AMA House Punts on Texas Plan to Fix QPP
By Steve Levine

A decision on whether the American Medical Association (AMA) will join the Texas Medical Association’s call for major changes to Medicare’s Quality Payment Program (QPP) will have to wait a few more months, the AMA House of Delegates decided at its annual meeting in Chicago last week. 

The QPP overhaul was just one of 11 resolutions the Texas delegation to the AMA took to the five-day meeting. Most of the other 10 received a very warm welcome. 

The most extensive policy proposal the Texans took to Chicago was Resolution 243, which grew out of TMA’s critical review of the shortcomings of the Centers for Medicare & Medicaid Services (CMS) report on the first-year of the QPP. The resolution laid out a detailed case for what’s missing in that report – and why it poses a danger if it’s accepted as a definitive portrayal of the QPP’s first year. It directed AMA to “strongly advocate” for changes to QPP laws and regulations to reduce the burden and financial risk the program puts on physicians, especially those in small and rural practices. 

During debate over Resolution 243, the delegates learned that the AMA Board of Trustees is developing a comprehensive report on the QPP for the house to consider at its 2019 interim meeting in November. The delegates voted to make Resolution 243 part of that upcoming report “as it would be premature for the House of Delegates to weigh in prior to the Board of Trustees’ deliberations.” 

The house adopted these five resolutions exactly as the Texas delegation submitted them:

• Resolution 228 directs AMA to work with state medical societies to “authorize only the use of titles and descriptors that align with the nonphysician providers’ state issued licenses.”
• Resolution 023 begins with this gut-punch statement: “Human trafficking is slavery.” It asks AMA to adopt as policy “that readily visible signs, notices, posters, placards, and other readily available educational materials providing information about reporting human trafficking activities or providing assistance to victims and survivors be permitted” in clinics, emergency departments, and other medical settings. AMA issued a news release touting this new policy.
• Resolution 024 advocates that AMA recommend that physicians use the term “intellectual disability” instead of “mental retardation” in clinical settings. The resolution points out that self-advocates began the campaign to “eliminate the pejorative and dehumanizing word ‘retarded’ from the public vernacular.”
• Resolution 242 directs AMA to work with health information technology vendors so their products “treat patients equally and appropriately, regardless of sexual or gender identity.”
• Resolution 323 calls on AMA to promote awareness of and remove barriers to the use of Project ECHO (Extension for Community Healthcare Outcomes) and similar programs that bring specialists’ expertise to distant primary care physicians in underserved areas. 

Two of the Texas resolutions went through some editing before the House of Delegates adopted them:

• Resolution 221 asked AMA to “support and actively work toward enactment” of state and federal legislation that would extend a new mother’s Medicaid coverage from the current 60 days to a full 12 months postpartum. The house combined this and a similar resolution into one new statement directing AMA to “work with relevant stakeholders to support extension of Medicaid coverage to 12 months postpartum.” Extending Medicaid coverage for new mothers was a critical but unsuccessful part of TMA’s agenda during the recently completed session of the Texas Legislature.
• Resolution 129 directed AMA to “study the implications of prescription drug importation for personal use and wholesale prescription drug purchase across our southern and northern borders.” In its place, the delegates adopted new policy saying AMA would support personal importation of prescription drugs only if they meet four standards designed to protect patient safety and product quality. 

Resolution 131 directed AMA to push CMS to update the practice expense component of Medicare’s relative value unit (RVU) system “so it accurately reflects current physician practice costs.” Given the $5 million estimated cost of that project, delegates asked the AMA Board of Trustees to make a final decision on whether to undertake it. 

Finally, for three of the Texas resolutions, the delegates decided to reaffirm existing AMA policy, which they said already covered the concerns those resolutions addressed:

• Resolution 130 called on AMA to lobby for federal legislation requiring patients be notified of any change in the manufacturer of their generic drugs.
• Resolution 716 asked AMA to “vigorously oppose” health plans’ exclusive use of software to analyze and audit, approve or not approve, and pay or not pay claims based just on the diagnosis code, CPT codes, and modifier codes on the claim form, with no review of the patient’s medical record.
• Resolution 715 asked AMA to advocate for primary care physicians to be able to remove from their Medicare Advantage panels patients with whom they have been “unable to establish a patient-physician relationship, despite multiple documented attempts.”