Published: May 4, 2018

AMA House of Delegates report: Issues impacting otolaryngology

The American Medical Association (AMA) held its 2017 Interim House of Delegates (HOD) Meeting in Honolulu, Hawaii, November 11-14.

Michael S. Goldrich, MD
Former Chair, AAO-HNS Delegation to the AMA House of Delegates

The American Medical Association (AMA) held its 2017 Interim House of Delegates (HOD) Meeting in Honolulu, Hawaii, November 11-14. Your Academy was represented by Michael Goldrich, MD, Delegation Chair; Robert Puchalski, MD, Delegate and Otolaryngology Section Council Chair; Douglas Myers, MD, Delegate; and James C. Denneny III, MD, AAO-HNS EVP/CEO, Alternate Delegate. Below is a summary of the meeting, highlighting a few of the many debated reports and resolutions most relevant to our specialty.

Modifier 25

In an issue relevant to all physicians, there is an effort by some payers to reduce by as much as 50 percent those Evaluation and Management services billed on the same date as procedures billed with a 25 Modifier. Such policies are already implemented (Independence, Harvard Pilgrim) or proposed (Anthem) in more than 16 states, and the AAO-HNS has communicated our concerns to these payers. The HOD passed policy, supported by the Academy, calling on the AMA to aggressively and immediately advocate on this issue via legislation, regulation, or litigation.


Though many of our member physicians are compensated by their hospitals for on-call availability and services, there are many hospitals that do not provide any “pay-for-call.” The AMA already had existing policy calling for hospitals and physicians to work collaboratively to develop solutions of compensation and other incentives to ensure on-call coverage. At the November meeting, stronger AMA policy was adopted, stating, “Physicians should be provided adequate compensation for being available and providing on-call and emergency services.” Also, the AMA will make available policy guidance for physicians to negotiate with hospital medical staffs to support physician compensation for on-call and emergency services.

Scope of Practice

The AAO-HNS has been an effective leader in the education of legislators and regulators regarding efforts by non-physician practitioners to inappropriately expand their scope of practice, relevant to their education and training. For our specialty, this patient protection has mostly been necessary due to scope expansion efforts within the audiology community. However, our advocacy has expanded to address other providers, including dentists, nurses, physician assistants, hearing aid dispensers, and chiropractors.

Most recently, there is an effort by advanced practice nurses to encourage state adoption of an APRN Compact to create multistate licensure privileges through an interstate commission. This effort would remove licensing decisions from state legislatures and Boards of Nursing and undermine existing laws requiring physician involvement in licensure and regulation.

Newly passed AMA policy supported by the AAO-HNS Delegation would establish a consistent national strategy through model legislation and public relations campaigns to: 1) Effectively oppose the continual, nationwide efforts to grant independent practice to non-physician practitioners; 2) Effectively educate the public, legislators, regulators, and healthcare administrators; and 3) Effectively oppose state and national level legislative efforts aimed at inappropriate scope of practice expansion of non-physician healthcare practitioners.

The next meeting of the AMA HOD is scheduled for June 9-13, 2018, in Chicago, IL. With questions regarding this report and other AMA HOD activities, please contact

More from May 2018 – Vol. 37, No. 4