laboratory Access Under CLIA:
  
  • With the co-sponsorship of the College of American Pathologists, ASCO called on the AMA to ask the Centers for Medicare & Medicaid Services (CMS) to clarify post-Public Health Emergency enforcement discretion guidance regarding Clinical Laboratory Improvement Amendments (CLIA). The resolution called for clarifying CMS guidance to allow all qualified physicians under CLIA, notably hematologists and oncologists, to be able to review digital data, digital results, and digital images at a remote location under their affiliated institutions’ primary CLIA certificates, instead of requiring unique certificates for each physician.
• Initial Consultation for Clinical Trials Under Medicare Advantage
  
  • Through this resolution, ASCO called on the AMA to advocate for CMS to allow and reimburse out-of-network referral of patients with Medicare Advantage (MA) for the purpose of consultation for enrollment in a clinical trial. It further asked that these consultations be considered administratively as participation in a clinical trial. This resolution is built upon a resolution from the AMA HOD Annual Meeting in June 2023 which asked CMS to have MA directly pay for the routine costs of clinical trials without switching patients to traditional Medicare. It will help ensure that patients' access to care is increased via reduced financial toxicity, and that health care providers are paid directly for these services.  
• ERISA Preemption of State Laws Regulating Pharmacy Benefit Managers
  
  • ASCO used this resolution to call on the AMA to study enacted state pharmacy benefit manager (PBM) legislation and create a model bill that would avoid the Employee Retirement Income Security Act of 1974 (ERISA) preemption. This model legislation will be done in a targeted way with the goal of allowing increased state-level regulation of PBMs, filling a current regulatory gap.
  • PBMs are companies designed by insurance companies to assist with the selection and pricing of pharmaceuticals and development of insurance formularies. With the increase in prices of many oncologic oral drugs, PBMs converted from a flat fee cost to a proportion of the cost of the drug. This shift has resulted in PBMs and insurers requesting manufacturers to raise, not lower, the cost of the drug and deliver a rebate to the PBM. Many states, prompted by physicians interested in lowering patient costs, are trying to pass laws regulating the ability of PBMs to profit from raising prices on drugs, but for MA plans and ERISA plans, state laws are prohibited from having an effect. Several states are embroiled in lawsuits with the PBMs who are using ERISA to preempt the reforms. ASCO’s request is for the AMA to develop model legislation to help states and physicians find a way to assist patients’ financial toxicity.

Essential Topics Addressed by Broader Medical Community Resolutions

In addition to the specific ASCO-sponsored resolutions, the AMA supported the following essential topics:

• Medicare: Preventing Payment Cuts, Ensuring Stability, and Saving Traditional Medicare  
  
  • Medicare physician reimbursement was a primary advocacy issue at the meeting as it is an essential part of the AMA Recovery Plan for America’s Physicians. Our voice can be more impactful when we join with other specialties. ASCO and the AMA advocated with Congress to prevent Medicare cuts and safeguard physician payment through various methods.
  • While the AMA has prioritized Medicare payment reform through legislative advocacy and grassroots efforts, including FixMedicareNow.org, the HOD asked that the AMA focus on prevention of imminent 3.4% Medicare payment cuts to ensure the “economic viability of medical practice.” In addition, this resolution asked the AMA to work towards sufficient payment updates to reflect the increasing cost of medical practice that would be tied to a relevant measure of inflation.
  • Saving traditional Medicare was also a key focus area. In addition to providing payment updates to account for changes in cost of medical care over time, the HOD passed policy expressing concern that the term “Medicare Advantage” can mislead Medicare beneficiaries and may threaten the viability of traditional Medicare. 
• Health Insurers and Collection of Patient Cost-Sharing
  
  • A report asked the AMA to shift the burden of collecting cost-sharing for patient care from physicians to insurers. The AMA will work with state and specialty societies to encourage this shift in collection responsibilities, thereby ensuring that physicians are appropriately reimbursed for provided services.
• Determining Medical Diagnoses and Medical Necessity
  
  • The AMA has long supported changes to the prior authorization process that delays care, places an undue burden on physician practices, and prevents patients from receiving necessary treatments. The HOD agreed that only physicians should make final determinations on the necessity of a medical treatment and that should a reviewing physician with equivalent expertise not be available, the treating physician’s judgment would determine necessity to prevent delay of care.
  • ASCO continues to conduct legislative and regulatory advocacy with the AMA and other specialties on prior authorization with Congress and CMS.

ASCO looks forward to continuing the momentum of this meeting and making major contributions to AMA policy.

For more information about ASCO’s advocacy efforts, visit ASCO’s Advocacy page.

Acknowledgment: ASCO staff Dominic Sawaya, JD, MPPA, and Jennifer Garvin, MS, contributed to this article.

Dr. McAneny is a medical oncologist and hematologist, the CEO of New Mexico Oncology Hematology Consultants, LTD, in Albuquerque, NM, a former AMA President, and a current ASCO AMA Delegate.

Dr. Page is a medical oncologist and hematologist at The Center for Cancer and Blood Disorders in Fort Worth and Weatherford, TX, and is a current ASCO AMA Delegate.

Dr. Novick is a radiation oncologist at Chester County Hospital and the University of Pennsylvania in West Chester and Philadelphia, PA, respectively, and is a current ASCO AMA Delegate.

Dr. Lee is a medical oncologist at Kaiser Permanente Oakland Medical Center in Oakland, CA, and is a current ASCO AMA Delegate.