SCCM Success at AMA House of Delegates Meetings

The American Medical Association (AMA) House of Delegates (HOD) meetings serve as a platform for reform, policy, and camaraderie among hundreds of voting members representing their states, specialties, and disciplines. Society of Critical Care Medicine (SCCM) members Tina R. Shah, MD, MPH; Kathleen Doo, MD, MHPE; Devang Sanghavi, MD, MHA; Daniel Udrea, MD; and Michael Nurok, MBChB, PhD, FCCM, represent the Society at AMA HOD meetings.
 
The HOD assembles twice each year. The annual meeting typically convenes in June, and an interim meeting typically convenes in November. At these meetings, the HOD creates broad policies on health, medical, professional, and governance issues, as well as the broad guiding principles for the conduction of the AMA’s business activities. These policies and resolutions adopted by the HOD guide the AMA’s advocacy efforts at all levels of government, from local to federal. SCCM and other medical societies work with the AMA to promote policies that align with the interests and needs of physicians and patients. These policies and resolutions are vital tools for advancing the medical profession’s priorities and improving public health outcomes. This article outlines the outcomes of the 2022 meetings and provides an update from the June 2023 meeting.
 
2022: Post-Intensive Care Syndrome Win at AMA Meeting
During the AMA’s June 2022 annual meeting, SCCM scored a major win when the AMA agreed to adopt a resolution related to post-intensive care syndrome (PICS). The SCCM delegation crafted this resolution, testified at the HOD, and gathered support from other organizations for more research, education, and funding on PICS. These efforts resulted in a letter from the AMA CEO to the U.S. Senate Appropriations Committee to advocate for PICS research and treatment. A new HOD policy was also adopted to support the development of an ICD-10 code or family of codes to recognize PICS.¹
 
From urging the federal government to prohibit smoking in public spaces to introducing anti-tobacco campaigns, the AMA has long fostered changes that have improved the health of critical care patients in the United States. The AMA HOD makes an impact through the production of sentinel reports across science, public health, and aspects of care delivery, as well as policy recommendations and advocacy with various stakeholders in the healthcare ecosystem. Specifically, policies and resolutions created by members (such as SCCM delegates) guide the AMA’s advocacy and public health efforts. Examples of past actions include declaring gun violence a public health crisis, introducing policies that support increasing firearm safety, advocating for transgender rights, opposing the repeal of the Affordable Care Act, and subjecting electronic cigarettes to the same regulations as regular cigarettes.²
 
Some of the AMA’s current priorities include comprehensive Medicare reform, fixing prior authorization-related problems, and supporting telehealth. Additionally, the AMA is reducing physician burnout by pushing for legislative and other solutions to help physicians and medical students seek personal care for wellness, burnout, fatigue, and depression.³
 
The November 2022 AMA HOD interim meeting was held in Honolulu. The SCCM delegation provided testimony and caucused with relevant groups to ensure that the perspective of SCCM’s multiprofessional organization of critical care experts was heard. The following topics, among others, were considered during this meeting and have now become policies awaiting action by AMA^4,5:
 

• Creating a national emergency cardiac care system: The Society for Cardiovascular Angiography and Interventions proposed a new framework for a national emergency cardiac care system to reduce high mortality rates and treatment disparities for cardiac emergencies among different sociodemographic groups. The AMA will explore how such a system (similar to stroke centers) can be created and implemented to standardize prehospital and inpatient care for cardiac emergencies.
• Advocating for a public option to expand health insurance: The AMA amended its previous policy H-165.823, which promotes measures such as autoenrollment to meet the health insurance coverage gap. The amendments focused on maximizing patient choice, expanding available health insurance options, increasing equity and access for uninsured people, encouraging marketplace competition, addressing cost-consciousness, and reducing the burden on physicians in a pluralistic healthcare system.
• Addressing structural racism inherent in pulse oximetry: SCCM has expressed concerns about the accuracy of pulse oximeters in patients with a high degree of skin pigmentation. Some research has shown a higher prevalence of occult hypoxemia and an associated increase in significant organ dysfunctions in these patients. The AMA will advocate to the U.S. Food and Drug Administration to ensure the provision of accurate and reliable readings when using pulse oximeters for all patients regardless of their degree of skin pigmentation.
• Addressing the physician shortage: In response to a projected shortfall in primary care physicians in the next decade, AMA passed a broad set of policies, including working with relevant stakeholders to increase positions and upgrade education strategies in graduate medical education, expanding opportunities for physician retention, and emphasizing a robust rural workforce to meet the rising demand for physicians.
• Categorizing gun violence as a public health crisis: The AMA has declared gun violence a public health crisis and has established a task force to address it. The task force will focus on developing violence prevention programs and evidence-based solutions to end firearm violence.
• Increasing awareness about the health consequences of climate change: The AMA has declared that climate change is a major public health threat and harms patients. Climate change is causing an increase in allergies, asthma, and respiratory and cardiovascular diseases, among others. To combat this, AMA is calling for the U.S. healthcare sector to take action to reduce greenhouse gas emissions and become carbon neutral. The AMA aims to reduce greenhouse gas emissions by 50% by 2030 and to achieve carbon neutrality by 2050. The organization is also taking further steps to reduce the environmental impact of healthcare.
• Diversifying the pipeline of physicians in the medical profession: The AMA is advocating for the expansion of pathway programs to diversify the medical profession and improve healthcare. The programs provide comprehensive educational support and enrichment to underrepresented middle school, high school, and college-aged students to help them prepare for a career in medicine.

 
June 2023 AMA HOD Annual Meeting
 
At the June 2023 AMA HOD annual meeting, Drs. Udrea, Shah, Doo, Sanghavi, and Nurok provided online and in-person testimonies and reviewed 267 business items, including 42 reports and 225 resolutions. Some of the key policies from the meeting, where your SCCM delegates provided testimony and caucused with relevant groups, were^6,7:
 

• Allowing opioid reversal medications in educational institutions: According to the Centers for Disease Control and Prevention’s provisional data issued in May 2022, more than 107,000 deaths occurred in 2021 due to drug overdose, a significant portion of which were opioid-related deaths. During the 2023 AMA HOD annual meeting, your SCCM delegates actively participated in passing a policy that directs the AMA to encourage states, communities, and educational settings to remove barriers to students carrying safe and effective reversal medications such as naloxone and making these medications readily accessible in order to prevent opioid overdose deaths.
• Increasing access to environment-friendly MDI options: The environmental impact of metered dose inhaler (MDI) propellants, particularly as emitters of greenhouse gases, has been recently studied. Frequent shortages of non-hydrofluorocarbon-containing MDI options and the patenting of new propellants further decrease their accessibility. Based on the reference committee hearing, a resolution was taken that AMA would study such climate effects of MDI propellants, explore options for reducing hydrofluorocarbons in the medical sector, and take strategic initiatives to encourage the development of alternative inhalers with equal efficacy.
• Removing racial and financial barriers to organ transplant: In an attempt to remove barriers to organ transplantation for eligible recipients, a resolution was taken that AMA will support initiatives toward laying the foundation for a model blinded to citizenship and financial needs. Regardless of insurance, social or immigration status, or patient contribution to illness, all transplant-eligible patients who can follow transplant center-specific protocols, including post-transplant care, will benefit from such initiatives. Moreover, by a recent amendment, another resolution encouraged the active involvement of physicians in promoting awareness of an increase in the organ donor pool by ethical means.
• Mattress safety in the hospital setting: This initiative focuses on the importance of appropriate beds, mattresses, and overlays for treating and preventing pressure ulcers in hospital settings. While attempts at improving outcomes related to these metrics are ongoing, a resolution was passed that AMA will collaborate with the relevant stakeholders to mitigate infections related to hospital bed and mattress use.
• Increasing availability of Medicare and Medicaid Services-related research data: A resolution was taken that AMA will advocate for compliance with Section 105(b) of the Medicare and CHIP Reauthorization Act of 2015 in order to provide timely and cost-effective access to Medicare claims-related data for research. This initiative supports data-driven clinical research in evidence-based practice. Through the resolution amendments, AMA will support reduced pricing of limited datasets for academic, nonprofit, and government researcher use.

 
Moving forward, your SCCM delegates will be working closely with the American Thoracic Society and American College of Chest Physicians to bring resolutions to the AMA’s November 2023 interim meeting. Some of the following topics are being actively discussed for potential advocacy: geographic strategies toward balancing patient flow between area hospitals in preparation for future pandemics, addressing violence in the workplace, and post-sepsis syndrome. Your delegates welcome further commentary or discussion on these or other topics.
 
Additional authors: Daniel Udrea, MD; Michael Nurok, MBChB, PhD, FCCM

References:

1. American Medical Association. 2022 Annual Meeting. Appendix: Reports of reference committees. 2022. Accessed September 20, 2023. https://www.ama-assn.org/system/files/a22-reference-committee-reports.pdf
2. American Medical Association. AMA continues efforts to prevent tobacco use. Press release. November 15, 2017. Accessed September 20, 2023. https://www.ama-assn.org/press-center/press-releases/ama-continues-efforts-prevent-tobacco-use
3. American Medical Association. AMA advocacy efforts. Updated June 22, 2023. Accessed September 20, 2023. https://www.ama-assn.org/delivering-care/patient-support-advocacy/ama-advocacy-efforts
4. O’Reilly KB. Highlights from the 2022 AMA Interim Meeting. American Medical Association. November 17, 2022. Accessed September 20, 2023. https://www.ama-assn.org/house-delegates/interim-meeting/highlights-2022-ama-interim-meeting
5. American Medical Association. 2022 Interim Meeting. Memorial resolutions adopted unanimously. Accessed September 20, 2023. https://www.ama-assn.org/system/files/i22-resolutions.pdf
6. American Medical Association. Highlights from the 2023 AMA annual meeting. June 14, 2023. Accessed September 20, 2023. https://www.ama-assn.org/house-delegates/annual-meeting/highlights-2023-ama-annual-meeting
7. American Medical Association. Business of the AMA House of Delegates annual meeting. Updated August 11, 2023. Accessed September 20, 2023. https://www.ama-assn.org/house-delegates/annual-meeting/business-ama-house-delegates-annual-meeting