AMA Raps ICD-10, Wraps Annual Meeting 2015

The AMA elects a new president, supports state efforts to remove personal and religious preference exemptions for immunizations, and seeks a hardship exemption for doctors who have problems transitioning to the ICD-10 coding system.

The American Medical Association wrapped up its annual meeting of its House of Delegates this week in Chicago, having elected a new president, and weighed in on ICD-10, vaccine exemptions, workplace violence against healthcare providers, and behavioral health, among other topics.

While the AMA doesn't make federal policy, the resolutions adopted by its House of Delegates wield considerable influence over Congress, which views the AMA as the primary voice of physicians in the US.

New Leadership
The AMA this week officially elected its youngest president in 160 years, Steven Stack, MD, a 43-year-old emergency physician from Lexington, KY. He takes over from outgoing AMA President Robert Wah, MD.

Stack breaks with tradition another way, by becoming the AMA's first emergency physician president. He previously held positions on various AMA committees, including an elected post on the AMA Board of Trustees in 2006.

AMA President Sets Problem-Solving Agenda

In other voting, Andrew W. Gurman, MD, an orthopaedic hand surgeon from Hollidaysburg, PA, was elected president-elect of the body. He is to assume the office of president in June 2016.

An ICD-10 Grace Period
One of the AMA's top issues is its opposition to the federal government's implementation schedule for ICD-10. In Chicago, AMA members voted in favor of asking for a two-year grace period from penalties that could occur because of ICD-10 implementation. The AMA's policy asks for a hardship exemption for doctors who had problems transitioning to the new coding system.

Hospitals and physician practices are just a few months away from the October 1 deadline to transition to ICD-10, and there have been complaints about the administrative burden all along the way.

The deadline has already been extended twice. At the opening session of this year's meeting, outgoing AMA President Wah told audience members that the acceptance rate of Medicare claims would fall to 81% based on early tests of the new codes.

During his term as AMA president, Wah emphasized how the sloppy implementation of various CMS programs contributed to physician burnout telling me last year that programs such as Meaningful Use, electronic prescribing, and physician quality reporting are good ideas individually, but that the different schedules, phases, and rounds of incentives and penalties present a big problem for physicians.

"The bottom line is that ICD-10 will significantly overwhelm physician practices with a 400% increase in the number of codes physicians must use for diagnosis, which will take time away from the valuable one-on-one patient-physician interface that is the hallmark of taking the best care of patients," said Russell Kridel, MD, an AMA board member, in a statement released to the media.

A Call for Fewer Vaccination Exemptions
One of the highest profile policies the AMA adopted at this year's annual meeting was aimed at parents who do not vaccinate their children because of religious or personal preferences. The AMA voted to support state efforts to remove personal and religious preference exemptions for immunization.

"When people are immunized, they also help prevent the spread of disease to others… protecting community health in today's mobile society requires that policymakers not permit individuals from opting out of immunization solely as a matter of personal preference or convenience," said Patrice A. Harris, MD, AMA board member, in a statement.

The AMA's new policy states that vaccinations exemptions that should be granted only when medically necessary.

Earlier this year, approximately 173 people from 21 states and Washington, DC, became infected with measles, a disease that can be deadly, especially to small children who can't be vaccinated because they are not old enough or because of a compromised immune system.

The Centers for Disease Control estimated the outbreak stemmed from an infected traveler who went to Disneyland, and was spread easily because of the low vaccination rates in some surrounding communities.

Integrating Behavioral Health & Primary Care
Some policies adopted by the AMA are meant to encourage a new way of practicing medicine, such as the policy supporting the integration of behavioral health and primary care in order to improve access and outcomes for patients with mental health needs.

This is a subject I have written about extensively because behavioral health needs of patients are increasing while resources to take of them are decreasing.

The AMA's policy encourages commercial payers as well as Medicaid agencies to reimburse healthcare providers for primary care and behavioral health services that are delivered on the same day. Medicare has extended its behavioral health reimbursement somewhat, but it is still far away from covering the costs of treating patients with a behavioral health need.

While the AMA's policy cites cost as a reason to improve the integration of these two services, one barrier that often exists has nothing to do with cost, but everything to do with time.

Primary care providers do not feel equipped to handle the mental health needs of their patients. They want to help their patients, but don't have the resources—whether it is time or expertise or even a referring physician—to send their patients to for additional services, so instead of asking, the need goes undetected and exacerbated.

Workplace Violence
In response to violent incidents in care settings, the AMA voted in support of a study on the matter. The vote came less than six months after Michael Davidson, MD, was shot and killed at Boston's Brigham and Women's Hospital. His assailant's family believes the gunman held Davidson responsible for the death of their mother, who had been his patient.

"Given that there are currently no clear interventions proposed to ensure a safer and more secure environment for healthcare providers, the AMA is committed to taking the necessary steps to help shed light on the various protocols, procedures, and mechanisms that can be put in place to do so," said AMA Board Chair Stephen R. Permut, MD, JD, in a media statement.

Visit AMA 2015 Annual Meeting for a complete list of the AMA's new policy statements, as well as video of the speeches delivered by AMA leaders.