Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
In today’s COVID-19 update, AMA President Susan R. Bailey, MD, is joined by the speaker and vice speaker of the AMA's House of Delegates—Bruce Scott, MD, and Lisa Egbert, MD, respectively—to discuss policymaking during the pandemic and share key takeaways from November's virtual Special Meeting of the House of Delegates (HOD).
Learn more at the AMA COVID-19 resource center.
- Susan R. Bailey, MD, president, AMA
- Lisa Egbert, MD, vice speaker, AMA House of Delegates
- Bruce Scott, MD, speaker, AMA House of Delegates
Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we're talking about policy making during the pandemic, with a recap of AMA's recent House of Delegates Special Meeting. I'm joined today by Dr. Susan Bailey, the AMA's president in Fort Worth, Texas. Dr. Bruce Scott, speaker of the AMA House of Delegates in Louisville, Kentucky and Dr. Lisa Bohman Egbert, vice speaker of the AMA House of Delegates in Dayton, Ohio. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Scott, the AMA just completed a special meeting of the House of Delegates. Why a special meeting and what was so special about it?
Dr. Scott: Well, Todd, the reason it was a special meeting is because the Board of Trustees recognize the reality of the continuing pandemic and canceled our regularly scheduled in-person meeting that was to be held in San Diego in November. But they recognized the importance of the House of Delegates getting together, and so they asked Dr. Egbert and I, as the speakers and presiding officers over the House of Delegates, to call a special meeting. What made it special was the fact that we were having a virtual meeting and that we were going to have robust, interactive debate at that meeting. Now, we had a virtual meeting in June, but that meeting had very few items of business. And at this meeting, we were going to attempt to cover 80 urgent and priority items of business before the House of Delegates. And we wanted to do all of that while protecting the democratic process that is the hallmark of our AMA House of Delegates.
Unger: Dr. Egbert, can you talk a little bit more about the changes you had to make to achieve that?
Dr. Egbert: Absolutely, Todd. So, this wasn't your typical Zoom meeting. We had over a thousand participants. And as you can imagine, if they were all raising their hand, that would get a little chaotic. So, we had to devise a plan, actually using two platforms where one was used to get into the speaking queue and the other was used a Zoom meeting to actually interact with us. So, we had to construct a lot of rules to get through this. We did a lot of practicing. We had several sessions where our delegates actually joined us in practice just to get to the point where we could do this. But I think we got it done. It was a challenge, but we figured it out.
Dr. Scott: Todd, just so you understand this is over 600 voting delegates and alternate delegates coming together, representing every state and virtually every specialty and even special interest groups as well. And so, what Dr. Egbert was talking about was quite a challenge.
Unger: Indeed. Dr. Bailey, you've seen your fair share of meetings. How do you think this one went?
Dr. Bailey: Oh, I think it was an incredible success. And I give all the credit to our amazing speaker and vice speaker who worked endless hours to pull this together and make it possible. I've had the opportunity to see a number of state and specialty society meetings since I became president in June. And I think that this meeting will serve as the gold standard on how to get people together and actually be able to have a conversation, to be able to discuss and make health policy and really an amazingly efficient way.
Dr. Egbert: We still hope those two and Todd that we'll be meeting in person in June at our regularly scheduled annual meeting.
Unger: I hope so too. We discussed earlier that the House had to prioritize what to consider. Dr. Bailey, what were some of the key issues that were focused on?
Dr. Bailey: We focused on issues that we felt were urgent for our current situation and really needed to be acted on quickly. And of course, not surprising health system reform dominated a good part of the conversation. One very important report the House passed was from our council on medical service, looking at the so-called public option as part of the Affordable Care Act. The AMA is still in total support of every American having meaningful, affordable coverage that's transferable and reimbursed or subsidized by tax credits, but adding a public option for people that don't qualify for any of the other aspects, AMA didn't have policy on until now.
And the policy that we made says that yes, AMA can support a public option, but some very strict guard rails need to be observed. And there are six of them. One is that it's restricted to people that don't have access to affordable employer sponsored coverage. Physician payments must be higher than prevailing Medicare rates. Physicians should have the freedom to choose whether or not they participate. The plan ought to be self-sustaining and not receive any type of favorable government subsidies to operate. And that people who are in the coverage gap in states that didn't expand Medicaid ought to be able to participate.
Unger: Dr. Egbert, access to care, obviously incredibly important right now during a pandemic. Can you talk about any other actions related to access?
Dr. Egbert: Absolutely. So, one of the things that was also important in that report is auto enrollment. So, we're allowing auto enrollment to occur, but we're recommending that the individual has an ability to opt out of anything that they would technically be auto enrolled in. So, it gives you the chance to have insurance, to make it easy. It makes it there for you automatically. But if you don't want it, or it's not the right insurance plan for you, you can opt out. And that's important. We want to make sure that people have that guardrail.
Another important thing that's very near and dear to physicians' hearts is the insurance companies use prior authorization to allow us to perform a procedure or do something for a patient, we have to prior authorize it with the insurance company. Well, one of the things, the policies that we passed was that if you view, the insurance company, wants to want to ask us to do prior authorization, then you should be available to us 24/7 to ask for that prior authorization and get it, just like we serve our patients 24/7. And I think that's very important policy.
Unger: Absolutely. Dr. Scott, one of the biggest headlines coming out of that meeting had to do with policy around recognizing racism as a public health threat. Can you talk to us more about that?
Dr. Scott: Absolutely. We know that racism negatively impacts and exacerbate health inequalities, particularly among historically marginalized communities, and made even worse by this pandemic. So, in June, the AMA Board of Trustees made a public statement recognizing the systemic racism and the impact that it has upon health. At this House of Delegates meeting, the House passed policy, in effect codifying that statement from the AMA Board of Trustees and pledging to continue to work towards elimination of systemic racism. Without systemic and structural level change, health inequalities will continue to exist and the overall health of our nation will suffer as a result.
The policy that was passed recognizes that racism and unconscious bias actually exist within health care delivery, but also, believe it or not, within medical research, and that this causes harm for those marginalized communities and society, therefore, as a whole. So, we also called upon government agencies and non-government organizations that fund research to increase research funding into the epidemiology of the risks and damages related to racism and how we can prevent that going forward.
Dr. Bailey: We also need to recognize the need in all phases of medical education to introduce a greater understanding of the causes, the influences and the effects of systemic cultural institutional, and even interpersonal racism, as well as how to prevent and ameliorate the health effects of racism.
Unger: So, beyond those big things that we've already talked about, were there some other important issues that you discussed at the meeting that you'd like to highlight? Dr. Scott, why don't you go first?
Dr. Scott: Another big thing right now for physicians and patients is access to telehealth. Telehealth has become a very important access point for many patients around the United States, particularly worsened or made more necessary by the pandemic. And one of the things that the House pushed for was payment that is equal to, or equivalent to, that payment that would be achieved by seeing the patient in person, and importantly, that telehealth would be available to the patient wherever the patient is located. And finally, and one of the things that the House made very clear, is that a provider non-physician at a health plan call line is not the same as a person's primary care doctor. We recognize the importance of continuity of care and maintaining that patient physician relationship, particularly in the midst of this pandemic.
Unger: Dr. Bailey, how about you?
Dr. Bailey: One of the things that I've been dealing with a lot in my presidency that the House dealt with is the impact of the pandemic on physician practices, especially private practices. AMA has done some surveying and some research and has shown that practices have had a significant drop in income since the beginning of the pandemic, probably over 30%.
Now, one way that doctors around the country are able to get involved in the AMA is through our Sections. We have Sections of all different kinds, minority affairs section, the Women Physician Section, the Integrated Practice Section, you name it. And at this meeting, the House of Delegates officially approved a Private Practice Physician Section. This group has been meeting together for a number of years, somewhat informally, and now has been made an official Section.
Some people may say, "Well, why do you need that?" Well, private practice is more and more becoming an endangered species in the practice of medicine. And we think, and I especially, since I am in private practice, think it's incredibly important that the needs of private practice positions are heard and met. And I'm really proud that the AMA approved this section and look forward to participating in it in the future.
Unger: Dr. Egbert, were there any other actions we should know about?
Dr. Egbert: We had lots of them, but I'll highlight a couple more. One of the things that I think has been a very, very important highlighted topic that our AMA's response has been amazing is to the need for PPE for our physicians. And not just physicians, but all health care staff. One of the reports that were passed at this meeting was that hospitals should be required to provide adequate PPE, not just for their employees, but for the physician staff that staff that hospital. And a counterpoint, that physician staff, if they are employed by the hospital, shouldn't be made to feel pressured to not say anything about their concerns for their own safety and the safety of their coworkers. So those were two really important things that I thought were, were highlights that we passed.
We, of course, recognized, as Dr. Bailey was saying, that financial support needs to be ongoing during this pandemic, that physician practices are really hurting, and especially the small practices. So that was another thing that was passed at this meeting. Likewise, we need to make sure that our medical education system is stabilized. It's supported by Medicare, the residency programs are. But schools and residency programs have had to kind of re-imagine how to teach these students and residents in a pandemic where you have to be careful, and you have to think about their safety as well. So, this has been an uphill battle for health care on every front and we have passed a lot of good policy about all of that.
Unger: Dr. Bailey, you've spent a lot of time during your term talking about data and science and particularly about the importance of transparency and knowledge around COVID-19 vaccine development distribution. There was some discussion of that at the House. Would you like to cover that as well?
Dr. Bailey: Yes. Physicians are the best ambassadors we have for vaccines. We believe in them very strongly. But when you have a new vaccine, it's important to make sure that physicians feel comfortable in the safety and efficacy of those vaccines. And only then will we be able to educate our patients to actually take the vaccines. And so, we passed a resolution calling upon a public education plan in conjunction with other medical organizations and interested stakeholders around the country to have a campaign to educate people about the benefits of COVID-19 vaccines, placing special emphasis on communities of color, where there has been a great deal of mistrust in the vaccine process in the past. I think this is going to be very important. I think it would be absolutely tragic if we had all these wonderful vaccines, but people didn't take them. And so, it's going to take an all hands on deck type effort to get the word out.
Unger: It absolutely will. Dr. Scott, as speaker of the House, I'll let you have final words here today.
Dr. Scott: Well, Todd, as you heard, we covered a lot of important messages during this meeting. The thing that came close loud and clear to me that is even during this special meeting virtual format, during a pandemic, that the AMA House of Delegates sets the path forward for our patients and for our profession, and we will get through this together.
Unger: Well said. Well, thank you so much, Dr. Bailey, Dr. Scott and Dr. Egbert for the important work that you do on behalf of this nation's physicians. We'll be back soon with another COVID-19 Update. For resources on COVID-19 visit ama-assn.org/COVID-19. Thanks for joining us. Take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.