BY P L JETER

LAKE BUENA VISTA - Health reform was top-of-agenda at the American Medical Association (AMA) House of Delegates 2016 Interim Meeting, held just days after the presidential election. The Nov. 12-15 meeting of the principle policy-making body of the AMA attracted nearly 600 participants from all 50 states to the Walt Disney World Swan & Dolphin Resort in Lake Buena Vista.

AMA delegates, representing 170 state and specialty medical societies, adopted a resolution emphasizing "firm commitment" to AMA's policy on healthcare reform. In preliminary discussions with President-elect Donald Trump's Transition Team and Congress, the AMA will continue efforts to cover the uninsured and strive to assure that future proposals don't result in coverage loss for insured patients.

AMA President Andrew W. Gurman, MD, pointed to policymakers, who have a notable opportunity "to reduce excessive regulatory burdens that diminish physicians' time devoted to patient care and increase costs."

AMA delegate Jason Pirozzolo, DO, director of sports medicine and trauma for Orlando Hand Surgery Associates and assistant clinical professor at Florida State University, said the meeting was livelier than usual, primarily because of the surprising results of the presidential election.

"Delegates were completely caught off guard because for the first time, we saw an opening for real change in healthcare," said Pirozzolo.

When the ACA quickly moved through Congress, Pirozzolo noted the then-unwritten bill passed primarily because of the AMA's support.

"However, the way AMA supported it was analogous to how it passed through Congress, which used procedural chicanery and parliamentary techniques to move the resolution along," he said. "Following that support, many delegates were frustrated with the AMA and the AMA lost a large portion of its membership. Over the past eight years, as we've seen patients lose their doctors and premiums skyrocket, the AMA has tried to reverse course on its ACA policy and change the healthcare system for the betterment of patients and physicians. Obviously with a democratic White House, the ability to make substantive changes was never really a possibility - until the election results were made public.

"As soon as delegates assembled in Orlando, they frantically pieced together a powerful and meaningful proposal that would lend guidance to President-Elect Trump's transition team as we lay the groundwork for meaningful reform," Pirozzolo said. "With the Florida Delegation and Chairman Dr. Corey Howard of Naples helping lead the discussion, we were able to work with most other states and large associations to accomplish this by developing policy that ultimately passed the House with absolutely no controversy or opposition."

AMA delegates discussed other issues including:

• Physicians backing steps toward value-based drug pricing.
• Easing student loan debt as one of various new medical education policies.
• Physicians setting the right tone regarding ethical obligations as care team leaders.
• Wounded veterans deserving infertility benefits via assisted-reproductive technology.
• Public health concerns (distracted driving, dangerous coal-tar sealcoats and smoking among youth) prompting physician policy.
• Joining the call-to-action to minimize gun violence by seeking universal background checks on gun purchases, restrictions on the sale of military-style weapons, and large-capacity magazines to civilians, plus more research on how to cut morbidity and mortality cases involving firearms.

"The other hot issue was Maintenance of Certification reform," said Pirozzolo. "With full support of the Florida delegation, I personally proposed an amendment that would result in a dramatic and immediate escalation of the effort the AMA will be imposing onto the ABMS (American Board of Medical Specialties) and member boards to modify their re-certification policies and cease the requirements for a high-stakes exam. After almost an hour of debate, we were successful."

Pirozzolo testified on the floor: "Most of us helping to lead state medical associations have been involved with the road show put forth by the ABMS, ABIM, and the ABFM, where they send representatives to present us their prefabricated and well-orchestrated talking points as they try to explain why they've been so painfully slow at eradicating the re-certification high-stakes exam and rolling back their costly and burdensome MOC mandates. This amendment will help to further strengthen and support state medical associations as we continue to help physicians practice medicine."

At the meeting, the physician who discovered CTE (chronic traumatic encephalopathy) in the death of an NFL player in 2002, received the AMA's highest honor: Distinguished Service Award. Bennet I. Omalu, MD, MBA, a forensic pathologist and neuropathologist, made the discovery while working at the Allegheny County Coroner's Office in Pittsburgh, Pa. He overcame a strong movement to discredit him and his research, and later became the chief medical examiner for San Joaquin County in California. He also serves as a professor at the University of California-Davis in the Department of Medical Pathology and Laboratory Medicine.

In summing up the historical meeting, Pirozzolo said the outcome of "having policy of this magnitude, which can frequently be polarizing, pass with no opposition on the floor of the House of Delegates, was an absolutely incredible feat and completely unprecedented."