September 2016 - Vol. 35, No. 8

Issues impacting otolaryngology

Liana Puscas, MD, MHS
Chair, AAO-HNS Delegation to the AMA House of Delegates

The American Medical Association (AMA) House of Delegates (HOD) held its annual meeting in Chicago in June. Your Academy was represented by Liana Puscas, MD, delegation chair; delegates Shannon P. Pryor, MD, and Robert Puchalski, MD; and alternate delegate James C. Denneny III, MD, AAO-HNS/F EVP/CEO.

Code of Medical Ethics

The AMA passed a modernized update of its Code of Medical Ethics. One of the main reasons for the founding of the AMA in 1847 was to create an ethical code by which reputable, well-trained physicians would abide. As medical education and professional regulation was much less stringent at that time, a group of physicians felt that standards for preliminary and medical education and ethical medical practice were necessary. The modernizing of the code has been an almost decade-long process with opportunity for input from all specialties, states, and individual physicians.

MACRA (Medicare Access and CHIP Reauthorization Act) implementation

Andrew M. Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, spoke to the HOD outlining CMS’ plans for MACRA. He identified four principles that were clearly understood by CMS after numerous discussions with physician groups, including the AMA and other organized medical societies. These principles were:

  1. Be patient-centered without disrupting practices and increase interoperability, requiring electronic health record (EHR) vendors to open up their platforms/software to allow easier reporting across requirements.
  2. Allow physician practices the flexibility to drive how they use the program.
  3. Consider the special needs of small or rural practices or those in underserved areas.
  4. Simplify the requirements as much as possible.

Mr. Slavitt also reported that CMS reduced by one-third the number of measures that will need to be reported. In addition, much of the advancing care information would be simplified to attestation; physicians could report as a group and be assessed as a group; and by simply being involved in an Alternative Payment Model (APM), a physician could receive credit for various aspects of the program.

USP compounding

The AAO-HNS, the American Academy of Otolaryngic Allergy (AAOA), the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), and many other societies sponsored a resolution overwhelmingly supported by the HOD relating to in-office physician compounding. The U.S. Pharmacopeial Convention (USP) recently proposed changes that would restrict the compounding of drugs solely to pharmacists and would prohibit the use of compounded allergen extract stock beyond its “use by” date. This proposed change would severely limit in-office compounding or drug preparation, particularly impacting otolaryngologists who provide allergy immunotherapy. The USP is accepting public comments on this proposed change, and Academy Members are strongly urged to provide comments describing the prohibitive cost and access to care issues that will result if these rules are implemented.

Other resolutions

The Academy delegation and the Otolaryngology Section Council also closely monitored the debate on resolutions addressing: physician-focused APMs through CMS; the development of specialty-appropriate access to care measures; advocacy on behalf of physicians with regard to hospital-sponsored EHRs; specialty society representation in the HOD; the future of mandatory recertifying examinations; and regulation of electronic nicotine delivery systems.

The next meeting of the AMA HOD will be November 12-15 in Orlando, Florida. With questions regarding this report and other AMA HOD activities, please contact