2014 HOUSE OF DELEGATES Updated: 2/25/2015 Chairman: Glenn Fussell, M.D. Staff: Susan Moore/Patricia Yeatts

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1 Reference Committee A 2014 HOUSE OF DELEGATES Updated: 2/25/2015 Chairman: Glenn Fussell, M.D. Staff: Susan Moore/Patricia Yeatts Title/Action Referral Status Completed Resolution 101A.14 (Transparency and Labeling of Generic Medications) Adopted as amended, that the Medical Association of Georgia (MAG) delegation to the American Medical Association (AMA) House of Delegates present a resolution requesting the AMA to pursue the transparency of prescribing generic drugs by ensuring that generic drugs are adequately labeled according to FDA requirements, including FDA bioequivalence data in the package insert. AMA Delegation (Patricia Yeatts) A resolution was drafted and submitted to the AMA for its consideration at the 2014 AMA Interim meeting held in Dallas, Texas. The AMA took the following action on resolution 101A: Policy H reaffirmed in lieu of Resolution 224. Resolution 102A.14 (Cancellation of MOC Program for Physicians Certified Before 1990) Title Change: Cancellation of MOC Program. Adopted by floor substitution that due to the overwhelming consensus of physicians that the current Maintenance of Certification (MOC) is ineffective, time-consuming, and economically burdensome, it is recommended that the Medical Association of Georgia (MAG) delegation to the American Medical Association (AMA) House of Delegates strongly encourage the AMA to support cancelling the current MOC program for physicians and utilize CME as currently required. AMA Delegation (Patricia Yeatts) A resolution was drafted and submitted to the AMA for its consideration at the 2014 AMA Interim meeting held in Dallas, Texas. The AMA took the following action on Resolution 102A: Substitute Resolution 920 adopted as amended in lieu of Resolutions 920, 926, 928, and 929, and the 10th bullet of Resolve 1 (about specialty boards being independent from entities designing the curriculum) referred. 1. amend the Policy H , Principles on Maintenance of Certification (MOC), to include the following: MOC should be based on evidence and designed to identify performance gaps and unmet needs, providing direction and guidance for improvement in physician performance and delivery of care.

2 Resolution 102A.14 (Cancellation of MOC Program) Cont. The MOC process should be evaluated periodically to measure physician satisfaction, knowledge uptake and intent to maintain or change practice. MOC should be used as a tool for continuous improvement. The MOC program should not be a mandated requirement for licensure, credentialing, reimbursement, network participation, or employment. Actively practicing physicians should be well-represented on specialty boards developing MOC. MOC activities and measurement should be relevant to clinical practice. The MOC process should not be cost prohibitive or present barriers to patient care. 2. encourage specialty boards to investigate and/or establish alternative approaches for MOC. 3. prepare a yearly report regarding the maintenance of certification process. 4. work with the American Board of Medical Specialties to eliminate practice performance assessment modules, as currently written, from the requirement of MOC. Resolution 103A.14 (Choosing Wisely Initiative) Adopted as amended, that the Medical Association of Georgia (MAG) agrees with the AMA in supporting the concepts of the American Board of Internal Medicine Foundation's "Choosing Wisely" program. Advocacy Communication (Susan Moore) Reference Committee A 2

3 Resolution 104A.14 (Cost of Meaningful Use Passed Onto Patients) Adopted as amended, that the Medical Association of Georgia (MAG) encourage the American Medical Association (AMA) to pursue legislation allowing all physicians to charge administrative surcharges outside of their contracts with insurance companies that can be used to cover the additional costs of regulatory requirements. AMA Delegation (Patricia Yeatts) Resolution 105A.14 (Expansion of Practice) DID NOT ADOPT, that the Medical Association of Georgia (MAG) educate members that OCGA (f) does not require a physician or APRN to be party to a nurse protocol agreement in order to receive reimbursement for medical treatment; and that MAG will oppose expansion of scope of practice for APRN performance of medical acts outside of physician requested acts that may be delegated. (Editorial Note: Retained current policies , , and ) No Referral It was decided that MAG retained current policies , , 360,986 and in lieu of new policy. No further action required. Resolution 106A.14 (Electronic Medical Records Waiver Policy) DID NOT ADOPT, that Medical Association of Georgia (MAG) support that physicians who are not comfortable with the use of electronic medical records (EMR) be granted a waiver allowing them to not use EMR with no financial consequences punishment or fine. (Editorial Note: Addressed in 110.A adopted as amended) No Referral MAG HOD adopted Resolution 110A in lieu of Resolution 106A pertaining to the same subject matter. No further action required Reference Committee A 3

4 Resolution 107A.14 (Maintenance of Certification) DID NOT ADOPT, that the Medical Association of Georgia (MAG) opposes the continuation of the American Board of Medical Specialties Maintenance of Certification and the American Osteopathic Association Osteopathic Continuous Certification programs. (Editorial Note: Addressed in 102.A adopted by HOD substitution) No Referral The HOD by substitution adopted Resolution 102A in lieu of Resolution 107A which addressed the same subject matter. No further action required. Resolution 108A.14 (Maintenance of Licensure) Adopted original resolve, that the Medical Association of Georgia (MAG) opposes any effort by the Georgia Composite Medical Board to adopt, use, or require the Federation of State Medical Boards Maintenance of Licensure (MOL) program as a condition of licensure on this basis. Council on Legislation Policy Statement: MAG opposes any efforts to use or require the Federation of State Medical Board Maintenance of Licensure (MOL) program as a condition of licensure. Resolution 109A.14, (Normal Saline Limitations) Adopted as amended, that the Medical Association of Georgia (MAG) educate physicians and the public about the drug and intravenous fluids shortages and the impact they are having on patient care delivery. Advocacy Education and Communication (Susan Moore) MAG received correspondence from Baxter Pharmaceuticals on the shortage. The message was posted on MAG's Web site and published in enews From MAG. Reference Committee A 4

5 Resolution 110A.14 (Preservation of Small Practices) Adopted as amended Resolve 1, that the Medical Association of Georgia (MAG) take positive action to retain private practices in Georgia and across the country. Adopted as amended Resolve 2, that the MAG Delegation to the American Medical Association (AMA) submit a resolution to the AMA House of Delegates that includes language: (1) encouraging physicians to maintain their private practices; (2) advocating for waivers for private practices to continue to use non-electronic medical records with no financial penalty; and (3) eliminating noncompete clauses for physicians who join hospital groups. AMA Delegation (Patricia Yeatts) A resolution was drafted and submitted to the AMA for its consideration at the 2014 AMA Interim meeting held in Dallas, Texas. The AMA took the following action on Resolution 110A: Policies D , H , and E-9.02 reaffirmed in lieu of Resolution 223. Resolution 111A.14 (Country of Origin for Prescription Medications) DID NOT ADOPT resolution 111A calling for MAG to urge AMA to support labeling of all prescription medication by country of origin. (Editorial Note: Addressed in 101.A adopted as amended) No referral It was decided by the House of Delegates to adopt Resolution 101A as amended in lieu of Resolution 111A which addressed the same subject matter. Reference Committee A 5

6 Resolution 112A.14 (Prior Approval Requirements of Insurance Companies) Adopted by substitution, that the Medical Association of Georgia advocate for a standardized prior approval process and that physicians may charge an administrative surcharge for prior approval outside of their contracts. Council on Legislation Scott Bohlke, M.D., Michael E. Greene, M.D., and Donald Palmisano spoke at an October conference on e- prescribing held in California. Manoj Shah, M.D., is scheduled to speak at an event in April 2015 in Philadelphia. Resolution 113A.14 (Maintenance of Certification) Adopted original Resolve 1, that the Medical Association of Georgia (MAG) opposes any efforts to require Maintenance of Certification (MOC) as a condition of medical licensure, or as a pre-requisite for hospital/staff privileges, employment in State of Georgia medical facilities, reimbursement from third parties, or issuance of malpractice insurance. Council on Legislation Policy Statement MAG opposes any efforts to require Maintenance of Certification (MOC) as a condition of medical licensure, or as a pre-requisite for hospital staff privileges, employment in State of Georgia medical facilities, reimbursement from third parties, or issuance of malpractice insurance. Adopted original Resolve 2, that MAG advocates that the lack of specialty board recertification should not restrict the ability of the physician to practice medicine in Georgia. Policy Statement MAG opposes the restriction of physicians to practice medicine in Georgia based on the lack of a specialty board recertification. Reference Committee A 6

7 Policy , (Treatment of Minors) Title/Action Referral Status Completed Reaffirmed policy , that MAG believes physicians should be allowed to treat minors for venereal disease or drug abuse, or suspected venereal disease or drug abuse, without being required to have prior parental consent for such treatment. The physician may elect to advise the parents of the treatment given, but should not be required to do so. MAG supports the position that any individual 18 years of age or over may give consent for medical or surgical treatment, and that any female may give such consent regardless of age or marital status when in connection with pregnancy or childbirth. (Reaffirmed 5/1/2000; 10/17/2009) Administration Policy will be recorded as reaffirmed by the House of Delegates in October Reference Committee A 7

8 Reference Committee C 2014 HOUSE OF DELEGATES Updated: 2/25/2015 Chairman: Cody McClatchey, M.D. Staff: Marcus Downs/Ryan Larosa Title/Action Referral Status Completed Resolution 301C.14 (Interstate Medical License Compact) Referred to the Board of Directors for a decision, that the Medical Association of Georgia (MAG) supports the Federation of State Medical Boards (FSMB) Interstate Compact allowing for expedited physician licensure if its amended to ensure complete state autonomy and address the many concerning clauses including, but not limited to, the state of principle license clause; the broad executive meetings clause; the commission s ability to promulgate rules that are binding on all member states; the state withdrawal requirements; and the judicial review clause. Board of Directors (Donald Palmisano) Resolution 302C.14 (Stabilized Patients on Biologic Medications) Adopted, that the Medical Association of Georgia (MAG) oppose any insurance program that requires patients stabilized on biologic therapy to be required to switch to another biologic medication. No Referral Policy Statement MAG shall oppose any insurance program that requires patients stabilized on biologic therapy to be required to switch to another.

9 Resolution 303C.14 (Support for Georgia Drug Monitoring Program) Adopted by substitution as amended from the floor that: 1) the Medical Association of Georgia actively support the legislature, securing funding by fiscal year 2015, to continue the Georgia Prescription Drug Monitoring Program (GA PDMP); 2) that the Medical Association of Georgia work in conjunction with the Georgia Composite Medical Board and Georgia Drug and Narcotics to secure additional funding outside of the legislature to ensure the viability of the GA PDMP after September 15, 2015; 3) that the Medical Association of Georgia Foundation as part of the Think About It campaign, market the benefit of the GA PDMP to all Georgia physicians; 4) that MAG work to allow delegate authority for accessing the GA PDMP; and 5) that MAG work to allow information indentified in the GA PDMP about a patient to be incorporated into that patient's medical record. Council on Legislation MAG has approached the Georgia Pharmacy Association to work toward achieving this directive. MAG met with representatives of the Georgia Drug and Narcotics on continued funding. Reference Committee C 2

10 Resolution 304C.14 (Biosimilar Medications) Adopted as amended, that the Medical Association of Georgia (MAG) promote legislation or regulation addressing prescribing issues for biologics, including: 1) a requirement ensuring that if a brand biologic medication is prescribed to a patient, that patient receives the specific brand medication; 2) notification of both the physician and patient before any biosimilar medication, either interchangeable or non interchangeable, is substituted for a biologic medication; 3) a non-interchangeable biosimilar is not allowed, a substitution must be done with an interchangeable biosimilar and not a non interchangeable biosimilar; and 4) a requirement that pharmacists and prescribers retain records of patients who receive biosimilars for a set period of time. Resolution 305C.14 (E-Prescribing) Adopted resolve 1, that the Medical Association of Georgia (MAG) advocate to the Georgia Board of Pharmacy to amend Georgia Rule so that the language is consistent with the language found in O.C.G.A and Adopted resolve 2, that MAG will work with the Legislature and Georgia Board of Pharmacy to allow and streamline the e-prescribing process for physicians. Advocacy Legislation/Regulatory Council on Legislation MAG is working with the Coalition on Biosimilars and met with sponsors of a potential bill prior to the legislative session. The Board of Directors on January 31, 2015 authorized MAG lobbyists to negotiate on a legislative bill that will provide notification up to a 48-hour requirement when substitutions are made on biosimilar medications with other biosimilars. Reference Committee C 3

11 Resolution 306C.14 (Extending the Medicaid Primary Care Pay Parity) Adopted resolve 1, that the Medical Association of Georgia (MAG) support legislation that extends the Medicaid Primary Care Pay Parity Program. Adopted resolve 2, that MAG support obstetrician/gynecologists being included in the Medicaid Primary Care Pay Parity Program. Council on Legislation MAG is working with the primary care specialties on this issue. MAG met multiple times with the Office of Planning and Budget, Governor's office and chairs of appropriate committees. Resolution 307C.14 (Georgia License for Expert Witnesses) Adopted as amended, that the Medical Association of Georgia strongly support any proposed legislation that all medical experts maintain a full or modified license in Georgia. Council on Legislation Policy Statement: MAG supports any proposed legislation that all medical experts maintain a full or modified license in Georgia. Resolution 308C.14 (New Medical Education Requirements for State Licensure) Referred to the Board of Directors that: 1) the Medical Association of Georgia (MAG) support FSMB Resolution 13-2 requiring applicants for licensure to have completed 36 months of progressive graduate medical education; and 2) that MAG does not support FSMB Resolution that recommends shortening the duration of undergraduate medical education from four years to three years. Board of Directors (Donald Palmisano) Reference Committee C 4

12 Resolution 309C.14 (Ordering a Prescription Drug Under Protocol) Referred as amended to the Board of Directors that: 1) the Medical Association of Georgia (MAG) adopt a policy that APRNs cannot prescribe drugs for treatment of an unconfirmed medical diagnosis and that this policy will supersede all other MAG policy; 2) that MAG support correction of present statute to clarify the distinction between prescribing and issuing a drug order or ordering a drug for the treatment of a previously established medical diagnosis; 3) that MAG adopt a policy that APRNs are trained to enter a nursing diagnosis for a patient and cannot enter an un-established medical diagnosis for a patient; this policy will supersede all other MAG policy; and 4) that MAG supports for APRNs to be governed by the Georgia Composite Medical Board. Board of Directors (Donald Palmisano) Resolution 310C.14 (Retention of Family Medicine Physicians in Georgia) Adopted by substitution, that the Medical Association of Georgia (MAG) will work closely with Georgia s primary care physicians including academic program directors to create economic incentives that will attract and retain primary care physicians in sufficient numbers in the state of Georgia by or before Advocacy Legislation/Regulatory MAG will continue to work with Area Health Education Center (AHEC) on these issues. Reference Committee C 5

13 Resolution 311C.14 (Network Adequacy) Adopted resolve 1, that the Medical Association of Georgia (MAG) support a requirement that all health insurance plans are regulated to ensure network adequacy by requiring insurers to provide transparency regarding the methodology for physician selection in health insurance networks and sufficient quality patient access to all physician specialties. Administration Policy Statement: MAG supports requirements that all health insurance plans are regulated to ensure network adequacy by requiring insurers to provide transparency regarding the methodology for physician selection in health insurance networks and sufficient quality patient access to all physician specialties. Adopted resolve 2, that MAG will work with the Georgia Insurance Commissioner and insurers on developing a plan to make certain that health insurance networks are regulated properly to govern the adequacy of the networks ensuring that the networks are vast enough to address the growing patient volume and provide sufficient quality patient access to all physician specialties, and requiring insurers to provide transparency regarding the methodology for physician selection in health insurance networks. Advocacy Legislation/Regulatory MAG, working with the Allied Health Professionals, have drafted a bill to address network adequacy. MAG continues to meet with the Commissioner of Insurance on this issue and support Physicians Advocacy Institute in its work with the National Association of Insurance Commissioners. Reference Committee C 6

14 Resolution 312C.14 (Expansion of Vaccination Protocol by Pharmacies) Adopted resolve 1, that the Medical Association of Georgia (MAG) not support expansion of prescriptive authority to prescribe and administer vaccines by blanket protocol beyond the current administration of the annual influenza vaccine. Advocacy Legislation/Education Policy Statement: MAG opposes expansion of prescriptive authority in prescribing and administering vaccines by blanket protocol beyond the current administration of the annual influenza vaccine. Adopted resolve 2, that MAG endorses vaccine education by all members of the medical team including pharmacists. Adopted resolve 3, MAG endorses appropriate reimbursement for vaccine costs and administration. Resolution 313C.14 (Hydrocodone Combination product Prescribing Authority for Emergency Department advanced Practice Providers) DID NOT ADOPT Resolution 313C calling for MAG, in conjunction with the Georgia College of Emergency Physicians (GCEP), support legislation or regulation that would give emergency department based advanced practice registered nurses and physician assistants the authority to prescribe limited amounts of Hydrocodone combination products within schedule II in compliance with O.C.G.A No referral No further action required Reference Committee C 7

15 Resolution 314C.14 (Rescheduling of Hydrocodone Combination Products to Schedule II) DID NOT ADOPT Resolution 314C calling for MAG's delegation to the AMA House of Delegates strongly encourage the AMA to vigorously object to the rescheduling of Hydrocodone combination products (HCPs) from Schedule III to Schedule II. No referral No further action required Reference Committee C 8

16 Reference Committee F 2014 HOUSE OF DELEGATES Updated: 2/25/2015 Chairman: Robert Jones, M.D. Staff: Sally Jacobs Title/Action Referral Status Completed Officer (Treasurer) Filed the report of the Treasurer (Officer 04.14) No referral The Report of the Treasurer will be recorded with the official proceeding of the 2014 House of Delegates. Resolution 401F.14 (Creation of the AMA Super PAC) Adopted, that the Medical Association of Georgia (MAG) delegation to the American Medical Association (AMA) House of Delegates submit a resolution asking that: AMA Delegation (Patricia Yeatts) A resolution was drafted and submitted to the AMA for consideration at its 2014 Interim meeting held in Dallas, Texas. The AMA referred this resolution with a report back to the 2015 annual meeting. 1) The AMA create and provide significant initial funding for a new subsidiary, the AMA Super PAC, to participate in independent expenditures for or against candidates for federal office. 2) The AMA Super PAC only supports candidates that have already been endorsed by AMPAC at the recommendation of state medical society PACs. 3) The AMA Board of Trustees determines the structure, organizing principles, name, membership and terms of office of the Organizing Board of Directors of the AMA Super PAC. 4) The AMA Board of Trustees determines the amount of funds to be dedicated annually to the AMA Super PAC.

17 Resolution 401F.14 (Creation of the AMA Super PAC) Conti. 5) The AMA Super PAC Board of Directors be responsible for determining the allocation of monies for independent expenditures, actively participate in all operational decisions regarding the independent expenditures and develop a plan to encourage contributions from other entities eligible to contribute to the Super PAC for the purposes of advancing the AMA s agenda for our patients and our profession. 6) The AMA Board of Trustees report back at A- 15 with recommendations for the new AMA Super PAC. Reference Committee F 2

18 Reference Committee HC 2014 HOUSE OF DELEGATES Updated: 2/25/2015 Chairman: Stephen Jarrard, M.D. Staff: Kate Boyenga/Trey Reese Title/Action Referral Status Completed Officer 01.14, Recommendation 1 (President's Report) DID NOT ADOPT recommendation 1 calling for MAG to support a pilot/demonstration project lasting five years allowing multispecialty clinics the ability to purchase a single specialty practice with a LNR ASC without having to go through the certificate of need process. Those practices participating in the pilot are allowed to keep functioning as the practices under a permanent exemption did under the pilot if the study results show the pilot/demonstration pilot was detrimental to the community. No referral No further action is required on this recommendation. Officer 01.14, Recommendation 2 (President's Report) Adopted by substitution recommendation 2, that the Medical Association of Georgia continue to promote and advance the goals of maintaining physician autonomy in their choice of practice environment and maintain patient access to affordable and quality care by seeking significant reformation or repeal of current Certificate of Need (CON) laws by: Advocacy Legislation/Regulatory 1) acquiring and analyzing data on CON laws which restrict physicians in their practices, including single and multi-specialty ambulatory surgical procedure and imaging centers, laboratories, and ancillary services;

19 Officer 01.14, Recommendation 2 (President's Report) Cont. 2) obtain specific case examples how current laws have negatively affected physicians, their practices and their patients from a lack of access to affordable care and regulatory restrictions; 3) actively develop alliances and align the support of similarly situated stakeholders to build consensus; and 4) develop a strategic plan to report to the 2015 House of Delegates on the analysis performed. Resolution 701HC.14 (Establishment of an Assistant Physician as a Provider of Primary Care) Referred to the Board of Director for a decision, that the Medical Association of Georgia (MAG) facilitate legislation that would allow MDs, MBBSs, and DOs with ECFMG certification to work under the supervision of a physician as an Assistant Physician (not to be confused with a Physician Assistant) delivering primary care for a stipend until such candidate is able to find an acceptable residency opportunity. Board of Directors (Donald Palmisano) See attached report prepared by legal counsel. Reference Committee HC 2

20 Policy (Federal Poverty Level) Reaffirmed Policy , that MAG supports expansion of Medicaid for low-income families up to 185 percent of the federal poverty level (current level as of July 2009 is about 50 percent of the federal poverty level. (HD 10/17/2009, Special Report: Appendix III) Administration Policy will be recorded at reaffirmed in the Policy Compendium. Reference Committee HC 3