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Pediatric issues, COVID among topics discussed at AMA meeting

January 2, 2022

Efforts to strengthen public health, combat the spread of disinformation by health professionals and support licensed physicians as the sole grantors of medical vaccine exemptions were endorsed by the American Medical Association (AMA) House of Delegates in response to the COVID-19 pandemic at its November special meeting.

The House of Delegates also tackled several issues related to pediatrics.

  • AMA policy that supports and advocates for the extension of Medicaid and Children’s Health Insurance Program maternal health care coverage to 12 months after the end of pregnancy now includes this postpartum coverage for non-citizen immigrants.
  • The “Confidential Health Services for Adolescents” policy was amended to address telehealth. It encourages physicians in a telehealth setting to require a separate examination and counseling for the adolescent, and to ensure that the patient is in a private space.
  • The policy “Considering Feminine Hygiene Products as Medical Necessity” was strengthened to support the coverage of menstrual hygiene products and diapers by public assistance programs. It also encourages public and private institutions, as well as places of work and education to provide free, readily available menstrual care products to workers, patrons and students.

Response to pandemic

Prior to the COVID-19 pandemic, U.S. public health agencies had sounded the alarm that lack of funding was hampering their ability to keep the country safe from disease and public health emergencies.

“The COVID-19 pandemic did not create these problems, but it inarguably exposed the cracks that had long existed in our public health infrastructure,” according to a report authored by the AMA’s Council on Science and Public Health that was accepted at the virtual meeting. “For decades, public health professionals have been advocating for greater resources to plan and prepare for just such a crisis.”

Key recommendations in the report direct the AMA to do the following:

  • Advocate for consistent, sustainable funding to support public health infrastructure.
  • Work with the Federation of Medicine and other stakeholders to strongly support the legal authority of health officials to enact reasonable, evidence-based public health measures, including mandates when necessary, to protect the public from serious illness, injury and death, and actively oppose efforts to strip such authority from health officials.
  • Advocate for public health data modernization and data-governance efforts, as well as efforts to promote interoperability between health care and public health.

Health professionals who recommend unproven cures for COVID-19 are endangering patients. When they make claims or observations that are deliberately contrary to prevailing evidence, it becomes unprofessional conduct. To address these challenges, the House of Delegates directed the AMA to collaborate with health professional societies and other stakeholders to combat public health disinformation disseminated by health professionals in all forms of media and address disinformation that undermines public health initiatives.

AMA policy states that nonmedical (religious, philosophic or personal belief) exemptions from immunizations endanger the health of individuals and communities. The policy was amended to state that only a licensed physician be allowed to grant a medical exemption to immunizations, as there are legitimate concerns regarding the qualification of nonphysicians to authorize medical exemptions for vaccines, despite being permitted to do so in some states.

Billing, payment issues

A resolution was adopted that addresses health insurance industry consolidation and use of its growing market share to unfairly promulgate unilateral billing rules for physicians and medical practices, including new payment policies that unfairly deny or unreasonably reduce payments.

Effective Jan. 1, 2021, the Centers for Medicare & Medicaid Services adopted updated Current Procedural Terminology (CPT) evaluation and management (E/M) codes for office visits. The codes aim to lessen the administrative burden of documentation and coding; reduce the need for audits and medical record documentation that are unnecessary for patient care; and ensure that payment for E/M is resource-based. Primary care practices are under financial strain due to COVID, and these coding updates are a welcome improvement.

The AMA has been working with electronic health record vendors, medical specialties and payers to educate them about the changes. (See AAP News articles on the CPT coding changes at https://bit.ly/3otiU4Vhttps://bit.ly/3otixHz and https://bit.ly/3rGRY3u.)

The AMA also has heard from members that many payers have not implemented these updates, often resulting in CPT down-coding. In response, the House of Delegates adopted a resolution that directs the AMA to step up its ongoing review of the proper use of the AMA CPT codes and vignettes in medical billing claims payments and misuse by the U.S. health insurance industry. Additionally, it asks that the “AMA undertake as soon as practical, a formal, legal review of ongoing grievous behaviors of the health insurance industry, including a search for potential litigation partners across the medical federation.”

Dr. Barone is chair of the AAP delegation to the AMA House of Delegates.

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