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November 28, 2017

Report from the 2017 AMA Interim Meeting

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Aloha from Honolulu, the location of the interim meeting of the American Medical Association (AMA). The interim meeting focuses on advocacy. Dr. Ethan Lazarus, delegate, and Dr. Carolynn Francavilla, alternate delegate, attended the meeting and represented OMA.

Obesity Caucus

In 2013, Dr. Lazarus formed an obesity caucus within the AMA. He and Dr. Francavilla hosted the obesity caucus again at the interim meeting. Attendees included representatives from the Endocrine Society, American Academy of Clinical Endocrinologists, American College of Obstetrics and Gynecology, Resident and Fellow Section, Illinois State, American Society for Metabolic and Bariatric Surgery, and others, as well as the deputy editor from JAMA.

We welcomed special guest, Dr. Patrice Harris, current AMA board member and immediate past chair of the board of the AMA. Dr. Harris has been a key player in positioning the AMA to address the opioid epidemic in the U.S. She pointed out that in 2014, the public felt that the opioid epidemic was “All the doctor’s fault!” Now, we understand that the opioid epidemic is multi-factorial, and in fact, many deaths are due to illicit opioids coming in illegally from other countries. This required a concerted effort among different state and specialty societies to change the opioid discussion. Part of this included the creation of a microsite within the AMA website to educate physicians on what is really going on.

We face similar challenges with regards to obesity. The messaging is that it is the patient’s fault, and that obesity is a disease of eating too much and moving too little. Physicians aren’t generally engaging in care, and the disease is subject to tremendous bias and stigma. We felt that learning from the progress made with regards to the opioid epidemic might help us learn to leverage the AMA to change the discussion around obesity. Additionally, we were happy to hear Dr. Harris would be taking on the topic of improving maternal obesity this year.

We are excited to work with the AMA board of trustees on developing strategies to improve the care of our patients.

Other Resolutions and Topics of Interest

There were also several significant issues debated by the AMA at this meeting. One of the most interesting regarded the use of a 25-modifier. This is a modifier that can be added when a separate procedure is performed at the time of an E&M coded office visit. For example, if you see a patient for an office visit but then want to give vaccinations, you would use the 25-modifier to indicate that a separate procedure was performed. Unfortunately, in many states, insurers have begun to decrease payment for the office visit by 50% when they see the 25-modifier, thus making it difficult to provide proper care to patients. The AMA passed policy to aggressively advocate that office visits are paid at a non-reduced rate in this situation.

There was another policy introduced by our endocrine colleagues calling on the AMA to research skyrocketing costs of insulin. Many insulin prices have increased by a factor of 10 over the past decade, and it is not unusual for insulin to cost over $2,000 per month. We helped build support for this resolution and testified on its behalf, helping it pass. We look forward to this report next year.

Additionally, new policy was adopted that calls on the AMA to encourage primary and secondary schools to incorporate balancing exposure to screens with physical activity and sleep into health class curricula. This is an effort to reduce obesity and improve mental health among youth. Another topic the AMA was asked to advocate for was improving the ease of e-prescribing of controlled substances.

Thank You, Dr. Francavilla

Finally, we wanted to extend a huge thank you to Dr. Carolynn Francavilla for serving as OMA’s alternate delegate in the AMA, a position she has held for the past three years. Dr. Francavilla has contributed to the increased visibility of OMA and obesity at AMA meetings. She helped to author resolutions, jointly hosted the obesity caucus, and represented OMA in the Young Physicians Section and at the Medical Student Specialty Showcase.

Dr. Francavilla has been elected to an alternate delegate spot in the Colorado delegation and will continue her work with the AMA through that position. We thank Dr. Francavilla for all the work she has done on behalf of OMA, and look forward to continuing to work with her and the rest of our Colorado colleagues.